EVALUATION OF TREATMENTS OF OPIOID AND COCAINE DEPENDENCE

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The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. NIDA/IRP treatment studies have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine- negative urine samples) in large inner-city samples of intravenous polydrug abusers. One recently completed study evaluated whether a behavioral intervention could be made more effective by initial reinforcement of an intermediate step toward abstinence (decreases in urine cocaine metabolite concentration). Throughout the study, all patients received daily oral methadone maintenance (50 mg/day) and weekly counseling. Following a 5-week baseline treatment, patients who continued to use cocaine were randomly assigned to one of two 8-week interventions: 1) vouchers contingent on cocaine-negative urine specimens (abstinence group); or 2) vouchers contingent on at least a 50% decrease in cocaine metabolite concentration compared to the previous specimen for 3 weeks, then only for cocaine-negative urine specimens for 5 weeks (stepwise group). Observed urine specimens were collected MWF; qualitative and quantitative urinalysis was performed. Vouchers had monetary value and were exchangeable for goods and services. Cocaine abstinence (% cocaine-negative urine specimens) increased during the 8-week intervention in both groups. While the stepwise schedule was in effect, the reinforcement schedules appeared equally effective in producing cocaine abstinence. At the transition to the abstinence schedule, the stepwise-treatment group showed significant additional improvement not seen in the abstinence group. Thus, the stepwise schedule may have prepared patients for abstinence. (Preston KL, Umbricht A, Wong C, and Epstein D. 61st Annual Scientific Meeting of the College of Problems on Drug Dependence, 1999.) Another NIDA/IRP study demonstrated the safety, efficacy, and patient acceptability of naltrexone-shortened opioid detoxification with buprenorphine. (Umbricht A, Montoya ID, Hoover DR, Demuth KL, Chiang CT, and Preston KL. Drug & Alcohol Dependence 56(3): 181-190, 1999.) A study nearing completion combines the contingency-management approach (reinforcement of cocaine-negative urines) with a cognitive-behavioral relapse-prevention therapy developed at our clinic; the investigators hypothesize that contingency management will create a temporal window of abstinence during which relapse-prevention therapy can be introduced to foster more durable changes in behavior. - substance abuse, substance abuse treatment, heroin, opiates, cocaine, methadone, contingency management, buprenorphine, naltrexone - Human Subjects