Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial

• Published in: The International journal of drug policy 2022-01, Vol.99, p.103464-103464, Article 103464
• Main Authors: Miguel, André Q.C., McPherson, Sterling M., Simões, Viviane, Yamauchi, Rodolfo, Madruga, Clarice S., Smith, Crystal L., da Silva, Claudio J., Laranjeira, Ronaldo R., McDonell, Michael G., Roll, John M., Mari, Jair J.
• Format: Article
• Language: English
• Subjects: Abstinence; Behavior Therapy; Brazil; Clinical trials; Cocaine; Cocaine-Related Disorders - therapy; Contingency learning; Contingency management; Crack; Crack Cocaine; Diagnostic tests; Disorders; Dissemination; Drug policy; Health problems; Health services utilization; Help seeking behavior; Homeless; Humans; Management; Missing data; Randomized controlled trial; Single-Blind Method; Treatment Outcome; Treatment programs; Urinalysis; Vouchers
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2021.103464

•Crack use is a severe health problem in Brazil.•Contingency management was effective in promoting crack cocaine abstinence.•Contingency management was effective in promoting treatment retention.•The incorporation of contingency management by Brazilian treatment programs should be encouraged. Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the “Crackland” region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n = 48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n = 50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p