Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers

• Published in: Drug and alcohol dependence 2005-08, Vol.79 (2), p.119-128
• Main Authors: Jones, Hendree E., Wong, Conrad J., Tuten, Michelle, Stitzer, Maxine L.
• Format: Article
• Language: English
• Subjects: Abstinence; Addictive behaviors; Adult; Adult and adolescent clinical studies; Aftercare; Ambulatory Care; Baltimore; Behavior Therapy; Biological and medical sciences; Detoxification; Drug abuse; Drug abusers; Drug addiction; Evaluation; Female; Fundamental and applied biological sciences. Psychology; Heroin; Heroin - urine; Humans; Male; Medical sciences; Neuropharmacology; Opioid, Cocaine, Aftercare; Opioid-Related Disorders - therapy; Opioid-Related Disorders - urine; Outcome and Process Assessment (Health Care); Outpatients; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Reinforcement; Reinforcement (Psychology); Residence Characteristics; Substance Abuse Detection; Therapy; Time Factors; Treatment
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2005.01.006

This controlled study examined the efficacy of reinforcement-based therapy (RBT) for producing enhanced abstinence outcomes over 12 months in opioid-dependent patients exiting a brief residential detoxification. Patients were randomly assigned upon completing their medically managed taper (i.e., detoxification) to RBT ( N = 66) or usual care ( N = 64) referral to community treatment programs. The 6-month RBT program offered an array of abstinence-based incentives including rent payment for recovery housing, program-led recreational activities and skills training for procuring employment. RBT produced significantly higher self-report and urinalysis-confirmed rates of abstinence from opioids and cocaine relative to usual care at 1 (42% versus 15%) and 3 (38% versus 17%) months during treatment but not at 6 or 12 months after enrollment. The RBT but not the usual care group showed significant increases in the number of days worked and the amount of legal income earned at 3, 6 and 12 months. The results of this randomized study suggest that an intensive reinforcement-based therapy that includes abstinence-based recovery housing is a promising approach; however, further research is needed to determine the role of treatment intensity and the specific efficacy of RBT's component parts.