Contingency management

A meta-analysis of placebo-controlled studies by Levin and Lehman (1991) showed that desipramine produced greater cocaine abstinence than placebo. Although a more recent review did not concur (Lima et al. 2001), secondary analyses of studies with imipramine, desipramine, and bupropion suggested that depressed cocaine abusers are more likely to show significant reductions in cocaine abuse than nondepressed cocaine abusers (Margolin et al. 1995 Nunes et al. 1991 Ziedonis and Kosten 1991). Furthermore, recent work with desipramine supported its efficacy in opioid-dependent patients, particularly in combination with contingency management therapies (Kosten et al. 2004 Oliveto et al. 1999). 

With all of these pharmacotherapies, concurrent behavioral treatment is critical to retain the patient in treatment and maintain adherence to medication treatment. Contingency management programs in which patients receive vouchers that can be used to purchase pro-social goods and services are the most common reinforcer approaches used to initiate and maintain stimulant-free urine test results (Anker and Crowley 1982 Boudin 1972 Higgins et al. 1991, 1993, 1994). The major problem with these approaches has been maintaining abstinence after the reinforcers are withdrawn completely and devel-... 

A number of psychosocial treatments for alcohol and other substance use disorders exist and are widely used. In this chapter, we discuss six of these psychotherapies as they are applied to alcohol, cocaine, and opioid dependence brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, behavioral treatments (including contingency management and community reinforcement approaches), behavioral marital therapy, and 12-step facilitation. We also describe studies that examined the efficacy of a medication in combination with one or more of the six psychotherapies. In the second section of the chapter, we highlight research that directly studied the interaction between psychosocial and pharmacological treatments. 

Carroll KM, Ball SA, Nich C, et al Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence efficacy of contingency management and significant other involvement. Arch Gen Psychiatry 58 755-761, 2001... 

Kosten T, Poling J, Oliveto A Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients. Addiction 98 665-671, 2003b... 

Rawson RA, Huber A, McCann M, et al A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry 59 817—824, 2002 Rohsenow DJ, Monti PM, Martin RA, et al Motivational enhancement and coping skills training for cocaine abusers effect on substance use outcomes. Addiction... 

Schottenfeld RS, Chawarski MC, Pakes JR, et al Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry 162 340-349, 2003 Smith JE, Meyers RJ, Delaney HD Community reinforcement approach with homeless alcohol-dependent individuals. J Consult Clin Psychol 66 341-348, 1998... 

While pharmacologic agents may help prevent relapse, psychotherapy should be the core therapeutic intervention. Motivational enhancement therapy (MET), cognitive-behavioral therapy (CBT), 12-step facilitation (TSF), behavioral couples therapy (BCT), community reinforcement approaches, and contingency management are the best-studied forms of psychotherapy in this group of patients. 

Contingency management consists of providing positive rewards for desirable behavior and setting limits and consequences for undesirable behavior. 

Epstein DH, Hawkins WE, Covi L, Umbricht A and Preston KL (2003). Cognitive behavioural therapy plus contingency management for cocaine use Findings during treatment and across 12-month follow-up. Psychology of Addictive Behavior, 17, 73-82. 

Silverman, W.K., Kurtines, W.M., Ginsburg, G.S., Weems, C.E, Ra-bian, B. and Serafini, L.T. (1999c) Contingency management, self-control, and education support in the treatment of childhood phobic disorders a randomized clinical trial. / Consult Clin Psychol 67 675-687. 

Spelz, M.L., Varley, C.K., Peterson, K., and Beilke, R. (1988) Effects of dextroamphetamine and contingency management on a preschooler with ADHD and oppositional defiant disorder. / Am Acad Child Adolesc Psychiatry 27 175—178. 

Behaviour therapies range from feedback of results to systematic contingency management... 

Contingency-management interventions for cannabis dependence. In Roffman RA Stephens RS (eds.) Cannabis Dependence Its nature, consequences and treatment. London Cambridge University Press, pp. 155-66... 

Prendergast M, Podus D, Finney J, Greenwell L Roll J (2006). Contingency management for treatment of substance use disorders a meta-analysis. Addiction, 101, 1546-60... 

Rawson RA, McCann MJ, Flammino F, Shoptaw S, Mitto K, Reiber C Ling W (2006). A comparison of contingency management and cognitive-behavioural approaches for stimulant-dependent individuals. Addiction 101, 267-74... 

Ciarroll, K. M., Sinha, R., Nich, C., Babuscio, T., Rounsavilic, B. (2002). Contingency management to enhance naltrexone treatment of opioid dependence A randomized clinical trial of rcinfbrccmcnt magnitude. Experimental and Clinical Psychopharmacolojyy, 10, 54-63. 

---