The purpose of this Stage III psychotherapy development project is to assess issues fundamental to the implementation of contingency management (CM) procedures into standard substance abuse treatment facilities: cost, simplicity, and transferability. A low-cost CM treatment, which provides opportunities to win prizes with an average expense of under $250 per subject, has been shown to be effective in retaining subjects in treatment and reducing substance use. Study I will assess whether a similar procedure with an even lower expected magnitude or reinforcement is associated with improved outcomes. 120 individuals meeting DSM-IV criteria for cocaine dependence will be randomly assigned to one of three conditions: (1) standard 12-week treatment plus CM with an expected probability of winning $250 worth of prizes, (b) standard treatment plus CM with an expected probability of winning $80 prizes, or (c) a control condition standard treatment without CM. In the first two conditions, subjects will earn opportunity to win prizes, ranging in value from $1 to $100, for providing drug-free urine specimens and for complying with steps toward their treatment goals. The two conditions will vary only in the magnitude of prizes available. Study II will assess the efficacy of the two CM procedures when delivered independently. Using the most efficacious treatment from Study I, 120 subjects will be randomly assigned to one of three conditions: (a) standard treatment plus CM, with drawing contingent only upon submission of clean urine samples, (b) standard treatment plus CM, with drawings contingent only upon submission of clean urine samples, (b) standard treatment plus CM, with drawing contingent only upon completion of activities related to treatment goals, or (c) standard treatment without CM. Study III will assess the efficacy of CM when provided and managed entirely by clinical staff. Following a staff training program, 240 subjects will be randomly assigned to one of two conditions: (a) standard treatment plus an efficacious CM intervention from Studies I and II or (b) standard treatment without CM. In this study, all aspects of the CM procedures will be managed and conducted entirely by the clinical staff in three clinical sites. In all three studies, drug use and severity of psychosocial problems will be measured pre-treatment, one month after treatment entry, at month 3 (post treatment), and at 6- and 9-month follow-up evaluations. We will also assess subject characteristics that are associated with improved outcomes within and across conditions. Additionally, we will evaluate cost-effectiveness of CM by assessing subjects' receipt of psychosocial and medical services, as well as criminal justice involvement, throughout the treatment and follow-up periods. Together these studies will determine an efficacious and relatively simple, inexpensive CM treatment strategy, as well as test its efficacy when delivered and managed entirely by non-research staff.
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