Methadone maintenance is an effective treatment modality, but on-going intravenous use of supplemental drugs during treatment, particularly cocaine, continues to be a serious problem. Previous studies from this laboratory have demonstrated that the methadone take-home privileges can be used as a contingent incentive during routine methadone treatment to improve treatment outcomes in some polydrug abusing patients, with the best predictor of positive response to a take-home incentive program being less severe drug abuse (as defined by relatively lower baseline rates of supplemental drug use). The present center component project will extend previous research using the methadone take-home incentive. The overall goal of the project is to provide practical information that will establish optimal parameters for implementation of take-home incentive procedures. Three controlled treatment outcome studies are proposed during the 5-year project to be conducted with appropriately selected subjects who may reasonably be expected to respond to a take-home incentive intervention. Study 1 will examine effects on drug abuse treatment outcome when the duration of abstinence required to earn take-home incentives is varied in a parametric fashion from a few days to 12 weeks. Study 2 will examine effects on treatment outcome when intensity of urine monitoring (and thus responsiveness to changes in drug use) is varied from high intensity (3 times per week) through moderate intensity (once per week) to low intensity (once per month) urine monitoring. Study 3 will examine the effect on treatment outcome of immediate versus delayed access to take- home privileges following treatment entry, with findings relevant to current FDA policy which imposes a considerable delay in access. Effects of the interventions will be evaluated on specific primary measures of drug use as well as on a broader range of measures of psychosocial functioning and behavioral adjustment. In all studies, patient characteristics that predict positive response to take-home incentives will be identified. Overall, this project should provide valuable information about effectiveness of take-home incentive programs for reducing supplemental drug abuse among methadone patients, practical information about the parameters for effective and optical utilization of these programs and information about the characteristics of drug abusers who respond to incentive programs, which will be valuable for patient-treatment matching. Thus, the project will provide information that has direct practical application and relevance to improving treatment for drug abuse patients enrolled in methadone maintenance.
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