This project will evaluate the clinical efficacy of contingency management procedures that could feasibly be implemented in community methadone maintenance programs. Experiment 1 investigates take-home incentive procedures during methadone maintenance treatment. New maintenance enrollees (N=240) will be randomly assigned to: 1) a urinalysis contingency in which take-homes are based exclusively on drug-free urine test results, 2) an employment contingency in which take-homes are based entirely on employment and job-seeking activities, or 3) a noncontingent control in which take-home privileges are not influenced by patient performance. Drug use and employment outcomes will be examined for evidence of differential treatment effects. Experiment 2 will utilize 90 maintenance patients who demonstrated stable, drug-free performance during Experiment 1 and who agree to continue treatment while participating in an evaluation of contingent and noncontingent adjunct medication availability during gradual methadone detoxification. For subjects randomly assigned to the contingent intervention, Valrelease doses (up to 30 mg/day) will be available only if recent urine specimens have tested opiate-free. Subjects assigned to noncontingent interventions will be able to request adjunct medication (active Valrelease for some, placebo for others) independently of urine test results. Retention and drug use outcomes will be examined for evidence of differential treatment effects. Experiment 3 will utilize 75 subjects who habitually supplement their methadone with illicit opiate and/or nonopiate drugs during treatment. These patients will participate in an evaluation of two avoidance procedures that may effectively control supplemental drug use: 1) dose-loss avoidance in which drug-positive urine tests result in small dose reductions while drug-free urines can restore the original dose, and 2) treatment termination avoidance in which subjects must meet an average drug-free urine criterion during the evaluation period in order to continue in treatment. Control subjects will receive usual care with no explicit contingencies. Urinalysis test results will be examined for evidence of differential treatment efficacy. Overall, these studies will provide important information about the ability of contingency management interventions to promote improved treatment outcomes among methadone maintenance patients. The information gained may result in improved treatment delivery procedures for both methadone maintenance and detoxification patients.
