In methadone maintenance patients, making program privileges contingent upon the submission of drug-free urines reduces the rate of illicit drug use. Nevertheless, such urinalysis (UA) contingency programs appear to work only for a subgroup of patients, and may not be practical in all treatment settings. There is a need, therefore, for other effective treatments that may be used in conjunction with, or instead of, UA contingencies. One alternative to reinforcing abstinence is the differential reinforcement of alternative behaviors (DRA). In this study we examine the replicability and portability of a DRA program found effective in a small research clinic by testing it in a large VA Medical Center. In addition to replicating a promising study, the proposal: 1) examines the viability of transferring behavioral technologies to a setting more similar to a typical community clinic than our university research clinic, 2) compares our DRA program with an intervention of known effectiveness (UA contingencies), 3) assesses the behavioral, psychological and social factors associated with differential treatment response, and 4) evaluates the durability of treatment effects over time. In a prior study (Iguchi, Belding et al., in press), patients received vouchers worth up to $15 per week for providing objective evidence of completing tasks planned with counselors to shape behaviors approximating treatment plan goals (TP-$15 group). Patients receiving this DRA condition improved more than those receiving either no programmatic reinforcement or $5 for each of three urines collected per week testing drug-free. Moreover, TP-$15 subjects continued to improve following cessation of the intervention. In the proposed extension of this research, 132 newly enrolled methadone maintenance patients at the Philadelphia, VA are assigned to one of three groups: the TP-$20 group is eligible to earn vouchers worth up to $20 per week, the STD group receives the standard VA treatment and no programmed reinforcement, and the UA-TH group is eligible to earn up to 4 take-home doses of medication per week by submitting drug-free urines. Interventions begin following a 10 week baseline period and continue until week 30. Assessments occur at intake and weeks 10, 20, 30, and 52 (follow up). Outcome measures include urinalysis results, self-reported drug-use and risk-behaviors, and psychosocial measures. The significance of the project includes potential validation of an alternative or adjunct to UA contingencies that produces more durable behavior change using a DRA procedure.
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