The section has continued to investigate two major non-pharmacological treatments of substance abuse. Last year a project was completed showing that a behavioral intervention, contingency management, was effective in decreasing cocaine use among a group of methadone maintenance patients. Patients in the contingency management group achieved substantially longer periods of sustained abstinence from cocaine use than persons in a yoked control group. A follow-up study is underway to refine the reinforcement protocol to improve rates of initiation and maintenance of abstinence. The original reinforcement schedule was designed to escalate in value so that the incentive grew as the length of time that patients were abstinent grew. Thus, there was a strong incentive to remain abstinent. The initial value of the vouchers, however, was small, and a number of subjects never achieved initial abstinence. In the current study, a bonus was added for the first few cocaine-negative urines and then faded out in order increase the proportion of subjects achieving abstinence; the escalating incentive value was retained to maintain abstinence. The contingency management procedure is also being applied in a second study to improve compliance with naltrexone treatment. Clinical experience has shown that compliance with naltrexone treatment tends to be very poor, seriously compromising its clinical utility. The purpose of the study is to test the efficacy of contingency management for improving patient compliance with naltrexone treatment. Counseling is an important element of virtually all drug abuse treatment; thus standardization and evaluation of counseling procedures is needed to establish effective treatment, whether counseling is the sole treatment or is given in combination with pharmacotherapy. A 12-week study was completed in which the efficacy of a standardized individual Cognitive/Behavioral/Interpersonal counseling program administered according to a specified therapy manual, given either twice weekly, once weekly, or every two weeks, were compared. Outcome measures included cocaine and other drug use (by self-report and urine toxicology), cocaine craving, psychological state, and psychosocial functioning. Preliminary analysis indicated that there were fewer initial drop-outs in the twice a week treatment group, but no significant differences in drug use outcome measures between groups after twelve weeks of treatment. The manual is currently being adapted for use in a group treatment format.
