Methadone treatment is the most widely available and effective treatment for opiate addiction. Because opiate users often abuse drugs other than opiates, methadone treatment should include interventions to reduce non- opioid drug use. A variety of factors in the treatment setting can be used to reinforce and modify behavior. Our previous research on contingency management procedures has used take-home doses of methadone and achieved modest success in reinforcing abstinence. In this continuation, we attempt to increase treatment success by using a token economy for flexible coordination of contingencies between multiple behaviors and multiple consequences. The enhanced contingency management intervention has the advantages of l) integrating multiple programmatic consequences, 2) reinforcing smaller units of behavior, 3) reinforcing multiple.appropriate behaviors, 4) introducing reinforcement from the first day of treatment, and 5) permitting more individualized treatment. A three group between subjects design with random assignment is used to compare the enhanced contingency management package (TOKEN group) to our previously assessed and successfully applied contingency management intervention (TAKE-HOME group) and to a no-reinforcement control condition (CONTROL group). These three groups represent a reinforcement dose response continuum. In all, 310 subjects (100 per group and 10 pilot subjects) will be recruited to participate in this nine-month protocol. TOKEN intervention subjects are expected to have superior treatment outcomes because we have integrated a number of behavioral components with demonstrated efficacy into a more comprehensive treatment package. Examination of the enhanced reinforcement program is also expected to provide insight into basic features of effective contingency management and drug abuse treatment. Multiple outcome measures will be used to determine relative treatment efficacy along a number of dimensions, as indicated by self-report and by objective indices, such as urine and breath analysis.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
2R01DA006096-06
Application #
2118414
Study Section
Special Emphasis Panel (SRCD (51))
Project Start
1989-09-30
Project End
1996-08-31
Budget Start
1994-09-30
Budget End
1995-08-31
Support Year
6
Fiscal Year
1994
Total Cost
Indirect Cost
Name
Allegheny University of Health Sciences
Department
Psychiatry
Type
Schools of Medicine
DUNS #
City
Philadelphia
State
PA
Country
United States
Zip Code
19129
Riehman, Kara S; Iguchi, Martin Y; Zeller, Michelle et al. (2003) The influence of partner drug use and relationship power on treatment engagement. Drug Alcohol Depend 70:1-10
Morral, A R; McCaffrey, D; Iguchi, M Y (2000) Hardcore drug users claim to be occasional users: drug use frequency underreporting. Drug Alcohol Depend 57:193-202
Morral, A R; Belding, M A; Iguchi, M Y (1999) Identifying methadone maintenance clients at risk for poor treatment response: pretreatment and early progress indicators. Drug Alcohol Depend 55:25-33
Iguchi, M Y (1998) Drug abuse treatment as HIV prevention: changes in social drug use patterns might also reduce risk. J Addict Dis 17:9-18
Belding, M A; Iguchi, M Y; Morral, A R et al. (1998) MMPI profiles of opiate addicts: predicting response to treatment. J Pers Assess 70:324-39
Belding, M A; Iguchi, M Y; Morral, A R et al. (1997) Assessing the helping alliance and its impact in the treatment of opiate dependence. Drug Alcohol Depend 48:51-9
Belding, M A; Iguchi, M Y; Lamb, R J (1997) Stages and processes of change as predictors of drug use among methadone maintenance patients. Exp Clin Psychopharmacol 5:65-73
Willems, J C; Iguchi, M Y; Lidz, V et al. (1997) Change in drug-using networks of injecting drug users during methadone treatment: a pilot study using snowball recruitment and intensive interviews. Subst Use Misuse 32:1539-54
Morral, A R; Iguchi, M Y; Belding, M A et al. (1997) Natural classes of treatment response. J Consult Clin Psychol 65:673-85
Iguchi, M Y; Belding, M A; Morral, A R et al. (1997) Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use. J Consult Clin Psychol 65:421-8

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