Contingency management (CM) interventions are efficacious treatments for cocaine dependence, but these procedures have rarely been implemented in community-based settings. The lack of use of these techniques is related, in part, to their costs. We recently developed a lower-cost CM treatment that provides opportunities to win prizes rather than vouchers. We demonstrated the efficacy of this technique in both drug-free (Petry et al., 2000; Petry et al., under review) and methadone-maintenance (Petry & Martin, 2002) community-based settings. Given the efficacy of such treatments, the time appears appropriate to train therapists to deliver CM. Thus, this project proposes to train 42 community-based treatment providers about the rationale for and the specifics of administering CM. Initial training will occur in 2-day workshops, followed by weekly supervision in delivery of CM with test cases. We expect that the vast majority of therapists will achieve high levels of competence and adherence in administering CM treatment within 3-5 test cases. The ultimate goal of training therapists to administer empirically validated treatments is to improve patient care and outcomes. To examine the efficacy of CM, each therapist who achieves adherence and competence in delivering CM will administer standard treatment alone or standard treatment plus CM to 10 cocaine-abusing outpatients. In the CM condition, patients will have the opportunity to win prizes ranging in value from $1 to $100 for submission of cocaine-negative urine samples, and the treatment will be in effect for 12 weeks. In total, about 360 patients will be randomly assigned to one of the two conditions. A research evaluator, blind to the patients' treatment conditions, will conduct follow-up assessments, scheduled for 3, 6 and 9 months after treatment initiation. We expect that patients assigned to the CM condition will remain in treatment longer and achieve greater durations of cocaine abstinence than patients assigned to standard treatment. Both short-term and long-term efficacy, as well as cost-effectiveness, will be evaluated when CM is administered by community-based therapists.
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