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Employment‐based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post‐intervention outcomes
Author(s) -
DeFulio Anthony,
Silverman Kenneth
Publication year - 2011
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2011.03364.x
Subject(s) - abstinence , contingency management , methadone , psychology , reinforcement , psychiatry , intervention (counseling) , relapse prevention , discontinuation , medicine , methadone maintenance , clinical psychology , social psychology
Aims Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long‐term abstinence. We sought to assess the effects of long‐term employment‐based reinforcement of cocaine abstinence after discontinuation of the intervention. Design Participants who initiated sustained opiate and cocaine abstinence during a 6‐month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n = 24), or an abstinence‐contingent employment ( n = 27) group that was required to provide cocaine‐ and opiate‐negative urine samples to work and maintain maximum rate of pay. Setting A non‐profit data entry business. Participants Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Measurements Urine samples and self‐reports were collected every 6 months for 30 months. Findings During the employment year, abstinence‐contingent employment participants provided significantly more cocaine‐negative samples than controls (82.7% and 54.2%; P = 0.01, OR = 4.61). During the follow‐up year, the groups had similar rates of cocaine‐negative samples (44.2% and 50.0%; P = 0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. Conclusions Employment‐based reinforcement effectively maintains long‐term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence‐contingent employment. Relapse could be prevented in many patients by leaving employment‐based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces.