TY - JOUR
T1 - Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence
AU - Brooner, Robert K.
AU - Kidorf, Michael S.
AU - King, Van L.
AU - Stoller, Kenneth B.
AU - Neufeld, Karin J.
AU - Kolodner, Ken
N1 - Funding Information:
This work was supported by NIH-NIDA grant R01 DA12049 (PI: R.K. Brooner). We gratefully acknowledge and thank Kori Kindbom, Samantha DiBastiani, and Rachel Burns for their many contributions to this work. We also thank the Baltimore Substance Abuse System, Inc. for their continuing support of the Addiction Treatment Services program of the Johns Hopkins Bayview Medical Center, and the patients who agreed to participate in the evaluation.
PY - 2007/5
Y1 - 2007/5
N2 - This 6-month randomized clinical trial (with 3-month follow-up) used a 2 × 2 design to compare the independent and combined effectiveness of two interventions designed to improve outcomes in treatment-seeking opioid dependent patients (n = 236): motivated stepped care (MSC) and contingent voucher incentives (CVI). MSC is an adaptive treatment strategy that uses principles of negative reinforcement and avoidance to motivate both attendance to varying levels of counseling services and brief periods of abstinence [Brooner, R.K., Kidorf, M., 2002. Using behavioral reinforcement to improve methadone treatment participation. Sci. Pract. Perspect. 1, 38-46; Brooner, R.K., Kidorf, M.S., King, V.L., Peirce, J.M., Bigelow, G.E., Kolodner, K., 2004. A modified "stepped care" approach to improve attendance behavior in treatment seeking opioid abusers. J. Subst. Abuse Treat. 27, 223-232]. In contrast, CVI [Higgins, S., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, B.A., Fenwick, J.W., 1991. A behavioral approach to achieving initial cocaine abstinence. Am. Psychiatr. 148, 1218-1224] relies on positive reinforcement to motivate drug abstinence. The results showed that the combined approach (MSC + CVI) was associated with the highest proportion of drug-negative urine samples during both the randomized and 3-month follow-up arms of the evaluation. The CVI-only and the MSC-only conditions evidenced similar proportions of drug-negative urine samples that were both significantly greater than the standard care (SC) comparison group. Voucher-based reinforcement was associated with better retention, while adaptive stepped-based care was associated with better adherence to scheduled counseling sessions. These results suggest that both CVI and MSC are more effective than routine care for reducing drug use in opioid dependent outpatients, and that the overall benefits of MSC are enhanced further by adding positive reinforcement.
AB - This 6-month randomized clinical trial (with 3-month follow-up) used a 2 × 2 design to compare the independent and combined effectiveness of two interventions designed to improve outcomes in treatment-seeking opioid dependent patients (n = 236): motivated stepped care (MSC) and contingent voucher incentives (CVI). MSC is an adaptive treatment strategy that uses principles of negative reinforcement and avoidance to motivate both attendance to varying levels of counseling services and brief periods of abstinence [Brooner, R.K., Kidorf, M., 2002. Using behavioral reinforcement to improve methadone treatment participation. Sci. Pract. Perspect. 1, 38-46; Brooner, R.K., Kidorf, M.S., King, V.L., Peirce, J.M., Bigelow, G.E., Kolodner, K., 2004. A modified "stepped care" approach to improve attendance behavior in treatment seeking opioid abusers. J. Subst. Abuse Treat. 27, 223-232]. In contrast, CVI [Higgins, S., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, B.A., Fenwick, J.W., 1991. A behavioral approach to achieving initial cocaine abstinence. Am. Psychiatr. 148, 1218-1224] relies on positive reinforcement to motivate drug abstinence. The results showed that the combined approach (MSC + CVI) was associated with the highest proportion of drug-negative urine samples during both the randomized and 3-month follow-up arms of the evaluation. The CVI-only and the MSC-only conditions evidenced similar proportions of drug-negative urine samples that were both significantly greater than the standard care (SC) comparison group. Voucher-based reinforcement was associated with better retention, while adaptive stepped-based care was associated with better adherence to scheduled counseling sessions. These results suggest that both CVI and MSC are more effective than routine care for reducing drug use in opioid dependent outpatients, and that the overall benefits of MSC are enhanced further by adding positive reinforcement.
KW - Adaptive care
KW - Behavioral reinforcement
KW - Methadone
KW - Opioid dependence
KW - Stepped care
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U2 - 10.1016/j.drugalcdep.2006.12.006
DO - 10.1016/j.drugalcdep.2006.12.006
M3 - Article
C2 - 17257782
AN - SCOPUS:34047125969
SN - 0376-8716
VL - 88
SP - S14-S23
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
IS - SUPPL. 2
ER -