A behavioral approach to achieving initial cocaine abstinence

TLDR

The study aimed to evaluate whether a contingency‑management and community‑reinforcement behavioral program could achieve initial cocaine abstinence among outpatient cocaine‑dependent patients, and a randomized trial is underway to test its generalizability. Participants received either the behavioral program—contingency management plus community reinforcement—or 12‑step counseling, with 13 and 15 patients respectively. The behavioral program led to higher retention (11/13 vs 5/12), greater 4‑week abstinence (10/13 vs 3/12), and achieved 8‑ and 12‑week abstinence in 6 and 3 patients, whereas no 12‑step patients reached 8 weeks, indicating the program’s promise for initial abstinence.

Abstract

The aim of this study was to assess the efficacy of a behavioral treatment program for achieving initial cocaine abstinence in individuals enrolled in outpatient treatment for cocaine dependence.Thirteen consecutively admitted outpatients were offered behavioral treatment consisting of contingency management procedures and the community reinforcement approach. Fifteen consecutively admitted outpatients were offered treatment with 12-step counseling. All 13 of the patients who were offered the behavioral treatment accepted it; 12 of the patients offered 12-step counseling accepted it.Eleven of the 13 patients in the behavioral treatment were retained for 12 weeks of treatment, compared with five of the 12 patients given 12-step counseling. Ten of the patients given behavioral therapy achieved 4 weeks of continuous cocaine abstinence, compared with only three of those given 12-step counseling. Six of the patients in the behavioral treatment group achieved 8 weeks, and three achieved 12 weeks; none of the patients in the 12-step counseling program achieved 8 weeks.The behavioral treatment described in this paper offers promise as an effective intervention for achieving initial cocaine abstinence. A randomized trial is underway to assess the generality of these findings.