A behavioral approach to achieving initial cocaine abstinence.
Level 3 - non-randomized controlled study
Non-randomized comparative cohort study of consecutive admissions
PubMed 1883001 · doi:10.1176/ajp.148.9.1218
What was done
Consecutive outpatients admitted for cocaine dependence were non-randomly offered either a behavioral treatment program combining contingency management with the community reinforcement approach (n = 13 offered, 13 accepted) or 12-step counseling (n = 15 offered, 12 accepted). Treatment retention and continuous cocaine abstinence were tracked over 12 weeks.
What was found
Retention at 12 weeks was higher in the behavioral treatment group (11 of 13) than in the 12-step counseling group (5 of 12). Continuous abstinence rates favored behavioral treatment across all reported time points: 4 weeks was achieved by 10 of 13 behavioral patients versus 3 of 12 counseling patients; 8 weeks was achieved by 6 of 13 versus 0 of 12; and 12 weeks was achieved by 3 of 13 versus 0 of 12.
Why it matters
This study provides early comparative evidence that combining contingency management with the community reinforcement approach improves outpatient treatment retention and initial continuous abstinence for cocaine dependence over standard 12-step counseling.
Limits
The study was non-randomized and relied on sequentially admitted cohorts, introducing potential selection bias. The sample size was very small (total n = 25 accepted and treated), and outcomes beyond 12 weeks were not reported in the abstract.
Cited by
- supports Psychologist Stephen Higgins pioneered the use of contingency management reinforcement protocols for treating cocaine addiction.