Randomized Trial of Continuing Care Enhancements for Cocaine-Dependent Patients following Initial Engagement

Autor/inn/en	McKay, James R.; Lynch, Kevin G.; Coviello, Donna; Morrison, Rebecca; Cary, Mark S.; Skalina, Lauren; Plebani, Jennifer
Titel	Randomized Trial of Continuing Care Enhancements for Cocaine-Dependent Patients following Initial Engagement
Quelle	In: Journal of Consulting and Clinical Psychology, 78 (2010) 1, S.111-120 (10 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0022-006X
DOI	10.1037/a0018139
Schlagwörter	Cocaine; Contingency Management; Toxicology; Patients; Group Counseling; Drug Addiction; Cognitive Restructuring; Behavior Modification; Prevention; Drug Use Testing; Rewards; Trend Analysis; Outcomes of Treatment + Suchen Sie Ihr Suchwort? Kokain; Krisenbewältigung; Toxikologie; Patient; Gruppenberatung; Drug dependence; Drug consomption; Drogenabhängigkeit; Behaviour modification; Verhaltensänderung; Prävention; Vorbeugung; Reward; Belohnung; Trendanalyse
Abstract	Objective: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. Method: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. Results: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = 0.05), with no significant CM x RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p less than 0.01, and RP, OR = 4.89 (1.51, 15.86), p less than 0.01, and produced better cocaine urine toxicology outcomes at 9 months than treatment as usual, OR = 4.21 (1.37, 12.88), p less than 0.01, and RP, OR = 4.24 (1.32, 13.65), p less than 0.01. Trends also favored CM + RP over CM at 6 months, OR = 2.93 (0.94, 9.07), p = 0.06, and 9 months, OR = 2.93 (0.94, 9.10), p = 0.06. Differences between the conditions were not significant after 9 months. Conclusions: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP. (Contains 3 figures and 2 tables.) (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10