Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients

FRANÇAIS :
Les 75 participants de l'étude ont suivi pendant 3 mois un traitement fondé sur la gestion des contingences avec pour chaque test urinaire sans drogue une augmentation de leur prime d'encouragement. Les 3 mois suivants, ils n'ont obtenu une prime que lors de 2, puis de 3 tests consécutifs sans drogue. Cette augmentation des exigences a entraîné une diminution des tests urinaires sans drogue, ce qui suggère la nécessité de plus d'intervention psychologique au cours des traitements de gestion de contingences.
ENGLISH :
Aims: During 3 months where contingency management (CM) had an escalating value for each consecutive drug-free urine (escalating CM), cocaine- and heroin-abusing patients significantly increased drug-free urines. The 'escalating CM' was eliminated during months 4-6 to assess any reduction in drug-free urines. Design: Patients who completed a 3-month, randomized, double-blind, trial evaluating CM versus non-CM and desipramine (DMI) versus placebo, had an 'escalating CM' eliminated during months 4-6. The CM and non-CM groups were compared using thrice-weekly urine samples. Setting: Out-patient buprenorphine maintenance for 6 months. Participants: All 75 of the 160 original study patients who completed month 3 of the clinical trial. Intervention: The `escalating CM' was eliminated for all 3 months and during months 5 and 6 the response requirement was also increased to two and then three consecutive drug-free urines in order to obtain a voucher. Measurements: Urine toxicology for opiates and cocaine. Findings: After eliminating the "escalating CM", the CM group showed a decline in combined opioid- and cocaine-free urines. This decline within the CM group was greater in those treated with DMI than placebo. Conclusions: Buprenorphine with DMI maintained drug abstinence after eliminating the "escalating CM", but not after increasing the response requirement, suggesting the need for more intensive psychosocial interventions during CM. (Author' s abstract)