A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence

FRANÇAIS :
L'objet de l'étude relatée dans cet article est de comparer l'efficacité des deux modes d'approches du traitement de la dépendance à la cocaïne chez des patients sous maintenance à la méthadone et d'explorer si les réductions de consommation se poursuivent après le traitement. L'hypothèse est que tous les traitements ont pour conséquence la réduction de consommation. Cependant on note que la maintenance sous méthadone seule ne diminue pas l'usage, que la gestion d'éventualités est plus opérante sur la réduction de la consommation au cours du traitement, que l'approche cognitivo-comportementale entraîne une baisse des consommations encore après le traitement. De plus il est montré que les trois approches combinées ont de meilleurs résultats qu'une seule d'entre elles.
ENGLISH :
Background: This study compared 2 psychosocial approaches for the treatment of cocaine dependence: contingence management (CM) and cognitive-behavioral therapy (CBT). Methods: Patients with cocaine dependence who were receiving methadone maintenance treatment (n = 120) were randomly assigned to 1 of 4 conditions: CM, CBT, combined CM and CBT (CBT + CM), or treatment as usual (ie, methadone maintenance treatment program only [MMTP only]) (n = 30 per cell). The CM procedures and CBT materials were comparable to those used in previously published research. The active study period was 16 weeks, requiring 3 clinic visits per week. Participants were evaluated during treatment and at 17, 26, and 52 weeks after admission. Results: Urinalysis results during the 16-week treatment period show that participants assigned to the 2 groups featuring CM had significantly superior in-treatment urinalysis results, whereas urinalysis results from participants in the CBT group were not significantly different than those from the MMTP-only group. At week 17, self-reported days of cocaine use were significantly reduced from baseline levels for all 3 treatment groups but not for the MMTP-only group. At the 26-week and 52-week follow-up points, CBT participants showed substantiel improvement, resulting in équivalent performance with the CM groups as indicated by both urinalysis and self-reported cocaine use data. Conclusions: Study findings provide solid evidence of efficacy for CM and CBT. Although the effect of CM is significantly greater during treatment, CBT appears to produce comparable long-term outcomes. There was no evidence of an additive effect for the 2 treatments in the CM + CBT group. (Author' s abstract)