Titre : | Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes (2011) |
Auteurs : | A. DEFULIO ; K. SILVERMAN ; S. MAGURA |
Type de document : | Article : Périodique |
Dans : | Addiction (Vol.106, n°5, May 2011) |
Article en page(s) : | 960-969 |
Note générale : | Commentary: Employment-based abstinence reinforcement: is there a next step? Magura S., p. 968-969. |
Langues: | Anglais |
Discipline : | TRA (Traitement et prise en charge / Treatment and care) |
Mots-clés : |
Thésaurus mots-clés ABSTINENCE ; COCAINE ; EMPLOI ; OBSERVANCE DU TRAITEMENT ; PROGRAMME ; TRAITEMENT DE MAINTENANCEThésaurus géographique ETATS-UNIS |
Résumé : |
AIMS. Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention.
DESIGN. Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n = 24), or an abstinence-contingent employment (n = 27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. SETTING. A non-profit data entry business. PARTICIPANTS. Unemployed welfare recipients who persistently used cocaine while in methadone treatment. MEASUREMENTS. Urine samples and self-reports were collected every 6 months for 30 months. FINDINGS. During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P = 0.01, OR = 4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P = 0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. CONCLUSIONS. Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces. [Review's abstract] |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 32 |
Affiliation : | Department of Psychiatry and Behavioral Sciences, Baltimore, MD, USA |
Cote : | Abonnement |
Lien : | http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03364.x/abstract |
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