|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.|
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASEABSTINENCE ; COCAINE ; EMPLOI ; OBSERVANCE DU TRAITEMENT ; PROGRAMME ; TRAITEMENT DE MAINTENANCE
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|