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


Thomas Kosten
VA Connecticut Healthcare System
Psychiatry 151D
950 Campbell Avenue, Bldg 35
West Haven, CT 06516
Tel: + 1 203 932 5711 ext. 7438
Fax: + 1 203 937 4915
E-mail: thomas.kosten@yale.edu


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.