CONTINGENT USE OF TAKE-HOMES AND SPLIT-DOSING TO REDUCE ILLICIT DRUG-USE OF METHADONE PATIENTS

This study tested a novel treatment intervention for illicit drug use that combines positive and aversive incentives. Sixteen chronic polydr ug abusing methadone maintenance patients who had not responded to our usual take-home incentive program were randomly assigned to one of tw o treatment groups, While in the experimental care condition, patients received a take-home following each drug-negative urine (free of opia tes, cocaine, and benzodiazepines as detected by EMIT) and were placed on a split-dose following each drug-positive urine. While in the cont rol condition, patients participated in a standard care protocol in wh ich they could not earn take-homes or be placed on split-dose. Patient s receiving a split-dose were required to attend the clinic on two sep arate occasions (morning and evening) to receive their full daily meth adone dose. After two months, patients crossed over to the alternative treatment condition for another two months. Results demonstrated that patients, while exposed to the experimental care condition, submitted significantly more drug-free urines (M = 29%) than when studied in st andard care (M = 9%) or at baseline (M = 12%). Twenty-eight percent of patients (n = 5) showed marked improvements in drug-free urines durin g the experimental intervention as compared with control or baseline c onditions. The combination of take-homes and split-dosing appears to h elp some polydrug abusing patients initiate and sustain abstinence.