AN ENHANCED POSITIVE REINFORCEMENT MODEL FOR THE SEVERELY IMPAIRED COCAINE ABUSER

This article describes a cognitive-behavioral treatment approach that has been extensively modified to work with inner-city methadone-mainta ined cocaine users. Modifications were deemed essential to address the problems of engagement and retention in treatment that are typically encountered with this population. While this approach relies on such b asic tenets of treatment as relapse prevention, cognitive restructurin g, and psychoeducation, an understanding of the particular psychologic al vulnerabilities of this population has been incorporated into the m odel. The modified approach utilizes positive reinforcement extensivel y. This includes use of concrete reinforcers to facilitate initial eng agement, and use of interpersonal reinforcers (therapist positive rega rd, attention, and respect) to increase program retention and sustain posttreatment change. Preliminary results indicate that 63% of patient s can complete this intensive 6-month program, with considerable reduc tions in cocaine use and significant change in drug injection behavior .