COMMUNITY REINFORCEMENT APPROACH IN THE TREATMENT OF OPIATE ADDICTS

The authors studied the efficacy of the community reinforcement approa ch (CRA) as compared to standard counseling in opiate-dependent patien ts on methadone maintenance. One hundred eighty subjects were randomiz ed to three treatment conditions: standard, CRA, and CRA with relapse prevention (CRA/RP). Of these, 151 subjects were followed up 6 months after intake. Since few of the RP sessions had been concluded at the 6 -month follow-up, the two CRA groups were combined for analyses. Weekl y urinalysis drug screens and Addiction Severity Index (ASI) scores at intake and 6 months were compared. The combined CRA groups did signif icantly better than the standard group in the following areas: consecu tive opiate-negative urinalysis (3 weeks), and the 6-month ASI drug co mposite score. These results support the benefit of adding CRA strateg ies to the treatment of patients who are opiate dependent and on metha done maintenance. Because of insufficient treatment exposure to Re at the 6-month follow-up, the additive effect of RP could not be adequate ly evaluated; further follow-up will be required.