Reinforcement-based intensive outpatient treatment for inner city opiate abusers: a short-term evaluation

We evaluated 3-month outcomes for reinforcement-based intensive outpatient treatment (RBT), a new relapse prevention behavior therapy for inner city o piate abusers. The therapy provides abstinence-contingent partial support o f housing, food and recreational activities, abstinence-contingent access t o social skills and job finding group therapy and non-contingent individual counseling all in the context of a day treatment program. Heroin abusers ( n = 52), contacted at a 3-day detoxification unit, were randomly assigned t o RBT (n = 28) or referred to community treatment resources (n = 24) after a staff escort from the detoxification unit. For RBT patients, treatment be gan on the day of discharge; 61% received partial rent support in a recover y house based on the need for drug-free housing; the remainder were eligibl e for partial support of utility payments where they lived. Abstinence-base d contingencies were in effect for 1 month with three times per week counse ling available for an additional 2 months. One month after detoxification, 61% of RBT versus 17% of referral patients were enrolled in outpatient trea tment (P < 0.01); RBT patients were significantly less likely than controls to have returned to any drug use; and 50% of RBT versus 21% of controls re ported 30 days of abstinence from heroin and cocaine with confirmatory nega tive urine (P < 0.05). RBT patients had significantly lower scores on the B eck Depression Inventory at 1 month (M = 9.0 versus 17.6 for controls; P < 0.05) and showed evidence of less alcohol use and higher rates of employmen t. These results establish the short-term efficacy for RBT and support cont inued development and evaluation of this new outpatient behavioral treatmen t. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.