Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance

Citation
Kl. Preston et al., Methadone dose increase and abstinence reinforcement for treatment of continued heroin use during methadone maintenance, ARCH G PSYC, 57(4), 2000, pp. 395-404
Citations number
47
Categorie Soggetti
Psychiatry,"Clinical Psycology & Psychiatry","Neurosciences & Behavoir
Journal title
ARCHIVES OF GENERAL PSYCHIATRY
ISSN journal
0003990X → ACNP
Volume
57
Issue
4
Year of publication
2000
Pages
395 - 404
Database
ISI
SICI code
0003-990X(200004)57:4<395:MDIAAR>2.0.ZU;2-8
Abstract
Background: Although methadone maintenance is an effective therapy for hero in dependence, some patients continue to use heroin and may benefit from th erapeutic modifications. This study evaluated a behavioral intervention, a pharmacological intervention, and a combination of both interventions. Methods: Throughout the study all patients received daily methadone hydroch loride maintenance (initially 50 mg/d orally) and weekly counseling. Follow ing baseline treatment patients who continued to use heroin were randomly a ssigned to 1 of 4 interventions: (1) contingent vouchers for opiate-negativ e urine specimens (n = 29 patients); (2) methadone hydrochloride dose incre ase to 70 mg/d (n = 31 patients); (3) combined contingent vouchers and meth adone dose increase (n = 32 patients); and (4) neither intervention (compar ison standard; n = 28 patients). Methadone dose increases were double blind . Vouchers had monetary value and were exchangeable for goods and services. Groups not receiving contingent vouchers received matching vouchers indepe ndent of urine rest results. Primary outcome measure was opiate-negative ur ine specimens (thrice weekly urinalysis). Results: Contingent vouchers and a methadone dose increase each significant ly increased the percentage of opiate-negative urine specimens during inter vention. Contingent vouchers, with or without a methadone dose increase, in creased the duration of sustained abstinence as assessed by urine screening s. Methadone dose increase, with or without contingent vouchers, reduced se lf-reported frequency of use and self-reported craving. Conclusions: In patients enrolled in a methadone-maintainence program who c ontinued to use heroin, abstinence reinforcement and a methadone dose incre ase were each effective in reducing use. When combined, they did not dramat ically enhance each other's effects on any 1 outcome measure, but they did seem to have complementary benefits.