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
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.