Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence - Efficacy of contingency management and significant other involvement
Km. Carroll et al., Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence - Efficacy of contingency management and significant other involvement, ARCH G PSYC, 58(8), 2001, pp. 755-761
Background: Contingency management (CM) and significant other involvement (
SO) were evaluated as strategies to enhance treatment retention, medication
compliance, and outcome for naltrexone treatment of opioid dependence.
Methods: One hundred twenty-seven recently detoxified opioid-dependent indi
viduals were randomly assigned to I of 3 conditions delivered for 12 weeks:
(1) standard naltrexone treatment, given 3 times a week; (2) naltrexone tr
eatment plus contingency management (CM), with delivery of vouchers conting
ent on naltrexone compliance and drug-free urine specimens;, or (3) naltrex
one treatment, CM, plus significant other involvement (SO), where a family
member was invited to participate in up to 6 family counseling sessions. Pr
incipal outcomes were retention in treatment, compliance with naltrexone th
erapy, and number of drug-free urine specimens.
Results: First, CM was associated with significant improvements in treatmen
t retention (7.4 vs 5.6 weeks; P=.05) and in reduction in opioid use (19 vs
14 opioid-free urine specimens; P=.04) compared with standard naltrexone t
reatment. Second, assignment to SO did not significantly improve retention,
compliance, or substance abuse outcomes compared with CM. Significant effe
cts for the SO condition over CM on retention, compliance, and drug use out
comes were seen only for the subgroup who attended at least I family counse
ling session. The SO condition was associated with significant (P=.02) impr
ovements in family functioning.
Conclusion: Behavioral therapies, such as CM, can be targeted to address we
aknesses of specific pharmacotherapies, such as noncompliance, and thus can
play a substantial role in broadening the utility of available pharmaco th
erapies.