Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence - Efficacy of contingency management and significant other involvement

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.