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Community Reinforcement Therapy for Cocaine-Dependent Outpatients
Stephen T. Higgins, PhD;
Stacey C. Sigmon, PhD;
Conrad J. Wong, PhD;
Sarah H. Heil, PhD;
Gary J. Badger, MS;
Robert Donham, MS;
Robert L. Dantona, BA;
Stacey Anthony, MS
Arch Gen Psychiatry. 2003;60:1043-1052.
Objective To examine the contributions of community reinforcement therapy to outcome in the community reinforcement approach (CRA) + vouchers outpatient treatment for cocaine dependence.
Methods One hundred cocaine-dependent outpatients were randomly assigned to one of 2 treatment conditions: CRA + vouchers or vouchers only. All patients earned incentives in the form of vouchers exchangeable for retail items contingent on cocaine-free urinalysis results during treatment weeks 1 to 12. Incentives were combined with a 24-week course of CRA therapy designed to promote healthy lifestyle changes in the CRA + vouchers condition, while incentives represented the primary treatment in the vouchers-only condition. Patient drug use and psychosocial functioning were assessed at intake and at least every 3 months for 2 years after treatment entry.
Results Patients treated with CRA + vouchers were retained better in treatment, used cocaine at a lower frequency during treatment but not follow-up, and reported a lower frequency of drinking to intoxication during treatment and follow-up compared with patients treated with vouchers only. Patients treated with CRA + vouchers also reported a higher frequency of days of paid employment during treatment and the initial 6 months of follow-up, decreased depressive symptoms during treatment only, and fewer hospitalizations and legal problems during follow-up.
Conclusions Combining CRA with vouchers had therapeutic effects on substance abuse and psychosocial functioning during treatment and posttreatment follow-up in cocaine-dependent outpatients, although effects on cocaine use appear to be limited to the treatment period.
From the Departments of Psychiatry (Drs Higgins, Sigmon, Wong, and Heil; Messrs Donham and Dantona; and Ms Anthony), Medical Biostatistics (Mr Badger), and Psychology (Drs Higgins, Sigmon, and Wong), University of Vermont, Burlington.
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