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Targeting Behavioral Therapies to Enhance Naltrexone Treatment of Opioid Dependence
Efficacy of Contingency Management and Significant Other Involvement
Kathleen M. Carroll, PhD;
Samuel A. Ball, PhD;
Charla Nich, MS;
Patrick G. O'Connor, MD, MPH;
Dorothy A. Eagan, RN, MPH;
Tami L. Frankforter;
Elisa G. Triffleman, MD;
Julia Shi, MD;
Bruce J. Rounsaville, MD
Arch Gen Psychiatry. 2001;58:755-761.
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 individuals
were randomly assigned to 1 of 3 conditions delivered for 12 weeks: (1) standard
naltrexone treatment, given 3 times a week; (2) naltrexone treatment plus
contingency management (CM), with delivery of vouchers contingent on naltrexone
compliance and drug-free urine specimens; or (3) naltrexone treatment, CM,
plus significant other involvement (SO), where a family member was invited
to participate in up to 6 family counseling sessions. Principal outcomes were
retention in treatment, compliance with naltrexone therapy, and number of
drug-free urine specimens.
Results First, CM was associated with significant improvements in treatment
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 treatment. Second, assignment to
SO did not significantly improve retention, compliance, or substance abuse
outcomes compared with CM. Significant effects for the SO condition over CM
on retention, compliance, and drug use outcomes were seen only for the subgroup
who attended at least 1 family counseling session. The SO condition was associated
with significant (P = .02) improvements in family
functioning.
Conclusion Behavioral therapies, such as CM, can be targeted to address weaknesses
of specific pharmacotherapies, such as noncompliance, and thus can play a
substantial role in broadening the utility of available pharmacotherapies.
From the Department of Psychiatry, Yale University School of Medicine,
New Haven, Conn. Dr Triffleman is now with the S3 Project, Oakland, Calif.
Corresponding author and reprints: Kathleen M. Carroll, PhD, Department
of Psychiatry, Yale University School of Medicine,, VA CT Healthcare System,
950 Campbell Ave (151D), West Haven, CT 06516 (e-mail: kathleen.carroll{at}yale.edu).
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