Drug use histories and treatment outcomes were compared for age, race and gender-matched samples of intravenous (IV; n=28) versus intranasal (IN; n=28) opiate abusers entering a 3-day inpatient detoxification unit. Data were derived from the Addiction Severity Index (ASI) interview. Both groups reported daily heroin use prior to detoxification, but IV users reported more days of alcohol and multiple drug use during the past 30 days. Despite age matching, IV users also started using alcohol at an earlier age and accumulated more lifetime months of regular alcohol, cocaine and multidrug use. IV users were more likely to enter treatment following the detox, but no significant outcome differences were noted at 1 and 3 months post-detoxification. The results show that intravenous, as compared to intranasal, opiate users have both a more severe pattern and a more extensive history of the use of non-opiate drugs.
Context: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence are efficacious in improving outcomes in substance abusers, but these treatments have rarely been implemented in community-based settings.Objective: To evaluate the efficacy of an abstinencebased contingency management intervention as an addition to usual care in community treatment settings.Design: Random assignment to usual care or usual care plus abstinence-based incentives for 12 weeks.Setting: Eight community-based outpatient psychosocial drug abuse treatment programs.Participants: A total of 415 cocaine or methamphetamine users beginning outpatient substance abuse treatment.Intervention: All participants received standard care, and those assigned to the abstinence-based incentive condition also earned chances to win prizes for submitting substance-free urine samples; the chances of winning prizes increased with continuous time abstinent.Main Outcome Measures: Retention, counseling attendance, total number of substance-free samples provided, percentage of stimulant-and alcohol-free samples submitted, and longest duration of confirmed stimulant abstinence.Results: Participants assigned to the abstinence-based incentive condition remained in treatment for a mean±SD of 8.0±4.2 weeks and attended a mean±SD of 19.2±16.8counseling sessions compared with 6.9±4.4 weeks and 15.7±14.4sessions for those assigned to the usual care condition (PϽ.02 for all).Participants in the abstinencebased incentive condition also submitted significantly more stimulant-and alcohol-free samples (PϽ.001).The abstinence-based incentive group was significantly more likely to achieve 4, 8, and 12 weeks of continuous abstinence than the control group, with odds ratios of 2.5, 2.7, and 4.5, respectively.However, the percentage of positive samples submitted was low overall and did not differ between conditions. Conclusion:The abstinence-based incentive procedure, which provided a mean of $203 in prizes per participant, was efficacious in improving retention and associated abstinence outcomes.
Three experiments were conducted in which detectability and symptomatic effects of acute (single-day) increases and decreases in the methadone dose of subjects on methadone maintenance were examined. Altered doses ranged from 0% to 200% of the stable methadone dose, which was typically 50 mg. In an initial experiment, explicit information was provided to subjects (N = 10) about the occurrence and size of altered doses. No explicit information was provided in a second experiment, but subjects (N = 14) could detect altered doses on the basis of taste. In the third experiment, subjects (N = 2) received no information about the direction, size, or schedule of altered doses. Large dose alterations (75% to 100% of stable dose) were reliably detected by subjects on methadone maintenance, although marked individual differences in sensitivity were apparent. With taste cues available, subjects underestimated the magnitude of dose decreases and increases by 50% and 75%. Without taste cues, subjects could reliably detect only decreased doses. Symptomatic effects related to direction and size of altered doses but not to information conditions. Withdrawal symptom checklist scores were elevated after large (75% to 100%) dose decreases under all information conditions, but few symptomatic effects were reported after dose increases under any information condition. Clinical Pharmacology and Therapeutics (1984) 36, 244–250; doi:10.1038/clpt.1984.170
