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Clinical Trial
. 2001 Aug;58(8):755-61.
doi: 10.1001/archpsyc.58.8.755.

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

K M Carroll  1 , S A Ball, C Nich, P G O'Connor, D A Eagan, T L Frankforter, E G Triffleman, J Shi, B J Rounsaville
Affiliations
Clinical Trial

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

K M Carroll et al. Arch Gen Psychiatry. 2001 Aug.

Abstract

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.

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Figures

Figure 1
Figure 1
Retention by week by treatment group (N=127). All subjects were taking naltrexone 3 times a week as maintenance therapy. CM indicates contingency management; SO+CM, significant other involvement and CM.
Figure 2
Figure 2
Probability of opioid use by week by treatment group (N=127), result of random regression analyses, using a linear model. All subjects were taking naltrexone 3 times a week as maintenance therapy. CM indicates contingency management; SO+CM, significant other involvement and CM.
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