Contingent use of take-homes and split-dosing to reduce illicit drug use of methadone patients

Abstract

This study tested a novel treatment intervention for illicit drug use that combines positive and aversive incentives. Sixteen chronic polydrug abusing methadone maintenance patients who had not responded to our usual take-home incentive program were randomly assigned to one of two treatment groups. While in the experimental care condition, patients received a take-home following each drug-negative urine (free of opiates, cocaine, and benzodiazepines as detected by EMIT) and were placed on a split-dose following each drug-positive urine. While in the control condition, patients participated in a standard care protocol in which they could not earn take-homes or be placed on split-dose. Patients receiving a split-dose were required to attend the clinic on two separate occasions (morning and evening) to receive their full daily methadone dose. After two months, patients crossed over to the alternative treatment condition for another two months. Results demonstrated that patients, while exposed to the experimental care condition, submitted significantly more drug-free urines (M = 29%) than when studied in standard care (M = 9%) or at baseline (M = 12%). Twenty-eight percent of patients (n = 5) showed marked improvements in drug-free urines during the experimental intervention as compared with control or baseline conditions. The combination of take-homes and split-dosing appears to help some polydrug abusing patients initiate and sustain abstinence.