Community Reinforcement Therapy for Cocaine-Dependent Outpatients

作者：Stephen T. Higgins, Stacey C. Sigmon, Conrad J. Wong, Sarah Hughes Heil, Gary J. Badger, Robert T. Donham, Robert L. Dantona, Stacey L. Anthony · 发表于：Archives of General Psychiatry · 年份：2003 · DOI：10.1001/archpsyc.60.9.1043 · 被引用次数：199 · 研究领域：Substance Abuse Treatment and Outcomes、Homelessness and Social Issues、Gambling Behavior and Treatments

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 p...