Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients

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AimsThis study examined whether increasing the amount of abstinence achieved during outpatient treatment for cocaine dependence is an effective method for increasing longer-term cocaine abstinence.DesignA two-condition, parallel groups, randomized controlled trial was conducted.SettingThe trial was conducted in a university-based research clinic.ParticipantsA total of 100 cocaine-dependent outpatients participated in the trial.InterventionParticipants were assigned randomly to receive treatment based on the community reinforcement approach (CRA) plus voucher-based incentives set at a relatively high monetary value (maximal value = $1995/12 weeks) or CRA with vouchers set at a relatively low monetary value (maximal value = $499/12 weeks). Vouchers were earned contingent on cocaine-negative urinalysis results during the initial 12 weeks of the 24-week outpatient treatment.MeasurementsOutcomes were evaluated using urine-toxicology testing, questionnaires and other self-report instruments.FindingsIncreasing voucher value increased the duration of continuous cocaine abstinence achieved during the 24-week treatment period. Point-prevalence cocaine abstinence assessed every 3 months throughout an 18-month follow-up period was greater in the high- than low-value voucher conditions. The duration of abstinence achieved during treatment predicted abstinence during follow-up, although that relationship weakened over time.ConclusionsIncreasing the value of abstinence-contingent incentives during the initial weeks of treatment appears to represent an effective method for increasing during-treatment and longer-term cocaine abstinence, but the positive association of during-treatment abstinence with longer-term outcome dissipates with time.

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