Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement
Open accessAbstract
OBJECTIVE: The effects of cognitive-behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. METHOD: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. RESULTS: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = .05), with no significant CM x RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p < .01, and RP, OR = 4.89 (1.51, 15.86), p < .01, and produced better cocaine urine toxicology outcomes at 9 months than treatment as usual, OR = 4.21 (1.37, 12.88), p < .01, and RP, OR = 4.24 (1.32, 13.65), p < .01. Trends also favored CM + RP over CM at 6 months, OR = 2.93 (0.94, 9.07), p = .06, and 9 months, OR = 2.93 (0.94, 9.10), p = .06. Differences between the conditions were not significant after 9 months. CONCLUSIONS: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP.
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One RCT in a mixed cocaine and methamphetamine use disorder population found positive effects on reduced substance use, suggesting telemedicine may be effective for methamphetamine use disorder.
“One RCT of a mixed population of patients with cocaine and methamphetamine use disorders found positive effects on reduced substance use, suggesting that telemedicine may be effective in the treatment of methamphetamine use disorder.95”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [95]
The Discussion (page not provided) reports better cocaine-use outcomes for participants who received incentives. But the study describes its participants as cocaine-dependent and its interventions as contingency management and relapse prevention, not telemedicine; it does not establish an effect for methamphetamine use disorder. (LLM, conf=0.88)
Experimental — accuracy not yet measuredResearch has demonstrated that patients with StUD who have not achieved initial treatment goals may benefit from extended treatment with EBIs to facilitate long-term recovery.
“Research has demonstrated that patients with StUD who have not achieved their treatment goals during the initial phase of treatment may benefit from extended treatment with EBIs to facilitate long-term recovery.95,99,103,104”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [95]
The Discussion (page not provided) reports that adding contingency management, particularly with relapse prevention, benefited cocaine-dependent patients and that effects persisted after treatment. But the participants had already achieved initial engagement and, in many cases, abstinence; the Limitations section says it is unclear whether the results would apply to patients who did not remain in initial treatment. The paper therefore does not establish the claimed benefit for patients who had not achieved initial treatment goals. (LLM, conf=0.88)
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ResultPetry, N., Alessi, S. M., Carroll, K., Hanson, T., Mackinnon, S., Rounsaville, B., & Sierra, S. (2006) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.74.3.592 · Cited by 122 · cited 1× · see citing works
“…voucher effects (Alessi, Hanson, Wieners, & Petry, 2007; Epstein et al., 2003; Higgins et al., 2003, 2006; Higgins, Wong, Badger, Ogden, & Dantona, 2000) and other studies showing no sustained effects (Milby et al., 2003; Petry et al., 2005, 2006; Rawson et al., 2002, 2006; Shoptaw et al., 2005).”
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Treating substance use disorders with adaptive continuing care.
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ResultEstablishing Specificity in Psychotherapy Scientifically: Design and Evidence Issues
Wampold, B. E. (2005) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.bpi025 · Cited by 50 · cited 1× · see citing works
“…factors in psychotherapy and counseling predict better outcomes in the treatment of addiction (Connors, Carroll, DiClemente, Longabaugh, & Donovan, 2007) and other disorders (Baskin, Tierney, Minami, & Wampold, 2003; Kazdin, 2005; Orlinsky, Ronnestad, & Willutzki, 2003; Wampold, 2001, 2005).”
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“There is considerable evidence that a strong therapeutic alliance and other general factors in psychotherapy and counseling predict better outcomes in the treatment of addiction (Connors, Carroll, DiClemente, Longabaugh, & Donovan, 2007) and other disorders (Baskin, Tierney, Minami, & Wampold, 2003; Kazdin, 2005; Orli…”
BackgroundEcology : science and practice
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“In this review, nonspecific contrasts were typically either treatment as usual (e.g., Bowen et al., 2014; McKay et al., 2010; Morgenstern, Blanchard, Morgan, Labouvie, & Hayaki, 2001; Papas et al., 2011) or conditions designed to account for nonspecific therapy factors (e.g., supportive therapy…”
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“Others have noted this trend toward more CM studies examining the sustainability of post-intervention treatment effects as well (McKay et al., 2010), but more needs to be done in terms of moving in the direction of all CM studies including follow-up assessments and increases in the quality of these…”
BackgroundResultAre the parts as good as the whole? A meta-analysis of component treatment studies.
Bell, E. C., Marcus, D. K., & Goodlad, J. K. (2013) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0033004 · Cited by 192 · see citing works
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“, 2006), an increasing number of studies demonstrate benefits of CM months after treatment ends (Alessi, Hanson, Wieners, & Petry, 2007; Carroll et al., 2016; Halpern et al., 2015; Higgins et al., 2000, 2007; Higgins, Heil, & Lussier, 2004; Kadden, Litt, Kabela-Cormier, & Petry, 2007; Kendzor et al., 2015; McDonell et…”
Bentzley, B. S., Han, S. S., Neuner, S., Humphreys, K., Kampman, K. M., & Halpern, C. H. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.8049 · Cited by 161 · see citing works
Psychosocial interventions for psychostimulant misuse
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Substance Abuse Intensive Outpatient Programs: Assessing the Evidence
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Symptoms of anhedonia, not depression, predict the outcome of treatment of cocaine dependence
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“In the McKay et al. (2010) dataset, we found that the baseline BDI anhedonia symptom scale was a significant predictor of non-abstinence from month 0 to 3 and month 3 to 6 (Table 1).”
BackgroundMethodResultInfluentialSelf-citationImpact of Continuing Care on Recovery From Substance Use Disorder
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Self-citationThe ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder
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“It is also noteworthy that few trials with adults (e.g., Carroll et al., 2012; McKay et al., 2010) and no trials with adolescents that we are aware of have studied the effects of CM without the addition of CBT, family, or another therapy.”
BackgroundKelly, P. J., Baker, A., Deane, F. P., KAY‐LAMBKIN, F. J., Bonevski, B., & Tregarthen, J. (2012) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2012.00465.x · Cited by 67 · see citing works
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A randomized trial of contingency management delivered in the context of group counseling
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“Cognitive-behavioral therapy alone or in combination with CM may result in persisting benefits (Carroll et al., 1994; Epstein, Hawkins, Covi, Umbricht, & Preston, 2003; McKay et al., 2010; Rawson et al., 2002; Rawson et al., 2006).”
BackgroundMcKay, J., Horn, D. V., Oslin, D., Ivey, M. A., Drapkin, M. L., Coviello, D. M., Yu, Q., & Lynch, K. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03483.x · Cited by 54 · see citing works
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The effects of continuing care on emerging adult outcomes following residential addiction treatment
Bergman, B. G., Hoeppner, B. B., Nelson, L. M., Slaymaker, V. J., & Kelly, J. F. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.05.017 · Cited by 34 · see citing works
Bjørnestad, J. R., McKay, J. R., Berg, H., Moltu, C., & Nesvåg, S. M. (2020) · Drug and Alcohol Review · doi:10.1111/dar.13051 · Cited by 33 · see citing works
Self-citationPsychosocial interventions for stimulant use disorder
Minozzi, S., Saulle, R., Amato, L., Traccis, F., & Agabio, R. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011866.pub3 · Cited by 32 · see citing works
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“The six continuing care initiatives varied in target populations and treatment strategies, but all addressed transitions in care through in-person or telephone counseling (see: McKay et al., 2010).”
BackgroundWorden, B. L., Davis, E., Genova, M., & Tolin, D. F. (2015) · Cognitive Therapy and Research · doi:10.1007/s10608-014-9666-0 · Cited by 27 · see citing works
“%) appeared less than that reported in some similar day program samples (42.3 % dropout rate in McKay et al. 2010; 70.8 % dropout rate in Patterson 2008; 78 % in Petry et al. 2000).”
ResultInfluentialInitial Abstinence Status and Contingency Management Treatment Outcomes: Does Race Matter?
Montgomery, L., Carroll, K., & Petry, N. (2015) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0039021 · Cited by 20 · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript outpatient settings (Barry, Sullivan & Petry 2009; Bride & Humble, 2008; McKay et al., 2010; Montgomery et al., 2012).”
BackgroundReading LINE s within the cocaine addicted brain
Doyle, G. A. R., Doucet-O’Hare, T. T., Hammond, M. J., Crist, R. C., Ewing, A. D., Ferraro, T. N., Mash, D. C., Kazazian, H. H., & Berrettini, W. H. (2017) · Brain and Behavior · doi:10.1002/brb3.678 · Cited by 15 · see citing works
“…treatment for CA is needed as dropout rates in treatment programs are high (Kampman et al., 2002), relapse is common among patients who complete treatment (McKay et al., 2010), and mortality among CA individuals is 4–8 fold greater compared to age and sex- matched peers (Degenhardt et al., 2011).”
BackgroundThe costs of crime associated with stimulant use in a Canadian setting
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“Contingency management and cognitive behavioural therapies (CM/CBT) have shown efficacy in trial-based settings, particularly short-run CM interventions, in which participants receive a prize or reward for maintaining abstinence (DeFulio et al., 2009; Jaffe et al., 2007; McKay et al., 2010; Rawson et al., 2006; Schuma…”
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“For example, if there are no open scientific questions about how to best address the needs of responders in an adaptive intervention (see [33, 34]), the SMART can re-randomize only non-responders to subsequent options.”
A Brief History of Group Therapy as a Field and the Representation of Women in Its Development
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Systematic Review of Cocaine-Treatment Interventions for Black Americans
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“…as usual (TAU) in an intensive outpatient program showed participants (89% Black) in the CM + RP condition self-reported less cocaine use and had more negative cocaine urine screens at 6-and 9-month follow-ups compared with participants in CM-only, RP-only, or TAU conditions (McKay et al., 2010).”
Psychotherapy for substance use disorders
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“In studies in patients with cocaine use disorder, anhedonia had a negative impact on the effectiveness of contingency management treatment (57, 61, 62).”
BackgroundAlcohol and Drug Use Disorders
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Addiction Recovery Monitoring and Support (ARMS)
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SubstanceAbuseIntensiveOutpatient Programs:AssessingtheEvidence
McCarty, D. W., Lyman, R., Dougherty, R. H., Daniels, A. S., & Delphin-Rittmon, M. E. (2014)
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- Authors
- McKay, J. R., Lynch, K. G., Coviello, D., Morrison, R., Cary, M. S., Skalina, L., & Plebani, J.
- Affiliations
- Philadelphia VA Medical Center (US)
- University of Pennsylvania (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010-02
- Volume
- 78
- Issue
- 1
- Pages
- 111-120
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3076098
- OpenAlex
- W2126089103
- Cited by
- 46
- References
- 52
- Citations by year
- 2024: 4 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 4 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 4
- FWCI
- 3.03
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01 DA14059; K02 DA000361)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Keywords
- cocaine dependence, relapse prevention, contingency management, intensive outpatient treatment, continuing care, treatment engagement, African American patients, addiction treatment
- MeSH terms
- Adult, Analysis of Variance, Cocaine, Continuity of Patient Care, Counseling, Female, Humans, Male, Outpatients, Patient Compliance, Reinforcement Schedule, Social Support, Substance Abuse Detection, Cognitive Behavioral Therapy, Chi-Square Distribution, Treatment Outcome, Cocaine-Related Disorders, Secondary Prevention
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