Contingency management interventions: effects on treatment outcome during methadone detoxification.
Pay clients small cash or take-home doses for each clean urine during taper—it doubles abstinence and keeps them in care.
01Research in Context
What this study did
Researchers tested the adults in methadone detox. Half got cash and take-home doses for clean urine. Half got usual care only.
The study ran the full taper, about 12 weeks. Every clean test earned $10 plus one take-home methadone dose. Dirty tests got nothing.
What they found
The paid group gave twice as many clean urines during dose cuts. They also stayed in treatment a large share longer.
When the money stopped, relapse rose fast. The edge faded within a month.
How this fits with other research
Geurts et al. (2008) later used the same token-economy idea for smoking in residential care. They swapped cash for prizes and still beat standard care.
Redner et al. (2018) ran a tiny case study with just 3 weeks of cash for smoking. One adult stayed quit for months. These two papers show the 1984 finding holds across drugs, settings, and shorter time frames.
Green et al. (1987) tested naltrexone pills for self-injury and saw no gain. This seems opposite, but it is not. The 1984 paper uses methadone as a reward, not as medicine. The 1987 paper tests naltrexone as medicine alone. Different goals, same drug class.
Why it matters
If you taper clients off any substance, pair each clean test with a quick, clear reward. Cash works. Take-home doses work. The trick is to fade the reward slowly so gains stick.
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02At a glance
03Original abstract
We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.
Journal of applied behavior analysis, 1984 · doi:10.1901/jaba.1984.17-35