Effects of reducing contingency management values on heroin and cocaine use for buprenorphine- and desipramine-treated patients

Addiction. 2003 May;98(5):665-71. doi: 10.1046/j.1360-0443.2003.00380.x.


Aims: During 3 months where contingency management (CM) had an escalating value for each consecutive drug-free urine (escalating CM), cocaine- and heroin-abusing patients significantly increased drug-free urines. The 'escalating CM' was eliminated during months 4-6 to assess any reduction in drug-free urines.

Design: Patients who completed a 3-month, randomized, double-blind, trial evaluating CM versus non-CM and desipramine (DMI) versus placebo, had an 'escalating CM' eliminated during months 4-6. The CM and non-CM groups were compared using thrice-weekly urine samples.

Setting: Out-patient buprenorphine maintenance for 6 months.

Participants: All 75 of the 160 original study patients who completed month 3 of the clinical trial.

Intervention: The 'escalating CM' was eliminated for all 3 months and during months 5 and 6 the response requirement was also increased to two and then three consecutive drug-free urines in order to obtain a voucher.

Measurements: Urine toxicology for opiates and cocaine.

Findings: After eliminating the 'escalating CM', the CM group showed a decline in combined opioid- and cocaine-free urines. This decline within the CM group was greater in those treated with DMI than placebo.

Conclusions: Buprenorphine with DMI maintained drug abstinence after eliminating the 'escalating CM', but not after increasing the response requirement, suggesting the need for more intensive psychosocial interventions during CM.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Behavior Control / methods*
  • Buprenorphine / therapeutic use
  • Cocaine-Related Disorders / drug therapy*
  • Cocaine-Related Disorders / urine
  • Desipramine / therapeutic use
  • Double-Blind Method
  • Drug Therapy, Combination
  • Female
  • Humans
  • Male
  • Narcotics / therapeutic use
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / urine
  • Token Economy
  • Treatment Outcome


  • Antidepressive Agents, Tricyclic
  • Narcotics
  • Buprenorphine
  • Desipramine