Broad beneficial effects of cocaine abstinence reinforcement among methadone patients

J Consult Clin Psychol. 1998 Oct;66(5):811-24. doi: 10.1037//0022-006x.66.5.811.


Escalating reinforcement for sustained abstinence has been effective in treating cocaine abuse. Under this schedule, patients receive vouchers for cocaine-free urine samples; vouchers have monetary values that increase with the number of consecutive cocaine-free urine samples. Cocaine-abusing methadone patients were randomly assigned to receive vouchers for 12 weeks under (a) an escalating schedule (n = 20), (b) an escalating schedule with start-up bonuses (n = 20), or (c) a noncontingent schedule (n = 19). Start-up bonuses were designed to provide added reinforcement for initiating abstinence; however, they did not improve outcomes. Both contingent interventions significantly increased cocaine abstinence. In addition, the contingent interventions increased abstinence from opiates and decreased reports of cocaine craving. These results replicate the efficacy of cocaine abstinence reinforcement and show that it can have broad beneficial effects.

Publication types

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

MeSH terms

  • Adult
  • Analysis of Variance
  • Behavior Therapy* / methods
  • Behavior Therapy* / standards
  • Cocaine-Related Disorders / complications
  • Cocaine-Related Disorders / prevention & control*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Methadone / therapeutic use
  • Narcotics / therapeutic use
  • Opioid-Related Disorders / complications*
  • Opioid-Related Disorders / rehabilitation
  • Reinforcement Schedule*
  • Substance Abuse Detection / psychology
  • Time Factors
  • Token Economy*
  • Treatment Outcome


  • Narcotics
  • Methadone