2006 - School of Social Service Administration - University of Chicago

Advocates’ Forum
public health aspects derived from MMT (Foote et al., 1994; Gollnisch, 1997;
Broome et al., 2001; Magura et al., 2002). Previous research also attempts to
summarize appropriate interventions (Saunders, Wilkinson, and Allsop, 1991;
Center for Substance Abuse Treatment, 1994, 2005; Haug et al., 2005)
and examine the efficacy of others. Some of the studied interventions include
relapse prevention (Carroll, 1996), CBT, and CM (Rawson et al., 2002;
Epstein et al., 2003). Other works also attempt to modify existing interventions
(Dansereau et al., 1996; Simpson et al., 1997; Boyd et al., 1998; Magura et al.,
2002; Avants and Margolin, 2004; Stopka et al., 2004).
Several studies report that CM intervention is highly successful in
decreasing the frequency with which MMT patients test positive for cocaine
use in urinalyses (Foote et al., 1994; Simpson, Dansereau, and Joe, 1997;
Simpson, Joe, et al., 1997; Magura et al., 2002; Rawson et al., 2002; Epstein
et al., 2003). 4 These studies indicate that patients were more likely to produce
a clean urine drop when they received incentives, such as bus cards, cash,
and vouchers, during the initial months of treatment. These effects, however,
diminished over time, and there was no significant difference between groups
receiving CM and those receiving a standard form of treatment (Rawson et al.,
2002; Epstein et al., 2003).
When employed with MMT patients, CBT is another intervention
method that is found to be successful in producing long-term abstinence from
illicit substances (Foote et al., 1994; Simpson, Dansereau, and Joe, 1997;
Simpson, Joe, et al., 1997; Magura et al., 2002; Rawson et al., 2002; Epstein
et al., 2003). 5 However, Jeffrey Foote and colleagues (1994) caution that
results are slow and several months are usually required before a clean urinalysis
is observed; measurable success may take a year or more.
Studies by David Epstein and associates (2003) and Richard Rawson and
colleagues (2002) examine the outcomes of CM and CBT interventions,
considering how patients fare in each program. The works also consider how
patients fare when both programs are combined. Both studies hypothesized
that the group receiving the two treatments would show a greater decrease in
positive cocaine urinalyses than that observed for the groups receiving only
CM or CBT, respectively. The outcomes of the two studies were similar to
others mentioned previously in this article. However, Epstein and associates
(2003) and Rawson and colleagues (2002) failed to find that the combination
of CM with CBT treatment produced a change in results; joining the two
interventions into one treatment produced no significant change in outcomes.
Rawson and colleagues (2002) suggest that patients may increasingly produce
negative urinalyses over time, but only if the two interventions are provided
successively, rather than concurrently.
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