Combining cognitive behavioral therapy and prize-based contingency management produces substantial benefits for cocaine program participants, a study finds.
Cocaine addiction is a fairly common form of substance addiction that unfortunately does not respond consistently to any type of medication-based treatment. For this reason, cocaine-centered treatment programs typically rely on at least one form of psychotherapy or counseling to help their clients/patients. In a study published in October 2014 in the journal Drug and Alcohol Dependence, researchers from two Swiss institutions assessed the effectiveness of a combined approach that treats cocaine addiction with two forms of psychotherapy, known as cognitive behavioral therapy and prize-based contingency management.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a common frontline treatment for people attempting to recover from cocaine addiction. Practitioners of this therapy believe that, in large part, addiction-supporting behaviors are learned, dysfunctional responses to stressful situations. They also believe that affected individuals can un-learn their dysfunctional responses and develop new stress reactions that don’t encourage substance intake. During the first stages of CBT, clients/patients learn to identify the situations that trigger their urges for substance use; they also learn to understand the underlying reasons behind their substance-using stress reactions. In the later stages of the therapy, clients/patients learn how to cope with their stress reactions, avoid substance use in stressful situations and establish an enduring pattern of substance-free daily life.
In addition to cases of cocaine abuse/addiction, cognitive behavioral therapy is useful for the treatment of abuse/addiction related to the intake of methamphetamine, marijuana, alcohol and nicotine/tobacco. Some people receive CBT in combination with medication or with other forms of non-medication-based therapy. While the therapy is traditionally conducted in person in group or individualized settings, current evidence indicates that it also produces significant benefits when administered remotely via computer.
Prize-Based Contingency Management
Contingency management is also noted for its ability to help people affected by cocaine abuse/addiction or other forms of stimulant abuse/addiction. This therapy uses some sort of real-world incentive to encourage participants in substance treatment to do such things as maintain substance abstinence, regularly attend group or individualized sessions and otherwise follow established program guidelines or objectives. Some contingency management programs rely on a form of the therapy called voucher-based reinforcement. This approach encourages abstinence and program compliance through the distribution of increasingly valuable vouchers for goods or services after every consecutive substance-negative urine drug test. Other programs use a form of the therapy called prize-based contingency management. This approach uses the chance to win a modest cash prize to encourage abstinence and program compliance. The odds of winning the cash go up with every consecutive substance-negative drug test.
Usefulness in Cocaine Treatment
In the study published in Drug and Alcohol Dependence, researchers from Switzerland’s University of Basel and Phenix Foundation used assessments of 60 people to gauge the usefulness of a combined course of cognitive behavioral therapy and prize-based contingency management in cocaine addiction treatment. All of the study participants were affected by cocaine addiction. Twenty-nine of the participants received a combination of CBT and prize-based contingency management for 24 weeks; the remaining 31 participants only received cognitive behavioral therapy over the same span of time. The researchers used four measurements to compare the effectiveness of the two treatment approaches: continued participation in cocaine treatment, the ability to completely avoid cocaine for at least three weeks in a row, the maximum number of consecutive cocaine-free weeks achieved and the percentage of cocaine-negative urine samples submitted during treatment, as well as at a follow-up assessment conducted half a year after the end of treatment.
All told, 63 percent of the original 60 enrollees were still involved when the study period came to a close. The researchers concluded that the members of both treatment groups experienced a significant decline in their cocaine consumption, as well as a significant increase in the number of cocaine-negative urine samples submitted. Compared to the group that only received cognitive behavioral therapy, the group that received a combination of CBT and prize-based contingency management submitted a higher percentage of cocaine-free urine samples on five weekly occasions over the course of the study. All of these weeks were bunched into the earlier stages of treatment.