Use of contingency contracts in specialty clinics for cocaine abuse

Animal research reveals that cocaine is a highly reinforcing drug, and patients describe it as "compelling"; the drug maintains vigorous self-administration behavior in animals and humans despite its clear adverse effects. This suggests that the drug is very difficult for experienced users to give up. It further suggests a need for vigorous treatment to produce and maintain abstinence, thus permitting patients to relearn drug-free behaviors which are alternative to continued cocaine use. This 12-month pilot study aimed to determine 1) whether cocaine abusers would enter and remain in treatment, and 2) whether contingency contracts appear to complement standard clinical treatment in initiating and maintaining abstinence. We established cocaine clinics in Denver and Aspen. Of the first 67 patients admitted into those clinics, 32 (48 percent) elected to utilize contingency contracts. Thirty-one of those completely abstained from cocaine use during the treatment. Of the 35 patients who did not elect to use contingency contracts, no one remained abstinent and in treatment for more than four weeks. The results indicate that cocaine abusers will enter treatment, and that contingency contracting may contribute to a favorable outcome.