Community reinforcement approach in the treatment of opiate addicts

The authors studied the efficacy of the community reinforcement approach (CRA) as compared to standard counseling in opiate-dependent patients on methadone maintenance. One hundred eighty subjects were randomized to three treatment conditions: standard, CRA, and CRA with relapse prevention (CRA/RP). Of these, 151 subjects were followed up 6 months after intake. Since few of the RP sessions had been concluded at the 6-month follow-up, the two CRA groups were combined for analyses. Weekly urinalysis drug screens and Addiction Severity Index (ASI) scores at intake and 6 months were compared. The combined CRA groups did significantly better than the standard group in the following areas: consecutive opiate-negative urinalysis (3 weeks), and the 6-month ASI drug composite score. These results support the benefit of adding CRA strategies to the treatment of patients who are opiate dependent and on methadone maintenance. Because of insufficient treatment exposure to RP at the 6-month follow-up, the additive effect of RP could not be adequately evaluated; further follow-up will be required.