Community Reinforcement Approach plus Vouchers for cocaine dependence treatment
DOI:
https://doi.org/10.20882/adicciones.323Keywords:
Cocaine dependence, CRA, vouchers, retention, community reinforcementAbstract
Cocaine use is an increasingly serious problem in Spain. The absence of effective drugs for the treatment of cocaine addiction and of empirically validated therapy programmes makes it necessary to resort to programmes that have shown their effectiveness in other countries. The aim of the present study was to explore the effectiveness of one of the programmes that has obtained the best results in the United States: the Community Reinforcement Approach (CRA) Plus Vouchers for the treatment of cocaine addiction. We assessed treatment retention and dropout rates and cocaine use during the first three months of intervention. The sample was made up of 37 patients addicted to cocaine who were assigned at random to one of two conditions: experimental (CRA Plus Vouchers) or control (Standard Treatment), both in the outpatient context. The results showed that 85.7% of the experimental group patients completed 12 weeks of treatment, compared to 69.6% of the control group. In the experimental group, 57.1% of the patients maintained continuous abstinence, compared to 39.1% of the control group. These results coincide with those of previous studies, all from outside Spain. Nevertheless, longer-term studies with larger samples are necessary in order to confirm the effectiveness of this program.References
Aguilar de Arcos, F., Verdejo García, A., Sánchez Barrera, M.
B., López Jiménez, A. y Pérez García, M. (2005). Perfil emocional de los consumidores de “revuelto” en comparación
con consumidores de heroína y de cocaína. Adicciones, 17(2), 131-138.
American Psychiatric Association (2002). DSM-IV-TR. Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. y Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571.
Bickel, W. K., Amass, L., Higgins, S. T., Badger, G. J. y Esch,
R. A. (1997). Effects of adding behavioral treatment to opioid detoxification with buprenorphine. Journal of Consulting and Clinical Psychology, 65(5), 803-810.
Budney, A. J. y Higgins, S. T. (1998). A Community Reinforcement Approach: Treating Cocaine Addiction. Retrieved February 7, 2006, from http://www.drugabuse.gov/TXManuals/CRA/CRA1.html
European Monitoring Centre for Drugs and Drug Addiction
(2005). The state of the drugs problem in Europe. Luxembourg: EMCDDA
García Rodríguez, O., Secades Villa, R., Fernández Hermida,
J. R., Carballo Crespo, J. L., Errasti Pérez, J. M. y Alhalabí Díaz, S. (2005). Comparación de pacientes cocainómanos y heroinómanos en el EuropASI. Adicciones, 17(1), 33-42.
Higgins, S. T., Alessi, S. M., y Dantona, R. L. (2002). Voucherbased incentives. A substance abuse treatment
innovation. Addictive Behaviors, 27(6), 887-910.
Higgins, S.T., Badger, G.J. y Budney, A.J. (2000). Initial abstinence and success in achieving longer term cocaine abstinence. Experimental and Clinical Psychopharmacology, 8, 377-386.
Higgins, S. T., Budney, A. J., Bickel, W. K., Foerg, F. E., Donham, R. y Badger, G. J. (1994). Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Archives of General Psychiatry, 51(7), 568-576.
Higgins, S. T., Budney, A. J., Bickel, W. K., Hughes, J. R., Foerg, F. y Badger, G. (1993). Achieving cocaine abstinence with a behavioral approach. American Journal of Psychiatry, 150(5), 763-769.
Higgins, P. G., Clough, D. H. y Wallerstedt, C. (1995). Drugtaking behaviours of pregnant substance abusers in
treatment. Journal of Advanced Nursing, 22(3), 425-432.
Higgins, S. T., Delaney, D. D., Budney, A. J., Bickel, W. K., Hughes, J. R., Foerg, F. y Fenwick, J. W. (1991). A behavioral approach to achieving initial cocaine abstinence. American Journal of Psychiatry, 148(9), 1218-1224.
Higgins, S. T., Heil, S. H. y Lussier, J. P. (2004). Clinical implications of reinforcement as a determinant of substance use disorders. Annual Review of Psychology, 55, 431-461.
Higgins, S. T., Sigmon, S. C., Wong, C. J., Heil, S. H., Badger, G. J., Donham, R., Dantona, R. L. y Anthony, S. (2003). Community reinforcement therapy for cocainedependent outpatients. Archives of General Psychiatry, 60(10), 1043-1052.
Hunt, G. M., y Azrin, N. H. (1973). A communityreinforcement
approach to alcoholism. Behaviour Research and Therapy, 11(1), 91-104.
Kokkevi, A. y Hartgers, C. (1995). European adaptation of a
multidimensional assessment instrument for drug and alcohol dependence. European Addiction Research, 1, 208-210.
Plan Nacional sobre Drogas (2005). Encuesta estatal sobre uso de drogas en enseñanzas secundarias 2004. Madrid: Delegación del Gobierno para el Plan Nacional sobre Drogas.
Ramos Atance, J.A. (2006). Búsqueda de un tratamiento farmacológico para la dependencia a la marihuana. Adicciones,
(1), 5-10.
Roozen, H. G., Boulogne, J. J., van Tulder, M. W., van den
Brink, W., De Jong, C. A., y Kerkhof, A. J. (2004). A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend, 74(1), 1-13.
San Molina, L. y Arranz, B. (2001). Aproximación terapéutica
de la dependencia de cocaína. Adicciones, 13(Suplemento 2), 191-208.
Secades Villa, R. y Fernández Hermida, J. R. (2003). Guía de
tratamientos psicológicos eficaces en la drogadicción: alcoholismo, cocaína y heroína. En M. Pérez Alvarez, J. R. Fernández Hermida, C. Fernández Rodríguez y I. Amigo Vázquez (Eds.), Guía de tratamientos psicológicos eficaces. I. Adultos (pp.107-139). Madrid: Ediciones Pirámide.
Selzer, M. L. (1971). The Michigan alcoholism screening
test: the quest for a new diagnostic instrument. The American Journal of Psychiatry, 127, 1653-1658
Shaner, A., Roberts, L.J., Eckman, T.A., Tucker, D.E., Tsuang,
J.W., Wilkins, J.N. y Mintz, J. (1997). Monetary reinforcement of abstinence from cocaine among mentally ill patients with cocaine dependence. Psychiatric Services, 48, 807-810.
Silverman, K., Wong, C.J., Higgins, S.T., Brooner, R.K., Montoya, I.D., Contoreggi,C., Umbricht-Schneiter, A., Schuster, C.R. y Preston, K.L. (1996). Increasing opiate abstinence through voucher-based reinforcement therapy. Drug and Alcohol Dependence, 41, 157-65.
Silverman, K., Wong, C.J., Umbricht-Schneiter, A., Montoya,
I.D., Schuster, C.R. y Preston, K.L. (1998). Broad beneficial effects of cocaine abstinence reinforcement among methadone patients. Journal of Consulting and Clinical Psychology, 66, 811-824.
Solé Puig, J. (2001). Tratamiento del consumo de cocaína.
Integrando psicoterapia y farmacoterapia. Adicciones, 13(Suplemento 2), 209-225.
Stitzer, M.L., Iguchi, M.Y. y Felch, L.J. (1992). Contingent take-home incentive: effects on drug use of methadonemaintenance
patients. Journal of Consulting and Clinical Psychology, 60, 927-934.
United Nations Office for Drugs and Crime (2005). World Drug Report 2005. Retrieved April 28, 2005, from www.unodc.org
Van den Brink, W. y van Ree, J. M. (2003). Pharmacological
treatments for heroin and cocaine addiction. European Neuropsychopharmacology, 13(6), 476-487.
