Advertisement

The Psychological Record

, Volume 67, Issue 2, pp 253–259 | Cite as

Monitoring Cocaine Use and Abstinence Among Cocaine Users for Contingency Management Interventions

  • August F. HoltynEmail author
  • Todd W. Knealing
  • Brantley P. Jarvis
  • Shrindhi Subramaniam
  • Kenneth Silverman
Original Article
  • 200 Downloads

Abstract

During contingency management interventions, reinforcement of cocaine abstinence is arranged by delivering an incentive when a urine sample tests cocaine-negative. The use of qualitative versus quantitative urinalysis testing may have important implications for effects on cocaine abstinence. Qualitative testing (i.e., testing that solely identifies whether a particular substance is present or absent) may not detect short-term cocaine abstinence because a single instance of cocaine use can result in cocaine-positive urine over many days. Quantitative testing (i.e., testing that identifies how much of a substance is present) may be more sensitive to short-term cocaine abstinence; however, the selection of a criterion for distinguishing new use versus carryover from previous use is an important consideration. The present study examined benzoylecgonine concentrations, the primary metabolite of cocaine, in urine samples collected three times per week for 30 weeks from 28 cocaine users who were exposed to a cocaine abstinence contingency. Of the positive urine samples (benzoylecgonine concentration >300 ng/ml), 29%, 21%, 14%, and 5% of the samples decreased in benzoylecgonine concentration by more than 20%, 40%, 60%, and 80% per day, respectively. As the size of the decrease increased, the likelihood of that sample occurring during a period leading to a cocaine-negative urine sample (benzoylecgonine concentration ≤300 ng/ml) also increased. The number of days required to produce a cocaine-negative sample following a positive sample ranged from 1 to 10 days and was significantly correlated with the starting benzoylecgonine level (r = 0.43, p < 0.001). The present analyses may aid in the development of procedures that allow for the precise reinforcement of recent cocaine abstinence during contingency management interventions.

Keywords

Benzoylecgonine Cocaine Contingency management Incentives 

Notes

Author Note

The preparation of this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under award numbers R01DA012564, R01DA013107, R01DA019497, R01 DA037314, and T32DA07209. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Funding

This study was funded by the National Institute on Drug Abuse of the National Institutes of Health under award numbers R01DA012564, R01DA013107, R01DA019497, R01 DA037314, and T32DA07209.

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the Johns Hopkins Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Cone, E. J., & Dickerson, S. L. (1993). Efficacy of urinalysis in monitoring heroin and cocaine abuse patterns: Implications in clinical trials for treatment of drug dependence. NIDA Research Monograph, 128, 46–46.Google Scholar
  2. Davis, D. R., Kurti, A. N., Skelly, J. M., Redner, R., White, T. J., & Higgins, S. T. (2016). A review of the literature on contingency management in the treatment of substance use disorders, 2009–2014. Preventive Medicine, 92, 36–46.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Higgins, S. T., Silverman, K., & Heil, S. H. (eds.). (2008). Contingency management in substance abuse treatment. Guilford Press.Google Scholar
  4. Higgins, S. T., Delaney, D. D., Budney, A. J., Bickel, W. K., Hughes, J. R., Foerg, F., & Fenwick, J. W. (1991). A behavioral approach to achieving initial cocaine abstinence. American Journal of Psychiatry, 148, 1218–1224.CrossRefPubMedGoogle Scholar
  5. Knapp, W. P., Soares, B., Farrell, M., & Silva de Lima, M. (2007). Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. The Cochrane Library.Google Scholar
  6. Leri, F., Bruneau, J., & Stewart, J. (2003). Understanding polydrug use: Review of heroin and cocaine co‐use. Addiction, 98, 7–22.CrossRefPubMedGoogle Scholar
  7. Lussier, J. P., Heil, S. H., Mongeon, J. A., Badger, G. J., & Higgins, S. T. (2006). A meta‐analysis of voucher‐based reinforcement therapy for substance use disorders. Addiction, 101(2), 192–203.CrossRefPubMedGoogle Scholar
  8. McCance‐Katz, E. F., Jatlow, P., & Rainey, P. M. (2010). Effect of cocaine use on methadone pharmacokinetics in humans. The American Journal on Addictions, 19, 47–52.CrossRefPubMedGoogle Scholar
  9. Minozzi, S., Saulle, R., De Crescenzo, F., & Amato, L. (2015). Psychosocial interventions for psychostimulant misuse. Cochrane Database of Systematic Reviews.Google Scholar
  10. Preston, K. L., Epstein, D. H., Cone, E. J., Wtsadik, A. T., Huestis, M. A., & Moolchan, E. T. (2002). Urinary elimination of cocaine metabolites in chronic cocaine users during cessation. Journal of Analytical Toxicology, 26(7), 393–400.CrossRefPubMedGoogle Scholar
  11. Preston, K. L., Goldberger, B. A., & Cone, E. J. (1998). Occurrence of cocaine in urine of substance-abuse treatment patients. Journal of Analytical Toxicology, 22(7), 580–586.CrossRefPubMedGoogle Scholar
  12. Preston, K. L., Silverman, K., Schuster, C. R., & Cone, E. J. (1997). Assessment of cocaine use with quantitative urinalysis and estimation of new uses. Addiction, 92(6), 717–727.CrossRefPubMedGoogle Scholar
  13. Shorter, D., Domingo, C. B., & Kosten, T. R. (2015). Emerging drugs for the treatment of cocaine use disorders: A review of neurobiological targets and pharmacotherapy. Expert Opinion on Emerging Drugs, 20, 15–29.CrossRefPubMedGoogle Scholar
  14. Silverman, K., Wong, C. J., Needham, M., Diemer, K. N., Knealing, T., Crone‐Todd, D., … Kolodner, K. (2007). A randomized trial of employment‐based reinforcement of cocaine abstinence in injection drug users. Journal of Applied Behavior Analysis, 40, 387–410.Google Scholar
  15. Verstraete, A. G. (2004). Detection times of drugs of abuse in blood, urine, and oral fluid. Therapeutic Drug Monitoring, 26(2), 200–205.CrossRefPubMedGoogle Scholar
  16. Weiss, R. D., & Gawin, F. H. (1988). Protracted elimination of cocaine metabolites in long-term, high-dose cocaine abusers. The American Journal of Medicine, 85(6), 879–880.CrossRefPubMedGoogle Scholar

Copyright information

© Association for Behavior Analysis International 2017

Authors and Affiliations

  • August F. Holtyn
    • 1
    • 2
    Email author
  • Todd W. Knealing
    • 1
    • 2
    • 3
  • Brantley P. Jarvis
    • 1
    • 2
  • Shrindhi Subramaniam
    • 1
    • 2
  • Kenneth Silverman
    • 1
    • 2
  1. 1.Johns Hopkins University, School of MedicineBaltimoreUSA
  2. 2.Center for Learning and Health, Department of Psychiatry & Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of PsychologyBriar Cliff UniversitySioux CityUSA

Personalised recommendations