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Contingency management plus acceptance and commitment therapy for initial cocaine abstinence: Results of a sequential multiple assignment randomized trial (SMART).
- Source :
-
Drug and alcohol dependence [Drug Alcohol Depend] 2024 Mar 01; Vol. 256, pp. 111078. Date of Electronic Publication: 2024 Jan 03. - Publication Year :
- 2024
-
Abstract
- Background: This study tested an adaptive intervention for optimizing abstinence outcomes over phases of treatment for cocaine use disorder using a SMART design. Phase 1 assessed whether 4 weeks of contingency management (CM) improved response with the addition of Acceptance and Commitment Therapy (ACT). Phase 2 assessed pharmacological augmentation with modafinil (MOD) vs. placebo (PLA) for individuals not achieving abstinence during Phase 1.<br />Method: For Phase 1 of treatment, participants (N=118) were randomly allocated to ACT+CM or Drug Counseling (DC+CM), the comparison condition. At week 4, treatment response was defined as the submission of six consecutive cocaine-negative urine drug screens (UDS). Phase 1 non-responders were re-randomized to MOD or PLA as adjunct to their initial treatment. Phase 1 responders continued receiving their initial treatment. Primary outcomes included response rate and proportion of cocaine-negative UDS for Phase 1 and 2. Analyses used Bayesian inference with 80% pre-specified as the posterior probability (PP) threshold constituting moderate evidence that an effect exists.<br />Results: Phase 1 response was higher in the ACT+CM group (24.5%) compared to the DC+CM group (17.5%; PP = 84.5%). In Phase 2, the proportion of cocaine-negative UDS among Phase 1 responders did not differ by initial treatment (PP = 61.8%) but remained higher overall compared to Phase 1 non-responders (PPs > 99%). No evidence of an effect favoring augmentation with MOD was observed.<br />Discussion: Adding ACT to CM increased abstinence initiation. Initial responders were more likely to remain abstinent compared to initial non-responders, for whom modafinil was not an effective pharmacotherapy augmentation strategy.<br />Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare.<br /> (Copyright © 2023. Published by Elsevier B.V.)
Details
- Language :
- English
- ISSN :
- 1879-0046
- Volume :
- 256
- Database :
- MEDLINE
- Journal :
- Drug and alcohol dependence
- Publication Type :
- Academic Journal
- Accession number :
- 38309089
- Full Text :
- https://doi.org/10.1016/j.drugalcdep.2023.111078