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Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches


Voucher-Based Reinforcement Therapy in Methadone Maintenance Treatment


A novel and promising voucher-based reinforcement system has been developed for the initiation and maintenance of cocaine abstinence (Higgins et al., 1991, Higgins et al., 1994). That system has been used with considerable effectiveness to produce sustained cocaine abstinence in cocaine dependent patients whose primary drug of abuse is cocaine (Higgins et al., 1994) as well as cocaine and heroin abstinence in inner city methadone maintenance patients who continue to use heroin and cocaine regularly during treatment (Silverman et al., 1996a; Silverman et al., 1996b). Under this abstinence reinforcement system, patients receive a voucher each time they provide a drug-free urine sample. The voucher has monetary value that can be exchanged for goods and services that are considered to be consistent with the goals of treatment. Initially the voucher values are low, but the value of the vouchers increases as the number of consecutive drug-free urines that the patient provides increases. Cocaine or heroin positive urines reset the value of the vouchers to the initial low value. This contingency of escalating incentives for sustained abstinence is designed specifically to reinforce periods of sustained cocaine abstinence.

Results show that patients receiving vouchers for drug free urine samples achieved significantly more weeks of abstinence and significantly more weeks of sustained abstinence than patients that were given vouchers independent of urinalysis results. In another study, urinalysis positive for heroin decreased significantly when the voucher program was instituted and increased significantly when it was discontinued. While this intervention may not be in a form that is amenable to immediate widespread application, the demonstrated effectiveness of this intervention further illustrates the relevance of the principle of reinforcement and the utility of monetary-based incentives in the treatment of drug abuse.


Silverman, K., Higgins, S., Brooner, R., Montoya, I., Cone, E., Schuster, C., & Preston, K. (1996). Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Archives of General Psychiatry, 53, 409-415.

Silverman, K., Wong, C., Higgins, S., Brooner, R., Montoya, I., Contoreggi, C., Umbricht-Schneiter, A., Schuster, C., Preston, K. (1996). Increasing opiate abstinence through voucher-based reinforcement therapy. Drug and Alcohol Dependence, 41, 157-165.

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