Skip Navigation

Link to  the National Institutes of Health  
The Science of Drug Abuse and Addiction from the National Institute on Drug Abuse Archives of the National Institute on Drug Abuse web site
Go to the Home page
   

Home > Publications > A Community Reinforcement Approach: Treating Cocaine Addiction

A Community Reinforcement Approach: Treating Cocaine Addiction



Exhibit 30: Disulfiram Contract

I, _________________________________, agree to take disulfiram at the regularly scheduled time outlined below.

I agree to do this for ______ days. After this time, I agree to talk to my therapist and to discuss whether or not to continue taking disulfiram. I also agree to have the person designated below witness the administration of the disulfiram each time it is scheduled.

I, _________________________________, agree to be present and witness each take-home administration of disulfiram.

Time: __________________

Days: __________________

Where: __________________

In response to _________________________________ taking disulfiram as scheduled, I agree to _________________________________ as a means of reinforcing the taking of disulfiram.

 

Patient's Signature:

________________________________

Partner's Signature:

________________________________

Therapist's Signature:

________________________________

Date:

________

 

[Use the Back Button on Your Browser to Return to the Previous Page]


Therapy Manuals for Drug Abuse:
Manual 2

 



 
TX  
TX
 
 

Contents



Archive Home | Accessibility | Privacy | FOIA (NIH) | Current NIDA Home Page
National Institutes of Health logo_Department of Health and Human Services Logo The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. . The U.S. government's official web portal