Contingency management and levodopa-carbidopa for cocaine treatment: a comparison of three behavioral targets

Exp Clin Psychopharmacol. 2010 Jun;18(3):238-44. doi: 10.1037/a0019195.

Abstract

New data support use of levodopa pharmacotherapy with behavioral contingency management (CM) as one efficacious combination in cocaine dependence disorder treatment. A potential mechanism of the combined treatment effects may be related to dopamine-induced enhancement of the saliency of contingently delivered reinforcers. Evidence to support this mechanism was sought by evaluating levodopa-enhancing effects across distinct CM conditions that varied in behavioral targets. A total of 136 treatment-seeking, cocaine dependent subjects participated in this 12-week, randomized, placebo-controlled trial of levodopa (vs. placebo) administered in combination with one of three behavioral CM conditions. In the CM-URINE condition, subjects received cash-valued vouchers contingent on cocaine-negative urine toxicology results. In the CM-ATTEND condition, the same voucher schedule was contingent on attending thrice weekly clinic visits. In the CM-MEDICATION condition, the same voucher schedule was contingent on Medication Event Monitoring Systems- and riboflavin-based evidence of pill-taking behavior. Primary outcomes associated with each CM target behavior were analyzed using generalized linear mixed models for repeated outcomes. CM responding in the CM-ATTEND and CM-MEDICATION conditions showed orderly effects, with each condition producing corresponding changes in targeted behaviors, regardless of medication condition. In contrast, CM responding in the CM-URINE condition was moderated by medication, with levodopa-treated subjects more likely to submit cocaine-negative urines. These findings specify the optimal target behavior for CM when used in combination with levodopa pharmacotherapy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Behavior Therapy / methods*
  • Carbidopa / therapeutic use*
  • Cocaine / urine
  • Cocaine-Related Disorders / psychology
  • Cocaine-Related Disorders / therapy*
  • Cocaine-Related Disorders / urine
  • Dopamine Agents / therapeutic use*
  • Female
  • Humans
  • Levodopa / therapeutic use*
  • Male
  • Medication Adherence
  • Middle Aged
  • Proportional Hazards Models
  • Reinforcement, Psychology
  • Treatment Outcome

Substances

  • Dopamine Agents
  • Levodopa
  • Cocaine
  • Carbidopa