Contingency management and motivational enhancement: a randomized clinical trial for college student smokers. Differences in the profile of neonatal abstinence syndrome signs in methadone- versus buprenorphine-exposed neonates. Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Medically assisted recovery from opiate dependence within the context of the UK drug strategy: methadone and Suboxone (buprenorphine-naloxone) patients compared. Concurrent alcohol dependence among methadone-maintained cocaine abusers is associated with greater abstinence. PET imaging of dopamine transporter and drug craving during methadone maintenance treatment and after prolonged abstinence in heroin users. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Evidence of cognitive and neurophysiological impairment in patients with untreated naive acromegaly. Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients.
INTRODUCTION The efficacy of contingency-management ( CM ) and motivational enhancement therapy ( MET ) for college student smoking cessation was examined . METHODS Nontreatment-seeking daily smokers ( N = 110 ) were r and omly assigned to 3 weeks of CM versus noncontingent reinforcement ( NR ) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design . Expired carbon monoxide ( CO ) sample s were collected twice daily for 3 weeks . Participants earned 5 US dollars for providing each sample ; additionally , those r and omized to CM earned escalating monetary rewards based on CO reductions ( Week 1 ) and smoking abstinence ( Weeks 2 - 3 ) . RESULTS Compared with NR , CM result ed in significantly lower CO levels and greater total and consecutive abstinence during the intervention . Those in the CM and MET groups reported greater interest in quitting smoking posttreatment , but rates of confirmed abstinence at follow-up were very low ( 4 % at 6-month follow-up ) and did not differ by group . DISCUSSION Findings support the short-term efficacy of CM for reducing smoking among college students . Future research should explore enhancements to CM in this population , including a longer intervention period and the recruitment of smokers who are motivated to quit AIMS To compare the profile of signs of  neonatal abstinence syndrome ( NAS )  in  methadone- versus buprenorphine-exposed infants . DESIGN , SETTING AND PARTICIPANTS Secondary analysis of NAS data from a multi-site , double-blind , double-dummy , flexible-dosing , r and omized clinical trial . Data from a total of 129 neonates born to opioid-dependent women who had been assigned to receive methadone or buprenorphine treatment during pregnancy were examined . MEASUREMENTS For 10 days after delivery , neonates ( methadone = 72 , buprenorphine = 57 ) were assessed regularly using a 19-item modified Finnegan scale . Data from neonates who required pharmacological treatment ( methadone = 41 , buprenorphine = 27 ) were included up to the time treatment was initiated . The incidence and mean severity of the total NAS score and each individual sign of NAS were calculated and compared between medication conditions , as was the median time until morphine treatment initiation among treated infants in each condition . FINDINGS Two NAS signs ( undisturbed tremors and hyperactive Moro reflex ) were observed significantly more frequently in methadone-exposed neonates and three ( nasal stuffiness , sneezing , loose stools ) were observed more frequently in buprenorphine-exposed neonates . Mean severity scores on the total NAS score and five individual signs ( disturbed and undisturbed tremors , hyperactive Moro reflex , excessive irritability , failure to thrive ) were significantly higher among methadone-exposed neonates , while sneezing was higher among buprenorphine-exposed neonates . Among treated neonates , methadone-exposed infants required treatment significantly earlier than buprenorphine-exposed infants ( 36 versus 59 hours postnatal , respectively ) . CONCLUSIONS The profile of neonatal abstinence syndrome differs in  methadone- versus buprenorphine-exposed neonates , with significant differences in incidence , severity and treatment initiation time . Overall , methadone-exposed neonates have a more severe neonatal abstinence syndrome Contingency management ( CM ) interventions frequently utilize vouchers as reinforcers , but a prize-based system is also efficacious . This study compared these approaches . Seventy-four cocaine-dependent methadone out patients were r and omly assigned to st and ard treatment ( ST ) , ST plus a maximum of $ 585 in contingent vouchers , or ST plus an expected average maximum of $ 300 in contingent prizes for 12 weeks . CM participants achieved longer duration s of abstinence ( LDA ) than ST participants , and CM conditions did not differ significantly in outcomes or amount of reinforcement earned . Although long-term abstinence did not differ by group , LDA during treatment was the best predictor of abstinence at 9 months . Thus , reinforcement with prizes was similar to voucher CM in promoting LDA , which is associated with posttreatment benefits The focus of drug policy in the UK has shifted markedly in the past 5 years to move beyond merely emphasising drug abstinence towards maximising individuals ' opportunities for recovery . The UK government continues to recognise the prescribing of narcotic medications indicated for opiate dependence as a key element of these individuals ' recovery journey . This article describes a small , naturalistic comparison of the efficacy of the two most commonly prescribed opiate substitute medications in the UK -- methadone hydrochloride ( methadone oral solution ) and Suboxone ( buprenorphine-naloxone sublingual tablets)--for reducing current heroin users ' ( n = 34 ) days of heroin use , and preventing short-term abstainers ( n = 37 ) from relapsing to regular heroin use . All patients had been prescribed either methadone or Suboxone for maintenance for 6 months prior to intake . Results showed that when controlling for a number of patient-level covariates , both methadone and Suboxone significantly reduced current users ' days of heroin use between the 90 days prior to intake and at the 8-month follow-up , with Suboxone yielding a significantly larger magnitude reduction in heroin use days than methadone . Methadone and Suboxone were highly and equally effective for preventing relapse to regular heroin use , with all but 3 of 37 ( 91.9 % ) patients who were abstinent at intake reporting past 90-day point prevalence heroin abstinence at the 8-month follow-up . Overall , prescribing methadone or Suboxone for eight continuous months was highly effective for initiating abstinence from heroin use , and for converting short-term abstinence to long-term abstinence . However , the study design , which was based on a relatively small sample size and was not able r and omise patients to medication and so could not control for the effects of potential prognostic factors inherent within each patient group , means that these conclusions can only be made tentatively . These positive but preliminary indications of the comparative efficacy of methadone and Suboxone for treating opiate dependence now require replication in a well-powered , r and omised controlled trial Concurrent alcohol dependence ( AD ) among polysubstance abusers has been associated with negative consequences , although it may not necessarily lead to poor treatment outcomes . One of the most efficacious treatments for cocaine abuse is contingency management ( CM ) , but little research has explored the impact of AD on abstinence outcomes , particularly among patients in methadone maintenance . Using data from three trials of CM for cocaine use , we compared baseline characteristics and posttreatment and follow-up cocaine outcomes between  methadone-maintained , cocaine-dependent patients ( N = 193 ) with and without concurrent AD , r and omized to st and ard care ( SC ) with or without CM . Patients with and without concurrent AD  had similar baseline characteristics , with the exception that AD patients reported more alcohol use . AD patients achieved longer duration s of cocaine abstinence and were more likely to su bmi t a cocaine-negative sample at follow-up than non-AD patients . Patients r and omized to CM achieved better outcomes than those r and omized to SC , but there was no interaction between treatment condition and AD status . These findings suggest that cocaine-using methadone patients  with AD achieve greater cocaine abstinence than their non-AD counterparts and should not necessarily be viewed as more difficult to treat It has been documented that methadone maintenance treatment is effective in reducing drug craving and relevant risk behaviors in heroin users . However , it is not understood whether methadone maintenance treatment impairs the dopamine transporter in the striatum . To establish whether chronic opiate use might impair brain dopamine neurons in humans , we assessed dopamine transporter ( DAT ) uptake function in the striatum ( cau date and putamen ) , and analyzed the correlation between DAT in the striatum and heroin craving and subjective anxiety in former heroin users with prolonged abstinence and in patients receiving methadone maintenance treatment .  Binding of [(11)C]-2beta-carbomethoxy-3beta-aryltropane ( [ (11)C ] CFT ) as a brain dopamine transporter lig and was measured with positron emission tomography ( PET ) in eleven former heroin users with prolonged abstinence , ten patients receiving methadone maintenance treatment and ten healthy control subjects .  Heroin craving and subjective anxiety in prolonged abstinence and methadone maintenance treatment groups were assessed and the correlations between DAT of striatum and heroin craving or subjective anxiety were determined . In comparison with healthy control subjects , methadone maintenance treatment subjects had lower DAT uptake function in the bilateral cau date and putamen and prolonged abstinence subjects showed significantly lower DAT uptake function in the bilateral cau date . Moreover , in comparison to the prolonged abstinence subjects , the methadone maintenance treatment subjects showed significant decreases of DAT uptake in the bilateral putamen . DAT uptake function in bilateral striatum was not associated with heroin craving in prolonged abstinence or in methadone maintenance treatment subjects ; however , DAT uptake function in the bilateral cau date was significantly correlated with subjective anxiety in methadone maintenance treatment subjects . Our findings suggest that chronic opioid use induces long-lasting striatum dopamine neuron impairment , and prolonged withdrawal from opioids can benefit the recovery of impaired dopamine neurons in the brain AIM Contingency management ( CM ) is efficacious in reducing drug use . This study examined whether CM also reduces human immunodeficiency virus ( HIV ) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment . DESIGN Data were analyzed from a subset of participants in a combined data set of three published r and omized controlled trials of CM treatments . SETTING A community-based methadone maintenance clinic . PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients . INTERVENTION Participants received either st and ard methadone treatment or st and ard methadone treatment with CM for 3 months . MEASUREMENTS The HIV Risk Behavior Scale ( HRBS ) was administered prior to r and omization to a study condition and 3 months after the study treatments ended . The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment . FINDINGS Relative to those assigned to st and ard care , participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors .  CM participants also achieved longer duration s of consecutive cocaine and opioid abstinence during treatment . Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores . CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients CONTEXT Recent studies have suggested that long-term exposure to high levels of GH and IGF-I affect brain and cognitive functions . However , very few human studies have challenged this hypothesis . OBJECTIVE The aim of this study is to explore whether GH/IGF-I excess in naive patients with acromegaly alters cognitive functions , particularly memory , and whether these alterations are accompanied by neurophysiological correlates . DESIGN We conducted a comprehensive neuropsychological and neurophysiological exam on 16 naive acromegaly patients and 16 strictly matched healthy controls . Comparative analyses were carried out on major neurocognitive domains ( executive functions , visual/verbal memory , attention , visuoconstructive abilities , and verbal fluency ) and on quantitative electroencephalogram and low-resolution brain electromagnetic tomography sources . Results were correlated with GH and IGF-I hormone concentrations . RESULTS Short- and long-term memory were the most severely impaired cognitive functions . Moreover , memory performance correlated negatively with GH and IGF-I concentrations . No association was detected between depression and memory impairment , and only a marginal association was found with quality of life . Finally , acromegaly patients showed power attenuation in fast frequency electroencephalogram b and s , as well as decreased activity in prefrontal and middle temporal cortices , that was associated to cognitive performance . CONCLUSIONS Results provide evidence of cognitive and neurophysiological impairment , characterized by moderate-to-severe memory impairment and decreased neural activity in specific brain areas . High levels of GH and IGF-I in acromegaly patients could be the basis for these findings Intravenous drug use is a major vector of HIV transmission . We assessed whether contingency management ( CM ) , in which participants earn reinforcers for drug abstinence , reduces HIV risk behaviors in methadone-maintained opiate- and cocaine-using out patients . Participants ( n=116 ) were r and omly assigned to  prize-based CM or to receipt of prize draws noncontingently on a schedule yoked to the CM group . Both groups received methadone and individual counseling throughout treatment . The HIV-Risk Taking Behaviour Scale was administered in written question naire form at 2-week intervals ( HRBS ; [ Darke , S. , Hall , W. , Heather , N. , Ward , J. , & Wodak , A. ( 1991 ) . The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users . AIDS , 5 , 181 - 185 ] ) . A mediation analysis was conducted to determine whether abstinence from opiates and cocaine mediated the effect of CM on HRBS scores . Changes in HRBS scores over time differed significantly by treatment ( F(9,334)=2.4 , p<0.05 ) , with HRBS scores decreasing over time in the CM group to a greater extent than in the noncontingent control group . Participants in the CM group had significantly lower rates of simultaneous cocaine/opiate-positive urine specimens than those in the noncontingent control group during CM treatment ( F(1,111)=6.8 , p=0.01 ) . The relationship between treatment condition and HRBS scores was mediated by abstinence . CM targeted toward cocaine and heroin use produces significant reductions in injection-related drug-taking behaviors associated with heightened risk for getting or transmitting HIV OBJECTIVE Contingency management ( CM ) reduces cocaine use in methadone patients , but only about 50 % of patients respond to CM interventions . This study evaluated whether increasing magnitudes of reinforcement will improve outcomes . METHOD Cocaine-dependent methadone patients ( N = 240 ) were r and omized to 1 of 4 12-week treatment conditions : usual care ( UC ) ; UC plus st and ard prize CM , in which average expected prize earnings were about $ 300 ; UC plus high magnitude prize CM , in which average expected prize earnings were about $ 900 ; or UC plus voucher CM , with an expected maximum of about $ 900 in vouchers . RESULTS All 3 CM conditions yielded significant reductions in cocaine use relative to UC  , with effect sizes ( d ) ranging from 0.38 to 0.59 . No differences were noted between CM conditions , with at least 55 % of patients in each CM condition achieving 1 week or more of cocaine abstinence versus 35 % in UC . During the 12 weeks after the intervention ended , CM  increased time until relapse relative to UC  , but the effects of CM were no longer significant at a 12-month follow-up . CONCLUSIONS Providing the st and ard magnitude of $ 300 in prizes was as effective as larger magnitude CM in cocaine-dependent methadone patients in this study . Given its strong evidence base and relatively low costs , st and ard magnitude prize CM should be considered for adoption in methadone clinics to encourage cocaine abstinence , but new methods need to be developed to sustain abstinence
HighlightsA broad range of domains of neuropsychological performance are significantly impaired in studies which have compared  methadone population s with the healthy controls .
However low power , poor quality and heterogenous population s limit the interpretation of these results .Short term ( less than 1 year ) abstinent groups , when compared with methadone groups , still exhibited cognitive impairments but results are inconclusive .
It is still not clear what the role of global sedative effects of opioids such as methadone have on cognitive impairment .
Only higher quality longitudinal studies using ecologically valid cognitive tests , in well‐defined population groups can address this question .Methadone population s present with a broad range of neuropsychological impairment when compared with healthy controls .
Results : Data from a total cohort of 1063 CM , 412 AP and 879 HP participants , from 23 independent studies  indicate global impairments in neurocognitive function in CM relative to HP participants .
Conclusion : Method ological issues such as small sample sizes , heterogeneity and poor quality limited the interpretation of the results and does not address whether the observed impairments reflect co‐morbid functioning , methadone‐related sedation and /or other factors .
Introduction : There is a presumption that neurocognition is commonly impaired in chronic methadone exposed individuals ( CM ) when compared with healthy controls ( HP ) .
Additionally , it remains unclear if short term ( < 1 year ) abstinence ( AP ) is associated with an altered cognitive profile when compared with CM .