Predicting Cocaine Group Treatment Outcome in Cocaine-Abusing Methadone Patients Golfo K. Tzilos, Gary L. Rhodes, David M. Ledgerwood, and Mark K. Greenwald Wayne State University The authors examined predictors of cocaine group treatment outcome in methadone main- tenance treatment (MMT) patients, including cocaine urinalysis at intake and demographic variables. Clinic policy is that patients identified as using cocaine must attend a weekly cocaine-focused, cognitive– behavioral therapy (CBT) group. Cocaine treatment is based on a behavioral (escape) contingency model whereby completers must attend group-counseling sessions and produce cocaine-negative urinalysis results. Among the 113 patients enrolled in the cocaine group, 43 (38%) were treatment completers (who attended 6 consecutive weeks of group and produced 6 consecutive weeks of cocaine-free urine tests) and 70 (62%) were treatment noncompleters. Treatment completion (i.e., cocaine abstinence) was significantly associated with baseline cocaine-free urinalysis and higher methadone dose. Keywords: methadone maintenance, cocaine, treatment, contingency management, urinalysis Up to 75% of opioid-dependent patients also use cocaine while in methadone maintenance treatment (MMT; Grella, Anglin, & Wugalter, 1995). MMT was designed to control only opioid dependence. Concomitant use of cocaine un- dermines therapeutic efforts in MMT (Barthwell & Gast- friend, 1992; Black, Dolan, Penk, Robinowitz, & Deford, 1987); for example, increasing the number of MMT patients who fail to comply with clinic rules, making the treatment and rehabilitation of these patients a particular challenge. Results from an ever-increasing number of clinical trials indicate that cocaine use at treatment baseline predicts worse outcome; for example, attrition and failure to attain initial abstinence (Alterman et al., 1997; Carroll et al., 1994; DeMaria, Sterline, & Weinstein, 2000; Downey, Helmus, & Schuster, 2000; Ehrman, Robbins, & Cornish, 2001; Kosten, Sofuoglu, Poling, Gonsai, & Oliveto, 2005; Marsch et al., 2005; Peirce et al., 2009; Preston et al., 1998; Sofuo- glu, Gonzalez, Poling, & Kosten, 2003; Stitzer et al., 2007), suggesting that this may be an important predictor of treat- ment response. Substance abuse treatment programs have routinely in- cluded forms of targeted behavioral reinforcement, such as take-home methadone privileges for patients who maintain long periods of abstinence or exhibit reductions in drug use (Petry, 2000). One such strategy is the set of interventions called contingency management (CM), in which a clinically desired behavior (i.e., drug use reduction or abstinence) is monitored using urinalysis and reinforced (Stitzer & Petry, 2006). For example, patients can receive vouchers or take-home methadone dose privileges as the reinforcer when they are treatment compliant. Numerous studies have demonstrated that CM is an efficacious treatment strategy when applied systematically to modify undesired behaviors in the treatment of alcohol, marijuana, benzodi- azepine, cocaine, opioid, and polydrug use (Bickel, Amass, Higgins, Badger, & Esch, 1997; Budney, Higgins, Rado- novich, & Novy, 2000; Dutra et al., 2008; Higgins et al., 1991, Higgins et al., 1993, 1994, 2000; Petry, 2000; Petry & Martin, 2002; Piotrowski et al., 1999; Silverman et al., 2004; Stitzer, Iguchi, & Felch, 1992, Stitzer, Petry, & Sil- verman, 1999). Higgins et al. (1991, Higgins et al., 1993, Higgins et al., 1994, Higgins et al., 1995, Higgins et al., 2000) developed and applied a voucher-based reinforce- ment approach for treatment of cocaine dependence with a series of studies that demonstrated efficacy (i.e., increased cocaine abstinence) during treatment and up to 1 year later. Silverman et al. (1996, 1998) extended this reinforcement approach to cocaine-abusing methadone patients, with their studies yielding similar results of cocaine abstinence, as well as increased rates of abstinence from opiates. More recently, adding CM to a standard substance abuse group therapy was found to be effective in improving therapy attendance (Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008; Petry, Martin, & Finocche, 2001). Griffith, Rowan- Szal, Roark, and Simpson (2000) conducted a meta-analysis demonstrating the effectiveness of CM programs for meth- adone patients and concluded that a CM treatment approach reduced drug use in this population. Escape-contingency management is a negative reinforce- ment technique that has been applied in the treatment of substance abuse. For example, Brooner and colleagues (2004) evaluated a motivated stepped-care (MSC) interven- tion in 127 opioid-dependent patients using methadone. Golfo K. Tzilos, Department of Psychology, Wayne State Univer- sity; Gary L. Rhodes, David M. Ledgerwood, and Mark K. Green- wald, Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine. Correspondence concerning this article should be addressed to Golfo K. Tzilos, Substance Abuse Research Division, Wayne State University, 2761 E. Jefferson Avenue, Detroit, MI 48207. E-mail: gtzilos@wayne.edu Experimental and Clinical Psychopharmacology © 2009 American Psychological Association 2009, Vol. 17, No. 5, 320 –325 1064-1297/09/$12.00 DOI: 10.1037/a0016835 320 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.