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. A Randomized Controlled Trial of Individual Cognitive Therapy, Group Cognitive Behaviour Therapy and Attentional Placebo for Adolescent Social Phobia Neurocognitive outcomes in off-pump versus on-pump bypass surgery: a randomized controlled trial. Punishment Induces Risky Decision-Making in Methadone-Maintained Opiate Users but not in Heroin Users or Healthy Volunteers Long-term (3-year) neurocognitive effectiveness of antipsychotic medications in first-episode non-affective psychosis: a randomized comparison of haloperidol, olanzapine, and risperidone Voucher-based contingent reinforcement of smoking abstinence among methadone-maintained patients: a pilot study. Absence of growth hormone effects on cognitive function in girls with Turner syndrome. Topiramate for cocaine dependence during methadone maintenance treatment: a randomized controlled trial. Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. An exploratory randomized controlled trial of a novel high-school-based smoking cessation intervention for adolescent smokers using abstinence-contingent incentives and cognitive behavioral therapy. Randomized trial comparing two treatment strategies using prize-based reinforcement of abstinence in cocaine and opiate users. Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. Modulation of risk-taking in marijuana users by transcranial direct current stimulation (tDCS) of the dorsolateral prefrontal cortex (DLPFC). Contingency management improves outcomes in cocaine-dependent outpatients with depressive symptoms.
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 Background : Very few studies have investigated the effects of individual disorder-specific treatment of social phobia ( SP ) in adolescents . The objective of this study was to compare the effects of individual cognitive therapy for SP , group cognitive behavioural therapy ( CBTG ) and attentional placebo ( AP ) among adolescents with a primary diagnosis of SP . Methods : A r and omized controlled design was used , and a total of 279 adolescents were assessed . Fifty-seven adolescents , between 13 and 16 years old , were allocated to individual cognitive therapy , CBTG or AP . The participants were assessed before treatment , at the end of treatment and at a 12-month follow-up using both self-report and a semi-structured interview . Results : The individual cognitive therapy showed significant reductions in symptoms , impairment and diagnostic criteria both at the end of treatment and at the 12-month follow-up . Compared with CBTG and AP , the individual cognitive therapy group demonstrated significantly greater effects on both symptom reduction and impairment . There were no significant differences between CBTG and AP . Conclusions : In a direct comparison between the most commonly used treatments for adolescent SP , we found that individual therapy was the most effective , yielding better effects than both CBTG and AP BACKGROUND Cognitive difficulties have been reported after coronary artery bypass graft surgery using cardiopulmonary bypass .  However , the cognitive benefit of off-pump surgery remains unclear . METHODS Consecutively listed c and i date s for elective bypass were r and omly assigned to either off-pump or on-pump techniques ( n = 107 ) . A battery of 11 st and ardized neuropsychological tests was administered before surgery , and again at 2 and 6 months after surgery . The two groups were compared using a range of statistical procedures , including growth modeling . RESULTS There were no significant differences in cognitive test scores between the off-pump and on-pump groups using t tests at any of the time points . There were no differences between off-pump and on-pump groups in the incidence of cognitive deficits at 2 months or 6 months , with the exception that fewer off-pump patients showed impairment on one test of verbal fluency at 6 months . When the pattern of cognitive change over time between the two groups was compared using sophisticated modeling techniques , the two groups were again comparable , except for results on the test of verbal fluency , in which the off-pump group showed more rapid postsurgical cognitive gains than the on-pump group . CONCLUSIONS The off-pump group appears to be generally comparable to the on-pump group in terms of short-term and long-term postsurgical neurocognitive outcomes Reinforcing properties of psychoactive substances are considered to be critically involved in the development and maintenance of substance dependence . While accumulating evidence suggests that the sensitivity to reinforcement values may generally be altered in chronic substance users , relatively little is known about the influence reinforcing feedback exerts on ongoing decision-making in these individuals . Decision-making was investigated using the Cambridge Risk Task , in which there is a conflict between an unlikely large reward option and a likely small reward option . Responses on a given trial were analyzed with respect to the outcome on the previous trial , providing a measure of the impact of prior feedback in modulating behavior . Five different groups were compared : ( i ) chronic amphetamine users , ( ii ) chronic opiate users in methadone maintenance treatment ( MMT ) , ( iii ) chronic users of illicit heroin , ( iv ) ex-drug users who had been long-term amphetamine / opiate users but were abstinent from all drugs of abuse for at least 1 year and ( v ) matched controls without a history of illicit substance use . Contrary to our predictions , choice preference was modified in response to feedback only in opiate users enrolled in MMT . Following a loss , the MMT opiate group chose the likely small reward option significantly less frequently than controls and heroin users . Our results suggest that different opiates are associated with distinctive behavioral responses to feedback . These findings are discussed with respect to the different mechanisms of action of heroin and methadone Introduction The initially postulated superior neurocognitive effectiveness of second-generation antipsychotics is currently under debate . Methods A prospect i ve , r and omized , open-label study was carried out to compare the long-term neurocognitive effectiveness of haloperidol , olanzapine , and risperidone in the first episode of schizophrenia spectrum disorders . A final sample of 79 patients r and omized to haloperidol ( N = 28 ) , olanzapine ( N = 23 ) , or risperidone ( N = 28 ) who completed clinical and cognitive evaluations at baseline and 3-year follow-up was included in the final analysis . Forty-one healthy individuals were also included in the final analysis . The main outcome measure was cognitive changes at 3-year follow-up . Due to the fact that some of the patients had switched their initially prescribed antipsychotic medication during the course of the study ( 6 out of 28 in haloperidol group , 18 out of 23 in olanzapine group , and 24 out of 28 in risperidone group continued with the initial study drug at 3-year assessment ) , we have also conducted a per protocol analysis . Results Overall , cognitive changes were similar in the three treatment groups and controls , although a greater improvement in Rey Auditory Verbal Learning Test , Digit Symbol , and Iowa Gambling Test was found in the treatment groups . The better performance observed on Rey Auditory Verbal Learning Test and Digit Symbol in olanzapine treatment group was likely explained by the lower prevalence of use of antimuscarinic drugs . These results were essentially similar to those found in the intention-to-treat analysis . Conclusions The major conclusion of this study is that haloperidol , olanzapine , and risperidone have not demonstrated substantial neurocognitive effectiveness , improving cognitive deficits present in the early phases of the illness . The study also underscores the importance of exploring new drugs for the treatment of cognitive impairments and associated functional disabilities in schizophrenia This study evaluated the efficacy of a contingency management ( CM ) intervention to promote smoking cessation in methadone-maintained patients . Twenty participants , r and omized into contingent ( n=10 ) or noncontingent ( n=10 ) experimental conditions , completed the 14-day study . Abstinence was determined using breath carbon monoxide and urine cotinine levels . Contingent participants received voucher-based incentives for biochemical evidence of smoking abstinence . Noncontingent participants earned vouchers independent of smoking status . Contingent participants achieved significantly more smoking abstinence and longer duration s of continuous smoking abstinence than did noncontingent participants . These results support the potential efficacy of using voucher-based CM to promote smoking cessation among methadone-maintained patients Turner syndrome ( TS ) is a genetic disorder characterized by short stature , gonadal dysgenesis , and a particular neurocognitive profile of normally developed language abilities ( particularly verbal IQ ) and impaired visual-spatial and /or visual-perceptual abilities . We have followed a large sample of girls with Turner syndrome who were enrolled in a long-term , double-blind , placebo-controlled trial of the effects of growth hormone ( GH ) treatment on final adult height . This study provides a unique opportunity to prospect ively evaluate the effects of GH treatment on neurocognitive function in this population of girls with Turner syndrome . The GH- and placebo-treated Turner syndrome subjects were well matched for age , treatment duration , race , karyotype , and socioeconomic status . Treatment ( GH or placebo ) duration s ranged from 1 - 7 yr . Whether GH deficiency and /or treatment in childhood and adolescence influences cognitive outcome in short children or GH-children is controversial . The major result of this study was the absence of GH treatment effects on cognitive function in girls with Turner syndrome . Our findings are in agreement with most of the previous studies that found no apparent growth hormone treatment effects on cognitive function in growth-hormone deficient children . We conclude that this study does not support a role for growth hormone in influencing childhood brain development in girls with Turner syndrome . Their characteristic nonverbal neurocognitive deficits were not altered with GH treatment into early adolescence BACKGROUND Dual dependence on opiate and cocaine occurs in about 60 % of patients admitted to methadone maintenance and negatively impacts prognosis ( Kosten et al. 2003 . Drug Alcohol Depend . 70 , 315 ) . Topiramate ( TOP ) is an antiepileptic drug that may have utility in the treatment of cocaine dependence because it enhances the GABAergic system , antagonizes the glutamatergic system , and has been identified by NIDA as one of only a few medications providing a " positive signal " warranting further clinical investigation . ( Vocci and Ling , 2005 . Pharmacol . Ther . 108 , 94 ) . METHOD In this double-blind controlled clinical trial , cocaine dependent methadone maintenance patients ( N=171 ) were r and omly assigned to one of four groups . Under a factorial design , participants received either TOP or placebo , and monetary voucher incentives that were either contingent ( CM ) or non-contingent ( Non-CM ) on drug abstinence . TOP participants were inducted onto TOP over 7 weeks , stabilized for 8 weeks at 300 mg daily then tapered over 3 weeks . Voucher incentives were supplied for 12 weeks , starting during the fourth week of TOP induction . Primary outcome measures were cocaine abstinence ( Y/N ) as measured by thrice weekly urinalysis and analyzed using Generalized Estimating Equations ( GEE ) and treatment retention . All analyses were intent to treat and included the 12-week evaluation phase of combined TOP/P treatment and voucher intervention period . RESULTS There was no significant difference in cocaine abstinence between the TOP vs. P conditions nor between the CM vs. Non-CM conditions . There was no significant TOP/CM interaction . Retention was not significantly different between the groups . CONCLUSION Topiramate is not efficacious for increasing cocaine abstinence in methadone patients This study compared the efficacy of 2 approaches for the treatment of cocaine dependence among methadone-maintained patients with and without antisocial personality disorder ( ASPD ) . Patients were r and omly assigned to 4 study conditions : cognitive-behavioral treatment ( CBT ) , contingency management ( CM ) , CBT with CM , or methadone maintenance . The Structural Clinical Interview for Mental Disorders-IV was administered to 108 patients to assess ASPD . A 2-way analysis of variance showed that patients with ASPD were more likely to abstain from cocaine use during treatment than patients without ASPD . The strong treatment effect for ASPD patients was primarily due to the CM condition . Regression analyses showed that ASPD remained significantly related to  CM treatment responsivity while controlling for other factors BACKGROUND There are few effective smoking cessation interventions for adolescent smokers . We developed a novel intervention to motivate tobacco use behavior change by ( 1 ) enhancing desire to quit through the use of abstinence-contingent incentives ( CM ) , ( 2 ) increasing cessation skills through the use of cognitive behavioral therapy ( CBT ) , and ( 3 ) removing cessation barriers through delivery within high schools . METHODS An exploratory four-week , r and omized controlled trial was conducted in Connecticut high schools to dismantle the independent and combined effects of CM and CBT ; smokers received CM alone , CBT alone , or CM+CBT .  Participants included 82 adolescent smokers seeking smoking cessation treatment . The primary outcome was seven-day end-of-treatment ( EOT ) point prevalence ( PP ) abstinence , determined using self-reports confirmed using urine cotinine levels . Secondary outcomes included one-day EOT PP abstinence and cigarette use during treatment and follow up . RESULTS Among participants who initiated treatment ( n=72 ) , group differences in seven-day EOT-PP abstinence were observed ( χ(2)=10.48 , p<0.01 ) with higher abstinence in the CM+CBT ( 36.7 % ) and CM ( 36.3 % ) conditions when compared with CBT ( 0 % ) . One-day EOT-PP abstinence evidence d similar effects ( χ(2)=10.39 , p<0.01 ; CM+CBT : 43 % , CM : 43 % , CBT : 4.3 % ) . Survival analyses indicated differences in time to first cigarette during treatment ( χ(2)=8.73 , p=0.003 ; CBT : Day 3 , CM : Day 9 , CM+CBT : Day 20 ) . At one- and three-month follow ups , while no differences were observed , the CM alone group had the slowest increase in cigarette use . CONCLUSIONS High-school , incentive-based smoking cessation interventions produce high rates of short-term abstinence among adolescent smokers ; adding cognitive behavioral therapy does not appear to further enhance outcomes We compared two strategies of prize-based contingency management ( CM ) in methadone-maintained out patients . Urine was tested thrice weekly for 5 weeks pre-CM , 12 weeks CM , and 8 weeks post-CM . Participants were r and omly assigned to a cocaine contingency ( four prize draws for each cocaine-negative urine , N=29 ) or an opiate-cocaine contingency ( one draw for each urine negative for opiates or cocaine , four draws if negative for both , N=38 ) . There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM . Opiate abstinence was greater in the opiate-cocaine group post-CM , and heroin craving was reduced in this group during and post-CM . Draws earned per cocaine-negative urine ( four vs. one ) did not affect cocaine use CONTEXT No effective pharmacotherapies exist for cocaine dependence , although contingency management ( CM ) has demonstrated efficacy . OBJECTIVE To compare the efficacy of bupropion hydrochloride and CM for reducing cocaine use in methadone hydrochloride-maintained individuals . DESIGN This 25-week , placebo-controlled , double-blind trial r and omly assigned participants to 1 of 4 treatment conditions : CM and placebo ( CMP ) , CM and 300 mg/d of bupropion hydrochloride ( CMB ) , voucher control and placebo ( VCP ) , or voucher control and bupropion ( VCB ) . SETTING Outpatient clinic at the Veterans Affairs Connecticut Healthcare System . PARTICIPANTS A total of 106 opiate-dependent , cocaine-abusing individuals . INTERVENTIONS All study participants received methadone hydrochloride ( range , 60 - 120 mg ) . Participants receiving bupropion hydrochloride were given 300 mg/d beginning at week 3 . In the CM conditions , each urine sample negative for both opioids and cocaine result ed in a monetary-based voucher that increased for consecutively drug-free urine sample s during weeks 1 to 13 . Completion of abstinence-related activities also result ed in a voucher . During weeks 14 to 25 , only completion of activities was reinforced in the CM group , regardless of sample results . The voucher control groups received vouchers for su bmi tting urine sample s , regardless of results , throughout the study . MAIN OUTCOME MEASURE Thrice-weekly urine toxicologic test results for cocaine and heroin . RESULTS Groups did not differ in baseline characteristics or retention rates . Opiate use decreased significantly , with all treatment groups attaining equivalent amounts of opiate use at the end of the study . In the CMB group , the proportion of cocaine-positive sample s significantly decreased during weeks 3 to 13 ( P<.001 ) relative to week 3 and remained low during weeks 14 to 25 . In the CMP group , cocaine use significantly increased during weeks 3 to 13 ( P<.001 ) relative to week 3 , but then cocaine use significantly decreased relative to the initial slope during weeks 14 to 25 ( P<.001 ) . In contrast , by treatment end , the VCB and VCP groups showed no significant improvement in cocaine use . CONCLUSION These findings suggest that combining CM with bupropion for the treatment of cocaine addiction may significantly improve outcomes relative to bupropion alone Cognitive deficits that are reported in heavy marijuana users  ( attention , memory , affect perception , decision-making ) appear to be completely reversible after a prolonged abstinence period of about 28 days . However , it remains unclear whether the reversibility of these cognitive deficits indicates that ( 1 ) chronic marijuana use is not associated with long-lasting changes in cortical networks or ( 2 ) that such changes occur but the brain adapts to and compensates for the drug-induced changes . Therefore , we examined whether chronic marijuana smokers would demonstrate a differential pattern of response in comparison to healthy volunteers on a decision-making paradigm ( Risk Task ) while undergoing sham or active transcranial direct current stimulation ( tDCS ) of the dorsolateral prefrontal cortex ( DLPFC ) . Twenty-five chronic marijuana users who were abstinent for at least 24h were r and omly assigned to receive left anodal/right cathodal tDCS of DLPFC ( n=8 ) , right anodal/left cathodal tDCS of DLPFC ( n=9 ) , or sham stimulation ( n=8 ) ; results on  Risk Task  during sham/active tDCS were compared to healthy volunteers from a previously published data set . Chronic marijuana users demonstrated more conservative ( i.e. less risky ) decision-making during sham stimulation . While right anodal stimulation of the DLPFC enhanced conservative decision-making in healthy volunteers , both right anodal and left anodal DLPFC stimulation increased the propensity for risk-taking in marijuana users . These findings reveal alterations in the decision-making neural networks among chronic marijuana users . Finally , we also assessed the effects of tDCS on marijuana craving and observed that right anodal/left cathodal tDCS of DLPFC is significantly associated with a diminished craving for marijuana Despite depressive symptoms being very common among patients seeking treatment for cocaine dependence , few studies have examined the effects of depressive symptoms on cocaine outpatient treatment outcomes , and there is even less research in the context of Contingency Management ( CM ) . The purpose of this study was to assess the main and interactive effects of co-occurring depressive symptoms on CM outcomes . Cocaine-dependent individuals ( N = 108 ) were r and omized to Community Reinforcement Approach ( CRA ) or CRA plus CM in two outpatient community clinical setting s. Participants were categorized according to depression symptoms , self-reported by means of the BDI at treatment entry . Outcome measures included treatment retention and documented cocaine abstinence over a 6-month treatment period . Depressive symptoms were more commonly found in females and in unemployed participants , and were associated with more drug-related , social , and psychiatric problems at treatment entry . Individuals with baseline depressive symptoms had poorer treatment outcomes than patients without depressive symptoms . The addition of CM to CRA made the program more effective than with CRA alone , regardless of depressive symptoms . CM was associated with better abstinence treatment outcomes , while the interaction between unemployment and depressive symptoms was associated with negative retention treatment outcomes . This study supports the efficacy of CM for cocaine-dependent out patients with and without depressive symptoms , and highlights its importance for improving treatment for unemployed and depressed cocaine-dependent individuals
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 .