Contingency Management Treatment for Crack Addiction - Study With Brazilian Population
Condition: Cocaine Related Disorders
MeSH terms: Cocaine-Related Disorders
Study type: Interventional

Summary: 
      Crack addiction has become a severe health problem in Brazil. Today, crack addiction is the
      primary cause for inpatient treatment for all illicit substances. When compared to cocaine,
      crack users develop much faster diagnoses for crack dependence, shows a more compulsive
      pattern of use, has higher probability of living or have lived in the streets, and of
      engaging in illegal activities. Consequently to this, mortality of crack addicts is 7 times
      higher than for the rest of the population.

      Despite all efforts being made for the development of effective pharmacological treatments
      for stimulant addiction (crack included), up to today, there is no robust evidence of
      efficacy of any pharmacological treatment. For that reason, the use of evidence based
      psychosocial interventions is so important for treating this population.

      Although today open treatment facilities in Brazil are more and more starting to use
      evidence-based interventions such as motivational interviewing, cognitive behavior therapy,
      relapse prevention and coping skills, such treatments present very modest results when
      treating crack addiction. The biggest difficulties encountered when treating this population
      are maintaining patients in treatment, reducing crack use and achieving continued abstinence.

      A psychosocial treatment based in behavioral principals' named Contingency Management (CM) is
      widely applied in the USA. Recent meta-analyses and review studies present robust evidence
      that, when applied alone or in adjunction with other psychosocial and pharmacological
      treatment, CM is the most effective treatment for what regards, treatment retention, reducing
      drug use and promoting continued abstinence.

      The purpose of this study is to evaluate if Contingence Management (CM) can be affective in
      the treatment of crack addiction in Brazil. To accomplish this, 60 individuals (male and
      female from 18 to 65 years of age) seeking open treatment for crack addiction will be
      randomized to 2 treatment conditions (Standard treatment (ST) or ST+CM. Both treatments will
      last 12 weeks with 3 and 6-month follow-up. In both groups patients will be encourage to
      leave urine samples 3 times week.

      Hypotheses: Patients receiving ST+CM will stay longer in treatment, have more negative tests
      for cocaine/crack, and achieve longer periods of cocaine/crack abstinence when compared to
      patients receiving ST alone.
    

Detailed description: 
      This study is a Randomized Clinical Trial deigned to investigate the effects of including
      Contingency Management to a standard public ambulatory treatment in Brazil on treatment
      attendance, retention in treatment, reduction of crack cocaine use and promotion of crack
      cocaine abstinence for crack dependent individuals seeking treatment for there addiction. In
      total 65 subjects will be randomized to receive Standard Treatment Alone or Standard
      Treatment plus Contingency Management. Both interventions will last for 12 weeks.
    

Intervention name(s): ST+CM; standard treatment
Intervention type(s): Behavioral; Behavioral
Intervention description(s): 12 weeks of the standard treatment offered by a open treatment service for drug addiction of the city of Sao Paulo (AME) plus Contingency Management; 12 weeks of standard treatment offered by AME (a open treatment service for drug addiction of the city of Sao Paulo)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cocaine related disorders; Contingency Management; psychosocial treatment