Does Voucher-Based Reinforcement Therapy (VBRT) Help Cocaine Addicts in Recovery?

Voucher-Based Reinforcement Therapy (VBRT) is a form of treatment used to help people recovering from addictions to cocaine and stimulants. It belongs to a larger group of therapies known collectively as contingency management (CM). A modified form of VBRT as a treatment option for people recovering from cocaine addiction is very effective. The use of a relatively long course of VBRT can substantially improve recovering cocaine addicts ability to remain drug-free.

All forms of contingency management use a system of rewards to encourage full and regular participation in a set program of activities. In the context of cocaine addiction, doctors and other professionals use CM to give their patients extra incentive to do such things as abstain from cocaine, attend treatment sessions, take any medications used during the course of the cocaine addiction recovery process and remain enrolled until the predetermined course of treatment comes to an end. In addition to providing rewards for program compliance, some CM approaches feature punishments designed to discourage program non-compliance.

In VBRT, participants receive vouchers as rewards for complying with the requirements of their programs. These vouchers are stand-ins for money, and can be used to do such things as buy desirable food items, attend movies or other entertainment options, or gain other privileges that don’t violate the tenets of the recovery process or discourage the maintenance of drug abstinence. Compliance with a VBRT approach is typically verified by periodic urine testing designed to detect the presence of any common addictive substance. As a rule, the value of each voucher goes up as a recovering addict’s periods of drug testing-confirmed abstinence grow longer over time. A standard course of voucher-based reinforcement therapy lasts for 12 weeks.

Previous research efforts have already identified standard VBRT as an effective treatment for people recovering from cocaine addiction. This is especially true for recovering cocaine addicts also addicted to opioid narcotics. In addition to VBRT, these individuals typically receive the medication methadone to address both their opioid and cocaine addictions and avoid the pitfalls of severe drug withdrawal during the recovery process.

During the first 24 weeks of the cocaine addiction recovery process, the recovering cocaine addicts participating in extended VBRT maintain their drug abstinence twice as often as the recovering addicts participating in standard VBRT. This increase ability to maintain abstinence also helps in persisting through the 36th week of extended VBRT. There may no be direct improvement in extended VBRT participants’ ability to remain drug-free long-term after the active phase of treatment. However, the increased ability of the people receiving this modified form of VBRT to remain drug-free during treatment can directly contribute to successful short-term outcomes during the recovery process, and also indirectly contribute to improved long-term outcomes over time.

The recipients of extended VBRT accumulate vouchers have to pay roughly twice the dollar amount as the recipients of the standard form of the therapy. Compared to standard VBRT recipients, it costs substantially less overall to maintain abstinence among extended VBRT recipients. The use of extended VBRT can potentially significantly improve the long-term abstinence rates of recovering cocaine addicts, as long as those recovering addicts also manage to maintain drug abstinence for lengthy periods of time during the active phase of the addiction recovery process.

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