A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users

Kenneth Silverman, Conrad J. Wong, Mick Needham, Karly N. Diemer, Todd Knealing, Darlene Crone-Todd, Michael Fingerhood, Paul Nuzzo, Kenneth Kolodner

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.

Original languageEnglish (US)
Pages (from-to)387-410
Number of pages24
JournalJournal of applied behavior analysis
Issue number3
StatePublished - Sep 2007


  • Abstinence reinforcement
  • Cocaine addiction
  • Contingency management
  • Drug abuse treatment
  • Employment
  • Methadone

ASJC Scopus subject areas

  • Philosophy
  • Sociology and Political Science
  • Applied Psychology


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