Increasing opiate abstinence through voucher-based reinforcement therapy

Kenneth Silverman, Conrad J. Wong, Stephen T. Higgins, Robert K. Brooner, Ivan D. Montoya, Carlo Contoreggi, Annie Umbricht-Schneiter, Charles R. Schuster, Kenzie L. Preston

Research output: Contribution to journalArticlepeer-review

138 Scopus citations


Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted (P ≤ 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P ≤ 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P ≤ 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.

Original languageEnglish (US)
Pages (from-to)157-165
Number of pages9
JournalDrug and alcohol dependence
Issue number2
StatePublished - Jun 1996


  • Abstinence reinforcement
  • Contingency management
  • Drug abuse
  • Heroin abuse
  • Heroin dependence
  • Intravenous drug abuse
  • Treatment

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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