Drug addiction can be a chronic problem. Abstinence reinforcement caninitiate drug abstinence, but as with other treatments many patientsrelapse after the intervention ends. Abstinence reinforcement can bemaintained to promote long-term drug abstinence, but practical means ofimplementing long-term abstinence reinforcement are needed.
Wereviewed 8 clinical trials conducted in Baltimore, MD from 1996 through2010 that evaluated the therapeutic workplace as a vehicle formaintaining reinforcement for the treatment of drug addiction. Thetherapeutic workplace uses employment-based reinforcement in whichemployees must provide objective evidence of drug abstinence ormedication adherence to work and earn wages.
Employment-basedreinforcement can initiate (3 of 4 studies) and maintain (2 studies)cocaine abstinence in methadone patients, although relapse can occureven after long-term exposure to abstinence reinforcement (1 study).Employment-based reinforcement can also promote abstinence from alcoholin homeless alcohol dependent adults (1 study), and maintain adherenceto extended-release naltrexone in opioid dependent adults (2 studies).
Treatmentsshould seek to promote life-long effects in patients. Therapeuticreinforcement may need to be maintained indefinitely to prevent relapse.Workplaces could be effective vehicles for the maintenance oftherapeutic reinforcement contingencies for drug abstinence andadherence to addiction medications (Authors).