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Maximizing the Efficacy of Cognitive Behavior Therapy and Contingency Management

This study has been completed.
National Institute on Drug Abuse (NIDA)
Information provided by (Responsible Party):
Yale University Identifier:
First received: July 7, 2006
Last updated: September 26, 2011
Last verified: September 2011
Cognitive-behavioral coping skills therapy (CBT) is a widely used and recognized treatment that has been empirically validated for a range of substance use disorders, often with emergent effects and continuing improvement even after treatment ends. Treatment retention and compliance are associated with enhanced treatment outcomes in CBT. Contingency management (CM) also has very strong support and is associated with rapid, robust effects on targeted outcomes. Despite their many strengths, neither CBT nor CM is universally effective. It is now essential to seek strategies to maximize and extend the effectiveness of these two approaches and to better understand how these treatments exert their effects.

Condition Intervention Phase
Marijuana Dependence
Behavioral: Standard CBT
Behavioral: CBT+CM/adherence
Behavioral: CM/abstinence
Behavioral: CM/abstinence+CBT
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Maximizing the Efficacy of Cognitive Behavior Therapy and Contingency Management

Resource links provided by NLM:

Further study details as provided by Yale University:

Primary Outcome Measures:
  • Self reported marijuana use (days of abstinence by week) and results of urine toxicology screens [ Time Frame: 12 weeks ]

Secondary Outcome Measures:
  • Economic analysis with use of PACC-SAT [ Time Frame: 12 weeks ]

Enrollment: 205
Study Start Date: December 2004
Study Completion Date: September 2010
Primary Completion Date: September 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
manualized delivery of CBT by trained clinicians
Behavioral: Standard CBT
Manualized delivery of CBT by trained clinicians
Active Comparator: 2
CBT with Contingency Management reinforcement for attendance and completing homework (CBT+CM/adherence)
Behavioral: CBT+CM/adherence
CBT and Clinical Management for attendance and completing homework
Experimental: 3
Contingency Management for abstinence alone (CM/abstinence)
Behavioral: CM/abstinence
Contingency Management
Active Comparator: 4
Contingency Management integrated with CBT (CM/abstinence+CBT)
Behavioral: CM/abstinence+CBT
Contingency Management for abstinence in addition to manualized CBT delivered by a trained clinician

Detailed Description:
The investigators propose to evaluate targeted strategies to maximize the effectiveness of CBT and CM, respectively. To maximize the effectiveness of CBT, the investigators will evaluate the benefit of adding CM, with reinforcement for session attendance and homework completion, to standard individual CBT for outpatient marijuana abusers, in order to expose participants to more skill training and opportunities for practice of skills. To maximize the effectiveness and durability of CM, we will evaluate the benefit of integrating it with skills training, specifically designed to reduce drop off effects, in order to extend CM's benefits beyond the active treatment period. We propose to conduct a Stage II trial which will: (1) Evaluate the efficacy of four conditions for 160 marijuana dependent outpatients: (a) Standard CBT, (b) CBT with CM reinforcement for attendance and completing homework (CBT+CM/adherence), (c) CM for abstinence alone (CM/abstinence), (d) CM for abstinence integrated with CBT (CM/abstinence+CBT), and (2) Evaluate the longer-term durability and / or delayed emergence of treatment effects after termination of the study treatments through a one-year follow-up. Secondary aims will be to conduct (a) detailed process studies to evaluate whether the proposed enhancements affect proximal and distal outcomes as hypothesized and (b) economic analyses. Study treatments will last 12 weeks.

Ages Eligible for Study:   18 Years to 65 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 18-65 year old marijuana dependent
  • willing to sign consent
  • no use of prescribed psychotropic drugs
  • willing to give three individuals as contacts
  • willing to accept randomization
  • read and write English (third grade level)

Exclusion Criteria:

  • unable to commit to 1 year follow up
  Contacts and Locations
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Please refer to this study by its identifier: NCT00350649

United States, Connecticut
ASAP/1 Long Wharf
New Haven, Connecticut, United States, 06512
Sponsors and Collaborators
Yale University
National Institute on Drug Abuse (NIDA)
Principal Investigator: Kathleen Carroll, PhD Yale School of Medicine
  More Information

Responsible Party: Yale University Identifier: NCT00350649     History of Changes
Other Study ID Numbers: 0407026913
Study First Received: July 7, 2006
Last Updated: September 26, 2011

Keywords provided by Yale University:
behavior modification
cognitive behavioral therapy
combination therapy
drug abuse therapy
drug addition
human therapy evaluation
clinical trial phase II
drug and alcohol abstinence
longitudinal human study
outcomes research
outpatient care
psychological reinforcement
therapy compliance
behavior and social research tag
human subjects
neuropsychological test
patient oriented research

Additional relevant MeSH terms:
Marijuana Abuse
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders processed this record on April 21, 2017