Stimulant Summit: Clinical trainer backs incentive-based treatment

For the treatment of stimulant addiction, what's old could become new again, famed clinical addictions trainer and author Cardwell C. Nuckols, PhD suggested this week at the National Cocaine, Meth & Stimulant Summit. A “contingency management” approach that offers individuals tangible rewards for engagement and retention in treatment is showing promise for patients with cocaine dependence, Nuckols said in a Nov. 13 workshop presentation at the conference in South Florida.

“We used it 20 or 30 years ago with street addicts,” Nuckols said of contingency management. Today, “We're getting a lot of mileage out of it, for opioids and for cocaine.”

His comments echoed those recently told to Addiction Professional by Richard Rawson, PhD, research professor at the University of Vermont and developer of the Matrix Model of behavioral treatment, who now considers contingency management a preferred strategy to a Matrix approach that has been considered the optimal research-based treatment for stimulant addiction.

Nuckols, a widely published author whose first book was Cocaine: Dependency to Recovery, said contingency management strategies that offer modest rewards for session attendance or negative drug tests seem to appeal to patients regardless of their socioeconomic status.

“Everyone seems to like a raffle,” he said. Treatment centers can run these efforts successfully on a very low budget, he pointed out.

Nuckols suggested a three-step process in implementing contingency management:

• Start with an attendance incentive for patients;

• Proceed with incentives for maintaining abstinence after steady attendance has been achieved; and

• Move to incentives for lifestyle change after sustained abstinence.

These approaches can work well in a clinical care environment that emphasizes cognitive-behavioral interventions, Nuckols said.

Clinical challenge

During his presentation, Nuckols repeatedly emphasized the challenge of working with a stimulant-dependent population that experiences rapid and often long-lasting deterioration. Particularly in the case of methamphetamine, this takes on dramatic physical and cognitive dimensions. The effects of methamphetamine addiction on the brain resemble exaggerated aging, he said.

With no approved medications to assist in the treatment of stimulant dependence, professionals mostly seek to stabilize the patient through behavioral support and strategies to combat isolation, Nuckols said.