***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Contingency management ( CM ) rapidly reduces cocaine use , but its effects subside after treatment . Cognitive-behavioral therapy ( CBT ) produces reductions months after treatment . Combined , the 2 might be complementary . One hundred ninety-three cocaine-using methadone-maintained out patients were r and omly assigned to 12 weeks of group therapy ( CBT or a control condition ) and voucher availability ( CM contingent on cocaine-negative urine or noncontingent ) . Follow-ups occurred 3 , 6 , and 12 months posttreatment . Primary outcome was cocaine-negative urine ( urinalysis 3 times/week during treatment and once at each follow-up ) . During treatment , initial effects of CM were dampened by CBT . Posttreatment , there were signs of additive benefits , significant in 3- versus 12-month contrasts . Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment In order to study possible interactions between opioids and cigarette smoking , we examined the effects of oral methadone administration on the smoking behavior of five male methadone-maintenance patients . Isolated subjects smoked their regular br and of cigarettes ad libitum in a naturalistic laboratory environment while reading or watching television . Ninety minutes before each daily 2-hr smoking session subjects received either placebo , dextromethorphan ( a taste blind ) or one of three doses of methadone , 0.5 , 1.0 or 2.0 times their regular maintenance dose ( 40 - 60 mg ) . Each subject received each treatment five times , in a mixed order across days . Methadone pretreatment result ed in a dose-related increase in the number of cigarettes smoked per session ( from a mean of 2.8 after placebo to 5.6 after the high dose of methadone ) . The total time spent puffing during the session increased from a mean of 27 sec after placebo to 74 sec after the high dose of methadone . CO levels in expired air ( a measure of actual smoke inhalation ) showed corresponding dose-related increases . Methadone administration also result ed in dose-related decreases in pupil diameter and increases in subjective ratings of smoking satisfaction and dose-strength .  Dextromethorphan had no significant effects on any measure of smoking behavior or subjective response . The results demonstrate that methadone can produce substantial increases in cigarette smoking and may have implication s regarding the proposed role of endogenous opioids in the smoking process This was a 6-month , r and omized , flexible-dose study comparing the effects of methadone ( Meth ) and buprenorphine ( Bup ) on retention rate and substance use in a sample of 140 opioid-dependent , primarily heroin-addicted , patients who had been without opioid substitution therapy in the 4 weeks prior to the study . The major aims were to compare the efficacy of Bup and Meth in a flexible dosing regimen and to identify possible predictors of outcome . There were no major inhomogeneities between treatment groups . All patients also received st and ardized psychosocial interventions .  Mean daily dosages after the induction phase were 44 - 50 mg for Meth and 9 - 12 mg for Bup . Results from this study indicate a favourable outcome , with an overall retention rate of 52.1 % and no significant differences between treatment groups ( 55.3 % vs. 48.4 % ) . Substance use decreased significantly over time in both groups and was non-significantly lower in the Bup group . Predictors of outcome were length of continuous opioid use and age at onset of opioid use , although these were only significant in the Bup group . Mean dosage and other parameters were not significant predictors of outcome . Overall , the results of this study give further evidence that substitution treatment is a safe and effective treatment for drug dependence . Meth and Bup are equally effective . Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome . The intensity of withdrawal symptoms showed the strongest correlation with drop-out . Future studies are warranted to further address patient profiles and outcome under different substitution regimens INTRODUCTION The relevance of tobacco use in opioid addiction ( OA ) has generated a dem and for available and more effective interventions . Thus , further analysis of less explored nicotine-opioid clinical interactions is warranted . METHODS A post-hoc analysis of OA participants in a double-blind , r and omized very low dose naltrexone ( VLNTX ) inpatient detoxification trial evaluated measures of opioid withdrawal and tobacco use .  Intreatment smokers were compared with nonsmokers , or smokers who were not allowed to smoke . RESULTS A total of 141 ( 81 % ) of 174 OA participants were smokers , all nicotine-dependent . Inpatient smoking was a predictor of opioid withdrawal discomfort . Intreatment smokers ( n = 96 ) showed significantly higher opioid craving ( F = 3.7 , p < .001 ) and lower detoxification completion rate ( χ(2 ) = 7.9 , p < .02 ) compared with smokers who were not allowed to smoke ( n = 45 ) or nonsmokers ( n = 33 ) . Smoking during treatment was associated with more elevated cigarette craving during detoxification ( F = 4.1 , p < .001 ) and a higher number of cigarettes smoked at follow-up ( F = 3.6 , p < .02 ) . Among intreatment smokers , VLNTX addition to methadone taper was effective in easing opioid withdrawal and craving more than other treatments , whereas the combination VLNTX-clonidine was associated with significantly reduced cigarette craving and smoking during detoxification . CONCLUSIONS Failure to address tobacco use may negatively affect pharmacologically managed opioid discontinuation . Opioid detoxification may offer a window of opportunity to exp and smoking cessation treatment , hence improving OA outcomes . The observed effects support testing of VLNTX-clonidine in smoking cessation trials among individuals with or without substance abuse Goods-based contingency management interventions ( e.g. , those using vouchers or prizes as incentives ) have demonstrated efficacy in reducing cocaine use  , but cost has limited dissemination to community clinics . Recent research suggests that development of a cash-based contingency management approach may improve treatment outcomes while reducing operational costs of the intervention . However , the clinical safety of providing cash-based incentives to substance abusers has been a concern . The present 16-week study compared the effects of goods-based versus cash-based incentives worth $ 0 , $ 25 , $ 50 , and $ 100 on short-term cocaine abstinence in a small sample of cocaine-dependent methadone patients ( N = 12 ) . A within-subject design was used ; a 9-day washout period separated each of 8 incentive conditions . Higher magnitude ( $ 50 and $ 100 ) cash-based incentives ( checks ) produced greater cocaine abstinence compared with the control ( $ 0 ) condition , but a magnitude effect was not seen for goods-based incentives ( vouchers ) . A trend was observed for greater rates of abstinence in the cash-based versus goods-based incentives at the $ 50 and $ 100 magnitudes . Receipt of $ 100 checks did not increase subsequent rates of cocaine use above those seen in control conditions . The efficacy and safety data provided in this and other recent studies suggest that use of cash-based incentives deserves consideration for clinical applications of contingency management , but additional confirmation in research using larger sample s and more prolonged periods of incentive delivery is needed We examined the effects of urine testing frequency on treatment outcome in a contingent methadone take-home program .  Study patients who su bmi tted<80 % opiate and /or cocaine positive urines during a 5-week baseline received 60 mg methadone throughout the study , su bmi tted urine sample s on Monday , Wednesday , and Friday , and were r and omized into one of three take-home incentive conditions . Study patients could receive three take-home doses per week if one urine sample r and omly selected each week ( Weekly ; n=16 ) or each month ( Monthly ; n=18 ) was negative for opiates and cocaine . Take-homes for R and om Drawing control patients ( n=19 ) were determined weekly independent of urine test results . Subjects in the Weekly group showed an immediate increase from baseline in percentage of drug-free urines ; those in the Monthly group showed a gradual increase over the first 3 months ; and those in R and om Drawings showed a decline in percentage of drug-free urines over time . The percentage of patients with sustained ( 8 or more weeks ) opiate and cocaine abstinence was 56.6 , 38.9 and 10.5 % for Weekly , Monthly and R and om Drawing groups , respectively ( P<0.002 ) . These results confirm that methadone take-homes contingent on drug-free urines prevent a decline in treatment performance over time and suggest that abstinence can be sustained with urine testing conducted as infrequently as once a month AIMS To evaluate relapse prevention ( relapse prevention ) and contingency management ( contingency management ) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers . DESIGN Experimental , 2 ( relapse prevention)x2 ( contingency management ) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period , followed by r and omization to 12 weeks of treatment , and 6- and 12-month follow-up visits . SETTING Three narcotic treatment centers in Los Angeles . PARTICIPANTS One hundred and seventy-five participants who met all inclusion and no exclusion criteria . INTERVENTION Participants received 12 weeks of nicotine replacement therapy and assignment to one of four conditions : patch-only , relapse prevention + patch , contingency management + patch and relapse prevention + contingency management + patch . MEASUREMENTS Thrice weekly sample s of breath ( analyzed for carbon monoxide ) and urine ( analyzed for metabolites of opiates and cocaine ) and weekly self-reported numbers of cigarettes smoked . FINDINGS Participants ( 73.1 % ) completed 12 weeks of treatment . During treatment , those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies ( F3,4680=6.3 , P=0.0003 ) , with no similar effect observed for relapse prevention . At follow-up evaluations , there were no significant differences between conditions . Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria ( F1,2054=14.38 , P=0.0002 ; F1,2419=16.52 , P<0.0001 ) . CONCLUSIONS Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence , although long-term effects are not generally maintained . Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment To test whether a combination of contingency management and methadone dose increase would promote abstinence from heroin and cocaine , we conducted a r and omized controlled trial using a 2 x 3 ( dosexcontingency ) factorial design in which dose assignment was double-blind . Participants were 252 heroin- and cocaine-abusing out patients on methadone maintenance . They were r and omly assigned to methadone dose ( 70 or 100mg/day , double-blind ) and voucher condition ( noncontingent , contingent on cocaine-negative urines , or " split " ) . The " split " contingency was a novel contingency that reinforced abstinence from either drug while doubly reinforcing simultaneous abstinence from both : the total value of incentives was " split " between drugs to contain costs . The main outcome measures were percentages of urine specimens negative for heroin , cocaine , and both simultaneously ; these were monitored during a 5-week baseline of st and ard treatment ( to determine study eligibility ) , a 12-week intervention , and a 10-week maintenance phase ( to examine intervention effects in return-to-baseline conditions ) . DSM-IV criteria for ongoing drug dependence were assessed at study exit . Urine-screen results showed that the methadone dose increase reduced heroin use but not cocaine use . The split 100 mg group was the only group to achieve a longer duration of simultaneous negatives than its same-dose noncontingent control group . The frequency of DSM-IV opiate and cocaine dependence diagnoses decreased in the active intervention groups . For a split contingency to promote simultaneous abstinence from cocaine and heroin , a relatively high dose of methadone appears necessary but not sufficient ; an increase in overall incentive amount may also be required This study compared the effects of 4 voucher incentive conditions of a brief abstinence test on continuous cocaine abstinence . In 3 conditions , cocaine-abusing methadone patients could earn $ 100 for 2 days of cocaine abstinence ; 2 of these conditions offered , on either a continuous or interrupted schedule , an additional $ 300 for evidence of sustained abstinence over the next 9 days . In the 4th condition , no incentives were available . In incentive conditions , 70 - 80 % of patients initiated abstinence , compared with 48 
    Output:
    
Contingency management appears to be efficacious for treating most drug use during treatment for opiate addiction .