Abstract
Purpose. The purpose of this study was to investigate the effectiveness of a behavioral contingency management approach on patients in an outpatient methadone maintenance program. Successful rehabilitation was determined by the evaluation of scores derived from the Evaluation Point System. The Evaluation Point System measured behavior in four specific areas: (a) incidence of drug abuse, (b) attendance at counseling sessions, (c) maintenance of acceptable behavior, and (d) self-improvement (i.e., working, attending school, and so forth). Collectively, these scores comprised Composite Raw Scores. The Evaluation Point System was also used as a dependent variable. In addition, subjective changes in self-perception were measured by pretest and posttest scores on the Tennessee Self Concept Scale.Procedure. The study involved thirty-two subjects, medically diagnosed as heroin addicts with at least a 2-year history of abuse. These subjects were randomly assigned to one of two groups, experimental or control. The treatment group used the Evaluation Point System as a structure for a behaviorally-oriented counseling approach. The control group used a non-directive orientation. Within each group, a pre-planned format was used to ensure consistency. All other conditions were held constant to the extent possible in a field study of this type.Wherever possible, the research design incorporated measures to heighten objectivity and consistency of data collection, while controlling for confounding and extraneous variables including the use of audio tapes and structured counseling formats for experimentor monitoring. Procedures were standardized beginning at the point of application for the program, and continuing through the 10-week trial period to the subsequent posttest on the Tennessee Self Concept Scale. Analysis of covariance was used to assess the data with significance set at the .05 level. The percent effective method of agreement was used to assess the validity and reliability of the Evaluation Point System as a measuring instrument.Findings. The primary findings of this investigation were: (1) There was no significant difference in Composite Raw Scores of the Evaluation Point System between groups. (2) There was no significant difference in self-concept scores on the Tennessee Self Concept Scale between groups. (3) There was no significant positive correlation between two variables, Composite Raw Scores on the Evaluation Point System and self-concept scores on the Tennessee Self Concept Scale.Conclusions. Within the limits of this study, the use of a behavioral contingency management approach in the counseling process does not appear to improve counseling effectiveness or self-esteem. However, the nature of the findings suggest a number of areas felt to be deserving of additional research. Areas for future research include (1) comparative studies using a behavioral contingency management approach with Veterans Administration and non-Veterans Administration patient populations; (2) comparative studies of high-dosage, low-dosage, and non-methadone maintenance outpatients utilizing a behavioral contingency management approach as it affects self-concept; and (3) studies comparing methadone maintenance patients with those ingesting LAMM (Levo-alpha acetylmethadol) utilizing a behavioral contingency management approach and the Tennessee Self Concept Scale.