Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries. To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil. Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions. Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05). This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil. This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.

中文翻译：

---

应急管理可有效促进有治疗反应不良史的强效可卡因使用者戒断和坚持治疗：一项交叉试验


在巴西，裂缝的使用已成为一个严重的健康问题。应急管理已显示出在高收入国家治疗可卡因使用障碍 (CUD) 方面的有效性的有力证据；然而，目前尚不清楚这种干预措施如何影响低收入国家的治疗。旨在评估巴西有治疗反应不良史的个体 CUD 治疗中应急管理的效果。治疗结束六个月后，之前分配到常规护理条件（UCC）的 32 名参与者被邀请在应急管理条件（CMC）中接受额外 12 周的治疗，其中 16 人接受了邀请。我们比较了仅接受两种治疗条件的 16 名参与者（14 名男性）获得的数据。与 UCC 期间相比，CMC 期间参与者参加了更多的治疗疗程，并且接受治疗的时间更长（两者均 p < .01）。与 UCC 相比，CMC 治疗期间提交的阴性可卡因样本的比例、可卡因戒断的平均最长持续时间以及治疗期间戒除可卡因的几率显着更高 (p < .05) 。这项研究提供了进一步的证据，表明应急管理可有效促进有治疗反应不佳病史的 CUD 患者戒断和坚持治疗。我们的研究结果支持将 CM 纳入巴西 CUD 公共治疗服务中。该研究于 2013 年 3 月 21 日在 ClinicalTrials.gov 注册，注册号为 NCT01815645。