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With VBRT, patients earn vouchers that are exchangeable for retail items, which is contingent on biochemically verified abstinence from recent drug use or meeting some other therapeutic target. The initial trials with VBRT integrated it with an intensive behavioral therapy known as the community reinforcement approach (CRA) and thus did not allow for inferences regarding what contributions VBRT was making to the positive outcomes obtained with the CRA-plus-vouchers intervention (Higgins et al. 1991). Nevertheless, the positive outcomes obtained with the CRA-plus-VBRT intervention were in such contrast with the many negative outcomes that were being reported in efforts to treat cocaine dependence that it garnered a large amount of attention.

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FIGURE 27–1. Estimated effect size (r) and 95% confidence intervals.Weighted average effect sizes and 95% confidence intervals for subsets of studies as a function of the moderator variables: target, control condition, duration, daily earnings, voucher-based reinforcement therapy (VBRT) delivery immediacy, setting, and study quality. All studies target abstinence (N = 30). Weighted average effect sizes are represented by closed diamonds and 95% confidence intervals by solid lines. Where confidence intervals do not overlap, differences between subsets of studies are significantly different at the 0.05 level.Source. Reprinted from Lussier JP, Heil SH, Mongeon JA, et al: "A Meta-Analysis of Voucher-Based Reinforcement Therapy for Substance Use Disorders." Addiction 101:192–203, 2006. Used with permission.

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