Carrots and sticks fail to change behavior in cocaine addiction

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Science  17 Jun 2016:
Vol. 352, Issue 6292, pp. 1468-1471
DOI: 10.1126/science.aaf3700

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  • RE: Relevant clinical literature to consider
    • Stephen T. Higgins, Professor, University of Vermont
    • Other Contributors:
      • Keith Humphreys, Professor, Stanford University

    Ersche et al. (Carrots and sticks fail to change behavior in cocaine addiction. Science. 2016 Jun 17;352(6292):1468-71) report that cocaine dependent adults exhibit learning impairments relative to healthy controls that render them relatively insensitive to avoidance training or other types of punitive control. The authors concluded their report by underscoring the potential utility of “interventions that focus on improving goal-directed behavior and implementing more desirable habits to replace habitual drug-taking”. Readers might be interested to know that more than 175 controlled clinical trials conducted over the past 25 years have established that positive incentive-based interventions are highly efficacious not only for treating cocaine dependence but also other substance use disorders (Lussier et al. 2006, Prendergast et al., 2006; Bensihek et al., 2014). Moreover, treatment impact is broader and more sustainable when incentives are combined with intensive behavior change therapy (Community Reinforcement Approach—CRA therapy) designed to promote the type of alternative, healthier habits that Ersche et al. prudently recommend (e.g., Higgins et al. 1994; 2000; 2003). Lastly, and importantly, a therapist manual outlining how to implement a validated incentives plus CRA intervention is available free on the National Institute of Drug Abuse website (

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    Competing Interests: The authors have no competing interests to disclose.