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Brobbin E, Parkin S, Deluca P, Drummond C. A qualitative exploration of the experiences of transdermal alcohol sensor devices amongst people in receipt of treatment for alcohol use disorder. Addict Behav Rep 2024; 19:100544. [PMID: 38596194 PMCID: PMC11002804 DOI: 10.1016/j.abrep.2024.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/04/2024] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Transdermal alcohol sensors (TAS) have the potential to be used as a clinical tool in alcohol treatment, but there is limited research with individuals with alcohol dependence using TAS. Our study is a qualitative evaluation of the views of people attending alcohol treatment and their experiences of wearing the BACtrack Skyn, within alcohol services in South London. Methods Participants with alcohol dependence wore a BACtrack Skyn TAS for one week and met with the researcher every two days, for a total of four meetings (for example: Monday, Wednesday, Friday, and Monday). In the final meeting, a post-wear survey (on their physical, social and comfort experience of the TAS) and semi-structured interview were completed. The Technology Acceptance Model (TAM) informed the topic guide and data analysis. Results Adults (N = 16) receiving alcohol treatment were recruited. Three core topics guided analysis: perceived usefulness, perceived ease of use and attitudes towards use. Participants found the TAS easy to wear and felt positive about its appearance and comfort. The only challenges reported were side effects, mostly skin irritation. The main two perceived uses were 1) TAS working as a drinking deterrent and 2) reducing daily breathalyser visits during detox. Conclusion Findings support the use of TAS amongst alcohol service users. Wearing the TAS for one week was acceptable and feasible for objective alcohol concentration measurement. Participants reported high perceived ease of use and usefulness of the Skyn in the context of alcohol treatment. These results are encouraging for the use of TAS in clinical settings.
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Affiliation(s)
- Eileen Brobbin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Stephen Parkin
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Paolo Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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2
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Durpoix A, Rolling J, Coutelle R, Lalanne L. Psychotherapies in opioid use disorder: toward a step-care model. J Neural Transm (Vienna) 2024; 131:437-452. [PMID: 37987829 PMCID: PMC11055728 DOI: 10.1007/s00702-023-02720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/01/2023] [Indexed: 11/22/2023]
Abstract
Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.
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Affiliation(s)
- Amaury Durpoix
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France
- Strasbourg University, Faculty of Medicine, Strasbourg, France
| | - Julie Rolling
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- Regional Center for Psychotrauma Great East, Strasbourg, France
- Centre National de la Recherche Scientifique Unité Propre de Recherche 3212 (CNRS UPR 3212), Institute for Cellular and Integrative Neurosciences (INCI), Strasbourg, France
| | - Romain Coutelle
- Psychiatry, Mental Health and Addictology Department, Strasbourg University Hospital, Strasbourg, France
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Laurence Lalanne
- Addictology Department, Strasbourg University Hospital, 1, place de l'Hôpital, 67091, Strasbourg, France.
- INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France.
- Strasbourg University, Faculty of Medicine, Strasbourg, France.
- Fédération de Médecine translationnelle de Strasbourg, Strasbourg, France.
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3
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Feingold D, Tzur Bitan D, Ferri M, Hoch E. Predictors of effective therapy among individuals with Cannabis Use Disorder: a review of the literature. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01781-4. [PMID: 38493284 DOI: 10.1007/s00406-024-01781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledge regarding factors associated with effective therapy and the underlying mechanisms of change among individuals with CUD presenting for treatment. The aim of the present paper was to review current knowledge on factors that have been shown to contribute to positive outcomes in CUD treatment. A scoping methodology was used, focusing on empirically evaluated studies that used defined, cannabis-related outcome measures. In eligible studies, factors of investigation were categorized as either 'mediators', i.e., treatment-related factors associated with the processes or mechanisms through which patients benefit from therapy, or 'moderators' which are patient-related characteristics that predict his/her odds to benefit from treatment or patient-related (i.e., moderators). Factors categorized as mediators were then classified 'specific factors' if they were related to a certain technique or treatment modality or 'common factors' if they were assessed beyond treatment modalities. Findings suggest that in CUD treatment, specific mediators include treatment duration, addressing motivation to change, acquiring coping skills, enhancing self-efficacy, and integrating several therapeutic components. Common mediators include therapeutic alliance, empathy, expectations and cultural adaptation. Moderators in CUD treatment include sex, ethnicity, age-related factors and comorbid disorders.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Achva Academic College, Achva, Israel.
| | - Dana Tzur Bitan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
- IFT Institut für Therapieforschung, Centre of Health and Addiction Research, Munich, Germany
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4
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Nawrocik-Madrid A, AlTfaili H, Lamb RJ, Ginsburg BC. A Rapid Procedure to Assess Shifts in Discriminative Control Over Drinking During Recovery-Like Behavior. Alcohol 2024:S0741-8329(24)00016-8. [PMID: 38395371 DOI: 10.1016/j.alcohol.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Previously, we reported that recovery-like behavior decreases stimulus control over drinking, and this likely plays a role in the clinical observation that longer recovery increases relapse resistance. Those studies were conducted using a procedure that required repeated assessment, preventing a longitudinal analysis of the changes in stimulus control over time in each individual. Here we recapitulate those results and extend them to female rats using a more efficient procedure that allows repeated assessment of changes in stimulus control over drinking during recovery. METHODS Under a multiple concurrent schedule, rats were trained to reliably respond predominately for ethanol (concurrent Ethanol FR5, Food FR150) in the presence of one stimulus and for food (concurrent Ethanol FR5, Food FR5) in the presence of another stimulus. Stimuli were either lights or tones, depending on the group. After that, a drinking phase in which only the stimulus occasioning ethanol responding was presented (10 or 20 sessions) followed by recovery-like sessions in which only the stimulus occasioning food responding was presented. During these sessions, rats were exposed to the ethanol stimulus under extinction during the first component on sessions 0, 1, 2, 4,8, and 16. The number of food responses during these stimulus exposures prior to the first 5 ethanol responses was the primary measure. RESULTS Consistent with the earlier procedure, the number of food responses during ethanol tests increased as a function of the number of recovery sessions completed, regardless of whether the stimuli were visual or auditory. However, there were no significant effects of extended alcohol exposure or sex. CONCLUSIONS A rapid procedure consistent with the earlier procedure and clinical evidence was developed in which stimulus control over drinking decreased following longer periods of recovery. Under conditions tested, stimulus type, length of drinking history and sex did not affect this relationship.
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Affiliation(s)
- Acacia Nawrocik-Madrid
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Hanana AlTfaili
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - R J Lamb
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Brett C Ginsburg
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
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5
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Adams ZW, Marriott BR, Hulvershorn LA, Hinckley JD. Treatment of Adolescent Cannabis Use Disorders. Psychiatr Clin North Am 2023; 46:775-788. [PMID: 37879838 DOI: 10.1016/j.psc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.
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Affiliation(s)
- Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA.
| | - Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Boulevard, Suite 4110, Indianapolis, IN 46202, USA
| | - Jesse D Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS-F546, Aurora, CO 80045, USA. https://twitter.com/JHinckleyMDPhD
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6
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Clay S, Wilkinson Z, Ginley M, Arunogiri S, Christmass M, Membrey D, MacCartney P, Sutherland R, Colledge-Frisby S, Marshall AD, Nagle J, Degenhardt L, Farrell M, McKetin R. Perspectives and sentiments on contingency management from people who use methamphetamine. Drug Alcohol Rev 2023; 42:1427-1437. [PMID: 37248676 DOI: 10.1111/dar.13691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Contingency management (CM) is currently the most efficacious treatment for methamphetamine use, yet it is rarely available in routine care. We examined the viewpoints of people who use methamphetamine on CM as a potential treatment for methamphetamine use disorder. METHODS Semi-structured qualitative interviews with 30 Australians aged 18 years or older who had used methamphetamine at least weekly in the past 6 months. RESULTS Participants reported overall positive attitudes towards CM as a potential treatment option for methamphetamine use disorder. However, there was need for greater flexibility in meeting participant treatment goals (e.g., reduced use or complete abstinence), with particular concern about the viability of initiating abstinence, both in terms of the sufficiency of the initial financial incentive and managing withdrawal symptoms. There was strong interest in the use of digital technologies to provide remote CM, particularly around the convenience and flexibility this offered. Despite this, participants remained keen to access adjunctive treatment and support services but stressed that engagement with these additional services should not be mandatory. Marketing of CM will need to address preconceptions about drug-testing used in abstinence-based CM being punitive (especially urine testing) and its connotations with criminal justice interventions. DISCUSSION AND CONCLUSION Positive attitudes towards CM bode well for potential uptake should CM be made available in routine clinical practice. However, there is a need to adapt CM to ensure it is feasible and attractive to people who are seeking treatment for methamphetamine use disorder.
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Affiliation(s)
- Simon Clay
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Zachary Wilkinson
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Meredith Ginley
- East Tennessee State University, Johnson City, Tennessee, USA
| | - Shalini Arunogiri
- Turning Point & Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Michael Christmass
- Next Step Community Alcohol and Other Drugs Service, Mental Health Commission, Perth, Australia
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Samantha Colledge-Frisby
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- National Drug Research Institute, Melbourne, Australia
| | - Alison D Marshall
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Jack Nagle
- Connections Based Living, Melbourne, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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7
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Kalmin MM, Nicolo C, Long W, Bodden D, Van Nunen L, Shoptaw S, Ipser J. A Systematic Review of the Efficacy of Contingency Management for Substance Use Disorders in Low and Middle Income Countries. Int J Behav Med 2023:10.1007/s12529-023-10197-8. [PMID: 37532862 DOI: 10.1007/s12529-023-10197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The impact of illicit substance use is especially devastating in low-resourced countries where factors such as poverty, unemployment, and inadequate services impede successful treatment. Contingency management (CM) is a treatment for substance use disorders that has shown to be effective in eliciting behaviour change. The efficacy of CM interventions in low and middle income countries (LMICs) has been under explored. METHODS The aim of this systematic review of randomized controlled trials was to assess measures of CM efficacy in addressing substance use disorders, while also considering contextual moderators of CM in LMICs. A search of PubMed, Scopus, and Cochrane library databases yielded 18 studies for inclusion, from which relevant data were extracted using modified versions of the Cochrane Characteristics of Studies tool. RESULTS Two studies were located in a low-income country, two in lower-middle income countries, and fourteen in upper middle-income countries. Overall, estimated efficacy estimates were similar to those from higher income countries. However, context-specific challenges that warrant further investigation included limited access to trained staff and structural and financial constraints. CONCLUSIONS While CM in LMICs is in its early stages of development, efficacy estimates were not substantially different compared to high income countries. Challenges such as costs, willingness to implement, and the stigma associated with addiction sets the stage for further research in these contexts.
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Affiliation(s)
- Mariah M Kalmin
- Department of Family Medicine, University of California, Los Angeles 1800 Wilshire Blvd., Suite 1800, 90024, Los Angeles, CA, US.
| | - Candice Nicolo
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Wahbie Long
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - David Bodden
- Department of Environmental Health, University of North Carolina, Chapel Hill, Chapel Hill, North, CA, US
| | - Lara Van Nunen
- Department of Neuroscience, University of Cape Town, Cape Town, South Africa
| | - Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles 1800 Wilshire Blvd., Suite 1800, 90024, Los Angeles, CA, US
| | - Jonathan Ipser
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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8
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Luba R, Carpenter KM, Evans SM, Slonim J, Foltin RW. Impulsivity and Treatment Outcomes in Individuals with Cocaine Use Disorder: Examining the Gap between Interest and Adherence. Subst Use Misuse 2023; 58:1014-1020. [PMID: 37078221 PMCID: PMC10299617 DOI: 10.1080/10826084.2023.2201851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Background: Impulsivity is implicated in the development and maintenance of Cocaine Use Disorder (CUD). Less work has examined impulsivity's role on interest in initiating treatment, treatment adherence, or treatment response. No pharmacotherapies are approved for CUD, so efforts to understand and bolster the effects of psychotherapy are important in guiding and refining treatment. The present study examined the impact of impulsivity on interest in treatment, treatment initiation, treatment adherence, and treatment outcomes in individuals with CUD. Methods: Following the completion of a larger study on impulsivity and CUD participants were offered 14 sessions of (12 weeks) Cognitive Behavioral Relapse Prevention (CBT-RP). Before starting treatment, participants completed seven self-report and four behavioral measures of impulsivity. Sixty-eight healthy adults (36% female) with CUD (aged 49.4 ± 7.9) expressed an interest in treatment. Results: Greater scores on several self-report measures of impulsivity, and fewer difficulties with delayed gratification were associated with increased interest in treatment in both males and females. 55 participants attended at least 1 treatment session, while 13 participants did attend a single session. Individuals who attended at least one treatment session scored lower on measures of lack of perseverance and procrastination. Still, measures of impulsivity did not reliably predict session attendance nor the frequency of cocaine-positive urine samples throughout treatment. Males attended nearly twice as many treatment sessions as females despite nonsignificant associations between impulsivity in males and the number of sessions attended. Conclusions: Greater impulsivity in individuals with CUD was associated with expressing an interest in treatment, but not treatment adherence or response.
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Affiliation(s)
- R Luba
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia, University Irving Medical Center, New York, NY, USA
| | - K M Carpenter
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia, University Irving Medical Center, New York, NY, USA
| | - S M Evans
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia, University Irving Medical Center, New York, NY, USA
| | - J Slonim
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia, University Irving Medical Center, New York, NY, USA
| | - R W Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia, University Irving Medical Center, New York, NY, USA
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9
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Healthy choices, healthy changes: A randomized trial of incentives to promote healthy eating and exercise in people with schizophrenia and other serious mental illnesses. Schizophr Res 2023; 255:1-8. [PMID: 36933290 DOI: 10.1016/j.schres.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers). METHODS From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models. RESULTS Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives. CONCLUSIONS Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02515981.
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10
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Adams ZW, Marriott BR, Hulvershorn LA, Hinckley J. Treatment of Adolescent Cannabis Use Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:141-155. [PMID: 36410901 PMCID: PMC10097012 DOI: 10.1016/j.chc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This review summarizes treatments for cannabis use disorder (CUD) in adolescents. The best supported CUD treatments are cognitive behavioral psychotherapies, including family-based models that facilitate environmental changes and youth-focused models that incorporate skills training, motivational interviewing, and contingency management to promote reductions in cannabis use. Some medications show promise in reducing cannabis craving and withdrawal symptoms. Further research is needed on the efficacy and implementation of existing treatments given the changes in cannabis use trends over time and on emerging technologies that may expand access to evidence-based CUD treatments.
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Affiliation(s)
- Zachary W Adams
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA.
| | - Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202, USA
| | - Leslie A Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, 1002 Wishard Boulevard, Suite 4110, Indianapolis, IN 46202, USA
| | - Jesse Hinckley
- Department of Psychiatry, University of Colorado School of Medicine, 13001 East 17th Place, MS-F546, Aurora, CO 80045, USA. https://twitter.com/JHinckleyMDPhD
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Abstract
Alcohol is one of the most widely consumed psychoactive drugs globally. Hazardous drinking, defined by quantity and frequency of consumption, is associated with acute and chronic morbidity. Alcohol use disorders (AUDs) are psychiatric syndromes characterized by impaired control over drinking and other symptoms. Contemporary aetiological perspectives on AUDs apply a biopsychosocial framework that emphasizes the interplay of genetics, neurobiology, psychology, and an individual's social and societal context. There is strong evidence that AUDs are genetically influenced, but with a complex polygenic architecture. Likewise, there is robust evidence for environmental influences, such as adverse childhood exposures and maladaptive developmental trajectories. Well-established biological and psychological determinants of AUDs include neuroadaptive changes following persistent use, differences in brain structure and function, and motivational determinants including overvaluation of alcohol reinforcement, acute effects of environmental triggers and stress, elevations in multiple facets of impulsivity, and lack of alternative reinforcers. Social factors include bidirectional roles of social networks and sociocultural influences, such as public health control strategies and social determinants of health. An array of evidence-based approaches for reducing alcohol harms are available, including screening, pharmacotherapies, psychological interventions and policy strategies, but are substantially underused. Priorities for the field include translating advances in basic biobehavioural research into novel clinical applications and, in turn, promoting widespread implementation of evidence-based clinical approaches in practice and health-care systems.
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12
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Thrailkill EA, Alcalá JA. Relapse after incentivized choice treatment in humans: A laboratory model for studying behavior change. Exp Clin Psychopharmacol 2022; 30:220-234. [PMID: 33507769 PMCID: PMC8363208 DOI: 10.1037/pha0000443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Behavior change interventions that incentivize desired behavior are highly effective for improving personal health, but difficult to maintain long term. Relapse is common and examining the mechanisms that contribute to relapse in experimental settings can identify processes relevant to substance abuse treatment. We developed a laboratory task that parallels a recent operant model of relapse after incentivized choice reported in the rodent laboratory. In two experiments, undergraduate participants first learned to make an operant response (keyboard button; R1) to earn a reinforcer consisting of an image of a preferred snack food (O1). In a second phase (Phase 2), R1 was still reinforced, but a new response (R2) was introduced and reinforced with a different reinforcer (a coin; O2). In a test phase, contingent incentives for R2 were removed (extinction) and relapse of R1 was assessed. Experiment 1 found that the O2 contingency suppressed R1 during Phase 2, and R1 relapsed rapidly in the test. Neither effect was consistently related to O2 value. Experiment 2 examined whether noncontingent presentations of O1 or O2 during the test could weaken relapse. Here, we found that noncontingent reinforcers did little to reduce or slow the increase in R1 responding. The present experiments highlight a laboratory approach to studying variables that may influence relapse after incentivized treatment. We identify and discuss areas for development to address differences between the present results and prior observations from animal and clinical studies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - José A. Alcalá
- Department of Neuroscience, Psychology and Behaviour, University of Leicester,Department of Psychology, University of Jaén
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13
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“Quit Cold Turkey”: Effects of a Quit-and-Win Smoking Cessation Challenge Offered at Christmas on Abstinence, Daily Cigarette Intake, and Cravings. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00780-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Coughlin LN, Bonar EE, Walton MA, Fernandez AC, Duguid I, Nahum-Shani I. New Directions for Motivational Incentive Interventions for Smoking Cessation. Front Digit Health 2022; 4:803301. [PMID: 35310552 PMCID: PMC8931767 DOI: 10.3389/fdgth.2022.803301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs. Purpose Technological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions. Conclusions Technological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.
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Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Lara N. Coughlin
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Isabelle Duguid
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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DeVito EE, Poling J, Babuscio T, Nich C, Carroll KM, Sofuoglu M. Modafinil Does Not Reduce Cocaine Use in Methadone-Maintained Individuals. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100032. [PMID: 36310662 PMCID: PMC9615926 DOI: 10.1016/j.dadr.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction There are no approved medications for the treatment of cocaine use disorder (CUD). Modafinil, a cognitive-enhancer with weak stimulant-like effects, has shown promise in initial studies as a treatment for CUD. Its potential efficacy has not been examined in individuals dually dependent on cocaine and opioids. Methods This study examined the efficacy of modafinil, in combination with contingency management (CM), for reducing cocaine and opioid use and improving cognitive function in methadone-stabilized individuals with opioid and cocaine dependence. We conducted a 17-week, double-blind, randomized controlled trial in which participants were randomized to one of four conditions: 1) modafinil + CM; 2) modafinil + yoked-control (YC); 3) placebo +CM; or 4) placebo + YC. Additionally, all subjects received platform treatments of cognitive behavioral therapy (CBT) and methadone. While the original planned sample size was N=160, a total of 91 participants were randomized. The two primary cocaine use outcomes were percentage of urine specimens positive for cocaine and percent of days of self-reported abstinence from cocaine during treatment. Cognitive function, opioid use, and secondary cocaine use outcomes were also considered. Results Modafinil was well-tolerated with minimal reports of adverse effects. Modafinil was no more effective than placebo in reducing cocaine or opioid use or improving cognitive performance. Conclusions In the context of a trial with robust control conditions and platform treatments, findings did not provide support for the efficacy of modafinil treatment for the treatment of CUD in methadone-stabilized individuals with dual opioid and cocaine dependence.
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Affiliation(s)
- Elise E. DeVito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - James Poling
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States
| | - Theresa Babuscio
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Charla Nich
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Kathleen M. Carroll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States,VA Connecticut Healthcare System, West Haven, CT, United States,Corresponding author at: VA Connecticut Healthcare System, 950 Campbell Ave., Bldg. 36/116A4, West Haven, CT 06516.
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16
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Lim TV, Cardinal RN, Bullmore ET, Robbins TW, Ersche KD. Impaired Learning From Negative Feedback in Stimulant Use Disorder: Dopaminergic Modulation. Int J Neuropsychopharmacol 2021; 24:867-878. [PMID: 34197589 PMCID: PMC8598302 DOI: 10.1093/ijnp/pyab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/17/2021] [Accepted: 06/30/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Drug-induced alterations to the dopamine system in stimulant use disorder (SUD) are hypothesized to impair reinforcement learning (RL). Computational modeling enables the investigation of the latent processes of RL in SUD patients, which could elucidate the nature of their impairments. METHODS We investigated RL in 44 SUD patients and 41 healthy control participants using a probabilistic RL task that assesses learning from reward and punishment separately. In an independent sample, we determined the modulatory role of dopamine in RL following a single dose of the dopamine D2/3 receptor antagonist amisulpride (400 mg) and the agonist pramipexole (0.5 mg) in a randomised, double-blind, placebo-controlled, crossover design. We analyzed task performance using computational modelling and hypothesized that RL impairments in SUD patients would be differentially modulated by a dopamine D2/3 receptor antagonist and agonist. RESULTS Computational analyses in both samples revealed significantly reduced learning rates from punishment in SUD patients compared with healthy controls, whilst their reward learning rates were not measurably impaired. In addition, the dopaminergic receptor agents modulated RL parameters differentially in both groups. Both amisulpride and pramipexole impaired RL parameters in healthy participants, but ameliorated learning from punishment in SUD patients. CONCLUSION Our findings suggest that RL impairments seen in SUD patients are associated with altered dopamine function.
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Affiliation(s)
- Tsen Vei Lim
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Edward T Bullmore
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Trevor W Robbins
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Karen D Ersche
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Becker SJ, Murphy CM, Hartzler B, Rash CJ, Janssen T, Roosa M, Madden LM, Garner BR. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial. Addict Sci Clin Pract 2021; 16:61. [PMID: 34635178 PMCID: PMC8505014 DOI: 10.1186/s13722-021-00268-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioid-related overdoses and harms have been declared a public health emergency in the United States, highlighting an urgent need to implement evidence-based treatments. Contingency management (CM) is one of the most effective behavioral interventions when delivered in combination with medication for opioid use disorder, but its implementation in opioid treatment programs is woefully limited. Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) was funded by the National Institute on Drug Abuse to identify effective strategies for helping opioid treatment programs improve CM implementation as an adjunct to medication. Specific aims will test the impact of two different strategies on implementation outcomes (primary aim) and patient outcomes (secondary aims), as well as test putative mediators of implementation effectiveness (exploratory aim). METHODS A 3-cohort, cluster-randomized, type 3 hybrid design is used with the opioid treatment programs as the unit of randomization. Thirty programs are randomized to one of two conditions. The control condition is the Addiction Technology Transfer Center (ATTC) Network implementation strategy, which consists of three core approaches: didactic training, performance feedback, and on-going consultation. The experimental condition is an enhanced ATTC strategy, with the same core ATTC elements plus two additional theory-driven elements. The two additional elements are Pay-for-Performance, which aims to increase implementing staff's extrinsic motivations, and Implementation & Sustainment Facilitation, which targets staff's intrinsic motivations. Data will be collected using a novel, CM Tracker tool to document CM session delivery, session audio recordings, provider surveys, and patient surveys. Implementation outcomes include CM Exposure (number of CM sessions delivered per patient), CM Skill (ratings of CM fidelity), and CM Sustainment (number of patients receiving CM after removal of support). Patient outcomes include self-reported opioid abstinence and opioid-related problems (both assessed at 3- and 6-months post-baseline). DISCUSSION There is urgent public health need to improve the implementation of CM as an adjunct to medication for opioid use disorder. Consistent with its hybrid type 3 design, Project MIMIC is advancing implementation science by comparing impacts of these two multifaceted strategies on both implementation and patient outcomes, and by examining the extent to which the impacts of those strategies can be explained by putative mediators. TRIAL REGISTRATION This clinical trial has been registered with clinicaltrials.gov (NCT03931174). Registered April 30, 2019. https://clinicaltrials.gov/ct2/show/NCT03931174?term=project+mimic&draw=2&rank=1.
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Affiliation(s)
- Sara J. Becker
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Cara M. Murphy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Bryan Hartzler
- Addictions, Drug, & Alcohol Institute, University of Washington, 1107 NE 45th Street, Suite 120, Seattle, WA 98105 USA
| | - Carla J. Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health, 263 Farmington Avenue, Farmington, CT 06030 USA
| | - Tim Janssen
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-5, Providence, RI 02912 USA
| | - Mat Roosa
- Roosa Consulting, LLC, 3 Bradford Drive, Syracuse, NY 13224 USA
| | - Lynn M. Madden
- APT Foundation, 1 Long Wharf Drive, Suite 321, New Haven, CT 06511 USA
| | - Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd.Research Triangle Park, P.O. Box 12194, Durham, NC 27709 USA
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Effectiveness of incorporating contingency management into a public treatment program for people who use crack cocaine in Brazil. A single-blind randomized controlled trial. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103464. [PMID: 34619447 DOI: 10.1016/j.drugpo.2021.103464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Smoked cocaine (i.e., crack use) is a severe health problem in Brazil, with the country being reported as having the largest crack market in the world. The objective of this study was to evaluate the effectiveness of incorporating Contingency Management targeting cocaine abstinence into a public treatment program in Brazil. METHODS Single-blind randomized controlled trial conducted at Unidade Recomeço Helvétia (URH), a public ambulatory treatment program for persons who use crack and live in the "Crackland" region in downtown São Paulo, Brazil. In total, 98 treatment-seeking individuals who use crack were randomized to one of two treatment conditions. Participants allocated to the control condition (n = 48) received 12 weeks of the standard treatment provided at URH. Participants allocated to the experimental condition (n = 50) received the same treatment in combination with Contingency Management (URH+CM). In URH+CM, participants were provided with vouchers with monetary value for submission of negative cocaine urinalysis twice weekly. RESULTS Compared to the URH group, the URH+CM group was significantly more likely to submit a negative cocaine urinalysis during treatment, with odds ratios ranging from 4.17 to 6.78, depending on how missing data was accounted for (p<0.01). Participants receiving Contingency Management also had higher odds of achieving three or more weeks of continuous abstinence (OR= 8.07; 95% CI [2.48, 26.24]), achieved longer durations of abstinence (B = 2.14; 95% CI [0.67, 3.61]), submitted a higher percentage of negative urinalysis (B = 19.85; 95% CI [6.89, 32.82]), and were retained in treatment for a longer period (B = 3.00; 95% CI [1.04, 4.97]), compared to those receiving URH alone (p<0.01 for all). CONCLUSIONS The incorporation of Contingency Management was effective in promoting cocaine abstinence and treatment retention. The large-scale dissemination of Contingency Management may be an effective strategy to treat Brazilians with cocaine use disorders.
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Pfund RA, Cook JE, McAfee NW, Huskinson SL, Parker JD. Challenges to Conducting Contingency Management Treatment for Substance Use Disorders: Practice Recommendations for Clinicians. ACTA ACUST UNITED AC 2021; 52:137-145. [PMID: 34421192 DOI: 10.1037/pro0000356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A growing empirical literature supports contingency management (CM) as an efficacious treatment for substance use disorders, especially when reinforcers are immediate, frequent, and of sufficient magnitude on escalating schedules. However, in real world-practice, CM is often conducted in ways that are inconsistent with research protocols. One reason for these inconsistencies may be due to pragmatic challenges inherent in conducting CM. In this article, we described an outpatient CM treatment program for drug use disorders and several specific challenges associated with adherence to CM parameters from research protocols. Finally, we propose possible solutions for these challenges and discuss implications for practice.
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20
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Gagnon M, Payne A, Guta A. What are the ethical implications of using prize-based contingency management in substance use? A scoping review. Harm Reduct J 2021; 18:82. [PMID: 34348710 PMCID: PMC8335458 DOI: 10.1186/s12954-021-00529-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The area of substance use is notable for its early uptake of incentives and wealth of research on the topic. This is particularly true for prize-based contingency management (PB-CM), a particular type of incentive that uses a fishbowl prize-draw design. Given that PB-CM interventions are gaining momentum to address the dual public health crises of opiate and stimulant use in North America and beyond, it is imperative that we better understand and critically analyze their implications. PURPOSE The purpose of this scoping review paper is to identify the characteristics of PB-CM interventions for people who use substances and explore ethical implications documented in the literature as well as emerging ethical implications that merit further consideration. METHODS The PRISMA-ScR checklist was used in conjunction with Arksey and O'Malley's methodological framework to guide this scoping review. We completed a two-pronged analysis of 52 research articles retrieved through a comprehensive search across three key scholarly databases. After extracting descriptive data from each article, we used 9 key domains to identify characteristics of the interventions followed by an analysis of ethical implications. RESULTS We analyzed the characteristics of PB-CM interventions which were predominantly quantitative studies aimed at studying the efficacy of PB-CM interventions. All of the interventions used a prize-draw format with a classic magnitude of 50%. Most of the interventions combined both negative and positive direction to reward processes, behaviors, and/or outcomes. One ethical implication was identified in the literature: the risk of gambling relapse. We also found three emerging ethical implications by further analyzing participant characteristics, intervention designs, and potential impact on the patient-provider relationship. These implications include the potential deceptive nature of PB-CM, the emphasis placed on the individual behaviors to the detriment of social and structural determinants of health, and failures to address vulnerability and power dynamics. CONCLUSIONS This scoping review offers important insights into the ethics on PB-CM and its implications for research ethics, clinical ethics, and public health ethics. Additionally, it raises important questions that can inform future research and dialogues to further tease out the ethical issues associated with PB-CM.
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Affiliation(s)
- Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada.
- School of Nursing, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Alayna Payne
- Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Ave, Victoria, BC, V8N 5M8, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
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21
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Carroll KM. The profound heterogeneity of substance use disorders: Implications for treatment development. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021; 30:358-364. [PMID: 34483503 PMCID: PMC8415637 DOI: 10.1177/09637214211026984] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A single treatment approach will never be sufficient to address the diversity of individuals with substance use disorders (SUDs). SUDs have historically defied definition through simple characterizations or models, and no single characterization has led to the development of broadly effective interventions. The range of dimensions of heterogeneity among individuals with SUDs, including severity, type of substance, and issues that frequently co-occur underscore that highly tailored approaches are needed. To approach personalized medicine for individuals with SUDs; two major developments are needed. First, given the diversity of individuals with SUDs, multivariate phenotyping approaches are needed to identify the particular features driving addictive processes in any individual. Second, a wider range of interventions that directly target core mechanisms of addiction and the problems that co-occur with them are needed. As clinicians cannot be expected to master the full range of interventions that may target these core processes, developing these so that they can be delivered easily, flexibly, and systematically via technology will facilitate our ability to truly tailor interventions to this highly complex and challenging population. One such technology-delivered intervention, computer-based training for cognitive behavioral therapy (CBT4CBT), is used as an example to illustrate a vision for the future of highly-tailored interventions for individuals with SUDs.
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22
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Jirapramukpitak T, Pattanaseri K, Chua KC, Takizawa P. Home-Based Contingency Management Delivered by Community Health Workers to Improve Alcohol Abstinence: A Randomized Control Trial. Alcohol Alcohol 2020; 55:171-178. [PMID: 31919523 DOI: 10.1093/alcalc/agz106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/26/2019] [Accepted: 12/09/2019] [Indexed: 11/15/2022] Open
Abstract
AIM To evaluate the effectiveness of home-based contingency management (CM) in improving abstinence in an incentive-dependent manner among alcoholic individuals. METHODS A 12-week, home-visit (HV) only controlled, randomized incentive-ranging trial of 161 adults with current alcohol dependence was recruited using social network theory techniques. Participants randomly received HV, low- (CM-L) or higher-magnitude CM (CM-H). Community health workers made regular home visits, monitored drinking behavior and delivered CM as appropriate. Two follow-up visits at weeks 13 and 16 were conducted to assess whether abstinence would still be maintained after the interventions discontinued. Rates of continuous reported abstinence (primary), numbers of positive breath samples (secondary) over the intervention period and rates of prolonged reported abstinence (secondary) were evaluated. RESULTS CM did not significantly improve the rates of continuous reported abstinence across the 12-week intervention period (odds ratio (OR) for trend 1.2, 95% confidence interval (CI) 0.7-2.1, P = 0.601). There was a significant reduction, however, in the average number of positive breath samples submitted by the CM-H group (generalized linear model, β -0.5, 95% CI -0.9 to -0.2, P = 0.005). The CM-H arm also had a significantly higher abstinence rate during the follow-up period (OR 3.4, 95% CI 1.3-8.8, P = 0.013). Event history model suggested that the CM-H condition had significantly higher chances of achieving renewed abstinence across the study period (OR 2.0, 95% CI 1.3-3.2, P = 0.003). CONCLUSIONS Home-based CM with sufficient incentive is promising in reducing alcohol use and in improving rates of abstinence over time. Allowing for a certain grace period may better capture the delayed treatment effect of home-based CM.
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Affiliation(s)
- Tawanchai Jirapramukpitak
- Institute for Population and Social Research, Mahidol University, Phuttamonthon 4 Road, Salaya, Phuttamonthon, Nakhon Pathom 73170, Thailand.,Centre of Excellence in Applied Epidemiology, Thammasat University, Paholyothin Road, Klong Luang, Prathumthani 12120, Thailand.,Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Keerati Pattanaseri
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Kia-Chong Chua
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Patcharapim Takizawa
- Department of Health Care Policy and Management, Graduate School of Comprehensive Human Sciences, Tsukuba University, Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan
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Schuster RM, Potter K, Lamberth E, Rychik N, Hareli M, Allen S, Broos HC, Mustoe A, Gilman JM, Pachas G, Evins AE. Alcohol substitution during one month of cannabis abstinence among non-treatment seeking youth. Prog Neuropsychopharmacol Biol Psychiatry 2020; 107:110205. [PMID: 33309538 PMCID: PMC7882030 DOI: 10.1016/j.pnpbp.2020.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Cannabis and alcohol use are correlated behaviors among youth. It is not known whether discontinuation of cannabis use is associated with changes in alcohol use. This study assessed alcohol use in youth before, during, and after 4 weeks of paid cannabis abstinence. METHODS Healthy, non-treatment seeking, cannabis users (n = 160), aged 14-25 years, 84% of whom used alcohol in the last month, were enrolled for a 4-week study with a 2-4 week follow-up. Participants were randomly assigned to 4 weeks of either biochemically-verified cannabis abstinence achieved through a contingency management framework (CB-Abst) or monitoring with no abstinence requirement (CB-Mon). Participants were assessed at baseline and approximately 4, 6, 10, 17, 24, and 31 days after enrollment. A follow-up visit with no cannabis abstinence requirement for CB-Abst was conducted after 2-4 weeks. RESULTS Sixty percent of individuals assigned to the CB-Abst condition increased in frequency and quantity of alcohol consumption during the 4-week period of incentivized cannabis abstinence. As a whole, CB-Abst increased by a mean of 0.6 drinking days and 0.2 drinks per day in the initial week of abstinence (p's < 0.006). There was no evidence for further increases in drinking frequency or quantity during the 30-day abstinence period (p's > 0.53). There was no change in drinking frequency or quantity during the 4-week monitoring or follow-up periods among CB-Mon. CONCLUSIONS On average, 4 weeks of incentivized (i.e., paid) cannabis abstinence among non-treatment seeking youth was associated with increased frequency and amount of alcohol use in week 1 that was sustained over 4 weeks and resolved with resumption of cannabis use. However, there was notable variability in individual-level response, with 60% increasing in alcohol use and 23% actually decreasing in alcohol use during cannabis abstinence. Findings suggest that increased alcohol use during cannabis abstinence among youth merits further study to determine whether this behavior occurs among treatment seeking youth and its clinical significance.
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Affiliation(s)
- Randi Melissa Schuster
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Erin Lamberth
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Natali Rychik
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Maya Hareli
- Department of Psychology, Loyola University Chicago, United States of America
| | - Sophia Allen
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Hannah C Broos
- Department of Psychology, University of Miami, United States of America
| | - Audrey Mustoe
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - Jodi M Gilman
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, MA General Hospital, United States of America; Harvard Medical School, Boston, MA, United States of America
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Kumar N, Mancino MJ, Thostenson JD, McGaugh J, Oliveto AH. Feasibility and Preliminary Efficacy of Isradipine During Outpatient Buprenorphine Stabilization and Detoxification: A Pilot Randomized, Placebo-Controlled Trial. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820970926. [PMID: 33281447 PMCID: PMC7686602 DOI: 10.1177/1178221820970926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
Background: Given the immense burden of the widespread use of opioids around the world,
exploring treatments that improve drug use outcomes, and craving and
withdrawal measures in individuals with opioid use disorder is crucial. This
pilot study examined the feasibility and preliminary efficacy of the L-type
calcium-channel blocker isradipine (ISR) to improve drug use outcomes, and
craving and withdrawal measures during buprenorphine (BUP)/ISR stabilization
and subsequent taper in opioid-dependent individuals. Methods: Participants were stabilized on BUP sublingual tablets within the first 2
days of week 1, were then randomized and inducted on either ISR or placebo,
gradually increasing the dose over the next 2 weeks, followed by a 10-day
BUP taper during weeks 5-6, and ISR/placebo taper during weeks 7 to 8.
Assessments included thrice-weekly measures of craving and withdrawal, as
well as vital signs and urine drug screens. Medication compliance was
assessed by monitoring number of missed clinic visit days. Results: Baseline characteristics of participants (n = 25; 60% male, 96% Caucasian,
48% employed, mean age 32.8 years) did not differ significantly between
treatment groups (isradipine, n = 11; placebo, n = 14). During the
stabilization phase (n = 19), ISR participants had significantly lower rates
of illicit opioid-positive urines (treatment × visit:
t = -2.16, P = 0.03), as well as reduction
in craving intensity (t = –2.50,
P = 0.01), frequency (t = –3.43,
P < 0.01) and duration (t = –2.51,
P = 0.01). ISR was well tolerated with mild adverse
effects. Conclusions: This study was likely underpowered due to being a pilot trial. Although
preliminary results suggest ISR may improve BUP-assisted treatment outcomes,
concerns about high number of exclusions (n = 11 during taper phase) based
on cardiovascular measures as well as ISR-induced changes in vital signs
with the immediate release formulation may limit the feasibility of this
approach. Trial Registration: Clinicaltrials.gov identifier NCT01895270. Registered 10 July 2013, https://clinicaltrials.gov/ct2/show/NCT01895270?id=NCT01895270&draw=2&rank=1
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Affiliation(s)
- Nihit Kumar
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael J Mancino
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff D Thostenson
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Janette McGaugh
- Ouachita Behavioral Health and Wellness, Hot Springs, AR, USA
| | - Alison H Oliveto
- Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Ellis JD, Struble CA, Fodor MC, Cairncross M, Lundahl LH, Ledgerwood DM. Contingency management for individuals with chronic health conditions: A systematic review and meta-analysis of randomized controlled trials. Behav Res Ther 2020; 136:103781. [PMID: 33302054 DOI: 10.1016/j.brat.2020.103781] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/24/2020] [Accepted: 11/16/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Contingency management (CM) interventions involve providing reinforcement for engaging in a desired behavior, and have been shown to increase treatment adherence and promote abstinence in the treatment of substance use disorders. This review was conducted to systematically review the literature on the effectiveness of CM when applied to a range of medical conditions outside of substance use disorders. METHOD The authors identified a total of 24 randomized studies examining the effects of CM on four outcomes: weight change, physical activity, medication/device adherence, and viral load that were included in the qualitative summary, and 20 studies included in the meta-analysis. RESULTS CM was associated with positive outcomes for physical activity and medication/device adherence compared to control conditions. Findings with weight loss and viral load were more mixed, and evidence for publication bias was found for both outcomes. The effects of CM tend to dissipate when the contingency is removed. Heterogeneity was observed across most outcomes. LIMITATIONS AND CONCLUSIONS This review provides preliminary support for the use of CM in increasing physical activity and improving adherence to medication for chronic health conditions while reinforcement is ongoing. Future studies should examine potential moderators and identify strategies to maintain these changes over time.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, USA
| | - Cara A Struble
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Marina C Fodor
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - Molly Cairncross
- Division of Physical Medicine and Rehabilitation, The University of British Columbia, Canada
| | - Leslie H Lundahl
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA
| | - David M Ledgerwood
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, USA.
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Raiff BR, Burrows C, Dwyer M. Behavior-Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions. Behav Anal Pract 2020; 14:240-252. [PMID: 33732594 DOI: 10.1007/s40617-020-00488-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus is the seventh leading cause of death in the United States, requiring a series of complex behavior changes that must be sustained for a lifetime (e.g., counting carbohydrates, self-monitoring blood glucose, adjusting insulin). Although complex, all of these tasks involve behavior, making them amenable targets for behavior analysts. In this article, the authors describe interventions that have focused on antecedent, consequent, multicomponent, and alternate procedures for the management of diabetes, highlighting ways in which technology has been used to overcome common barriers to the use of these intensive, evidence-based interventions. Additional variables relevant to poorly managed diabetes (e.g., delay discounting) are also discussed. Future research and practice should focus on harnessing continued advances in information technology while also considering underexplored behavioral technologies for the effective treatment of diabetes, with a focus on identifying sustainable, long-term solutions for maintaining proper diabetes management. Practical implementation of these interventions will depend on having qualified behavior analysts working in integrated primary care settings where the interventions are most likely to be used, which will require interdisciplinary training and collaboration.
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Affiliation(s)
- Bethany R Raiff
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
| | - Connor Burrows
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
| | - Matthew Dwyer
- Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028 USA
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The effects of bilingual Acceptance and Commitment Training (ACT) on exercise in bilingual international university students. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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The use of financial incentives to prevent unhealthy behaviors: A review. Soc Sci Med 2020; 261:113236. [PMID: 32781370 DOI: 10.1016/j.socscimed.2020.113236] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
Behaviors that are putting people's health at risk are widespread and some of them are on the rise. Some of these behaviors can be prohibited or prevented by taxation. But financial incentives such as conditional cash transfers are also increasingly proposed and tested to discourage such behaviors, in domains as varied as HIV/AIDS, drugs, alcohol, smoking, and obesity. This paper presents the theoretical justification for using such incentives, distinguishing between the price, income effects, and the nudge effects. The growing literature about the effectiveness of financial incentives to prevent undesirable behaviors is reviewed in detail for each type of harmful behavior. Finally, the paper discusses the long-term sustainability of such incentives, a key issue if they are to be scaled up beyond pilot programs and research projects. The current evidence on whether such incentives have an impact after they are discontinued is mixed. Some design features, like lotteries or commitment devices, could induce savings as well as increase effectiveness, therefore improving sustainability.
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Litt MD, Kadden RM, Tennen H, Petry NM. Individualized assessment and treatment program (IATP) for cannabis use disorder: Randomized controlled trial with and without contingency management. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:40-51. [PMID: 31318225 PMCID: PMC6980271 DOI: 10.1037/adb0000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study tested a new approach to the treatment of cannabis use disorder (CUD). CUD is difficult to treat, and achieving abstinence is particularly difficult. The individualized assessment and treatment program (IATP) was intended to address this problem by providing a highly individualized approach to the training of coping skills most relevant for each individual. To do this, an experience sampling procedure was used prior to treatment to record patients' marijuana use behavior and associated thoughts, feelings, coping behaviors, and situations. This information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in drug-use situations. The present study tested IATP against a conventional combined motivational enhancement cognitive-behavioral treatment (MET-CBT), with or without the addition of contingency management (CM) for abstinence. The patients were 198 men and women randomly assigned to 1 of 4 nine-session treatment conditions: MET-CBT, MET-CBT-CM, IATP, or IATP-CM. Patients were assessed out to 14 months. Planned contrasts indicated that the IATP conditions yielded greater levels of abstinence than did the MET-CBT conditions. The addition of CM did not bolster the performance of IATP but did do so for MET-CBT. As expected, IATP lead to greater use of coping skills than did the MET-CBT conditions. However, coping skills use was not a significant predictor of outcome when other variables were in the same analyses. Self-efficacy was a robust predictor and mediator of outcome. We suggest that the IATP may act by enhancing self-efficacy. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Mark D Litt
- Division of Behavioral Sciences and Community Health, UConn Health
| | | | - Howard Tennen
- Department of Community Medicine and Health Care, UConn Health
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30
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Rash CJ, Petry NM, Alessi SM, Barnett NP. Monitoring alcohol use in heavy drinking soup kitchen attendees. Alcohol 2019; 81:139-147. [PMID: 30308286 DOI: 10.1016/j.alcohol.2018.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/24/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Abstract
Rates of heavy alcohol use in soup kitchen attendees range from 30% to 38%, but these data are based entirely on self-reported drinking. Little is known about the intensity or frequency of drinking in this population. We assessed alcohol use transdermally every 30 min over a 3-week period among heavy drinkers who attended local soup kitchens. In addition to transdermal alcohol monitoring, participants were randomly assigned to daily breath alcohol monitoring with or without reinforcement for alcohol-negative breath samples (BrAC). Analyses assessed feasibility of transdermal monitoring and examined alcohol use based on BrAC, transdermal, and self-report data, as well as effect sizes for these metrics based on group assignment. Nineteen participants completed the 21-day monitoring period in full; three persons removed the anklet 3-16 days early due to hospitalization, impending hospitalization, or incarceration. Participants reported minimal impacts of the monitors, and severity ratings of side effects were mild. When using BrAC, transdermal, and self-report data, the percentage of non-drinking days was 93%, 58%, and 57%, and the longest duration of consecutive non-drinking days averaged 10.3, 7.2, and 5.7 days, respectively. About half of drinking days involved heavy drinking (5 + drinks). Self-report and transdermal drinking days correlated significantly, p < .001, but neither index was associated with BrAC. Group comparisons indicate small-to-moderate sized effects of reinforcement compared to no reinforcement for increasing the proportion of alcohol-negative breath samples and durations of consecutive non-drinking samples during the study when BrAC was the metric. Transdermal data and self-report data indicated a more complex pattern. Reinforcement participants drank more often but at lower quantities than monitoring (control) participants per both transdermal and self-report data. These data suggest that transdermal monitors are well tolerated and document substantial heavy drinking in this population. Soup kitchens users are in need of alcohol interventions, and soup kitchens may represent a novel opportunistic setting for intervention delivery for an important and growing health disparities population.
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31
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Saini V, Mitteer DR. A review of investigations of operant renewal with human participants: Implications for theory and practice. J Exp Anal Behav 2019; 113:105-123. [PMID: 31758573 DOI: 10.1002/jeab.562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/08/2019] [Indexed: 11/07/2022]
Abstract
Operant renewal is the recurrence of a previously eliminated target behavior as a function of changing stimulus contexts. Renewal as a model of treatment relapse in humans suggests that a change in stimulus conditions or context is sufficient to produce relapse of a previously eliminated maladaptive behavior. The extent to which general findings from operant renewal studies involving nonhuman animal subjects are supported by relapse studies involving human participants is unknown. We conducted a systematic review of studies demonstrating or mitigating operant renewal in human participants in peer-reviewed studies found in PsycINFO, ERIC, PubMed, and Scopus between 1980 and 2019. We identified 12 studies involving 61 participants and 93 cases of operant renewal. We coded descriptive data on participant and study characteristics and calculated summary statistics. Results indicated that the renewal effect was a robust phenomenon, supported by demonstrations in both clinical and human-laboratory studies, and across a variety of variables and experimental preparations. However, there were relatively few studies involving human participants that attempted to reduce or eliminate renewal of clinically meaningful behavior. We discuss variables relevant for studying renewal in socially meaningful contexts, practical limitations of observing the renewal effect in real-world settings, implications for theoretical models of renewal, and identify barriers to methodology unique to human participants. We provide directions for future research related to implementing and translating nonhuman animal studies of renewal to applied settings.
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Rash CJ, Alessi SM, Zajac K. Examining implementation of contingency management in real-world settings. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:89-98. [PMID: 31343197 DOI: 10.1037/adb0000496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Very little is known about how reward programs are implemented in real-world substance use treatment settings and whether training in contingency management (CM), an empirically supported rewards-based intervention, impacts their design quality. Providers (N = 214) completed surveys assessing CM beliefs, training, and practices related to use of tangible rewards in treatment. For providers reporting they had not used rewards in treatment previously (54%, n = 116), we assessed beliefs about and interest in adopting a reward-based program. For those endorsing prior reward experience (46%, n = 98), we assessed the features and delivery of rewards and the relation of reward-based intervention training to 4 parameters related to CM efficacy: reinforcement magnitude, immediacy, frequency, and escalation. Among providers without reward experience, endorsement of supportive statements about CM predicted interest in adopting a rewards-based program. Providers with reward experience most often targeted treatment attendance and engaged in behaviors likely to decrease the effectiveness of the intervention, including use of low magnitudes (≤ $25/client), delayed reinforcement, failure to escalate reward values, and offering reward opportunities less than weekly. Providers with longer durations of training were more likely to engage in behaviors consistent with effective CM, including larger magnitude rewards and immediate delivery of rewards. Results indicate that real-world treatment clinics are using reward-based programs but not in ways consistent with research protocols. Longer training exposure is associated with greater adherence to some aspects of CM protocol design. Other evidence-based design features are not being implemented as recommended, even with training. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carla J Rash
- University of Connecticut Health School of Medicine
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33
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Oluwoye O, Kriegel L, Alcover KC, McPherson S, McDonell MG, Roll JM. The dissemination and implementation of contingency management for substance use disorders: A systematic review. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 34:99-110. [PMID: 31259569 DOI: 10.1037/adb0000487] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management is one of the most effective behavioral interventions for substance use. However, the implementation of contingency management has not been as widespread as might be expected given its efficacy. This review summarizes literature that examines the dissemination and implementation of contingency management for substance use in community (e.g., specialized substance use treatment) and clinical (e.g., primary care) settings. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases including Google Scholar, World of Knowledge, PsycINFO, and PubMed were searched. Search results yielded 100 articles and after the screening of titles and abstracts 44 were identified. Full-text articles were examined for eligibility and yielded 24 articles that were included in this review. Of the 24 articles included in the review, the majority (n = 11) focused on implementing contingency management in methadone clinics and opioid treatment programs. Training methods, implementation strategies, fidelity assessments, and attitudes toward the implementation of contingency management are discussed in greater detail. These findings highlight the importance of organizational input and ongoing supervision and consultation, and the need for additional research that is guided by theoretical frameworks and use rigorous study designs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Liat Kriegel
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Karl C Alcover
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Sterling McPherson
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - John M Roll
- Elson S. Floyd College of Medicine, Washington State University, Spokane
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Rash CJ, DePhilippis D. Considerations for Implementing Contingency Management in Substance Abuse Treatment Clinics: The Veterans Affairs Initiative as a Model. Perspect Behav Sci 2019; 42:479-499. [PMID: 31976446 DOI: 10.1007/s40614-019-00204-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Contingency management (CM) is an efficacious intervention for the treatment of substance use disorders that is widely applicable across a range of client populations and characteristics. Despite its strong evidence base, CM remains underutilized in real world practice. This article introduces CM for clinicians interested in adopting CM and briefly reviews this research evidence. In addition, CM protocols are described, with emphasis on the specific design considerations important to CM's efficacy. The recent Department of Veterans Affairs (VA) initiative, which represents the first successful large-scale implementation effort, is presented. It provides a model for the training and supervision components that may be critical to implementation with fidelity. Continued research in this area, as well as further demonstrations of successful dissemination and implementation, will be critical for improving the adoption of this intervention in clinical, nonresearch settings.
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Affiliation(s)
- Carla J Rash
- 1Calhoun Cardiology Center, University of Connecticut Health School of Medicine, 263 Farmington, Avenue (MC 3944), Farmington, CT 06030-3944 USA
| | - Dominick DePhilippis
- 2Center of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Veterans Administration Medical Center, Perelman School of Medicine, Department of Veterans Affairs, Pennsylvania, PA USA
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Schulte MHJ, Kaag AM, Boendermaker WJ, van den Brink W, Goudriaan AE, Wiers RW. The effect of N-acetylcysteine and working memory training on neural mechanisms of working memory and cue reactivity in regular cocaine users. Psychiatry Res Neuroimaging 2019; 287:56-59. [PMID: 30991248 DOI: 10.1016/j.pscychresns.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 12/23/2022]
Abstract
The current study investigated the combined effects of N-acetylcysteine and working memory (WM) training on behavioral and neural mechanisms of cue reactivity and WM in cocaine users in a randomized, double-blind design. Twenty-four of 38 cocaine-using men completed a 25-day treatment with either 2400 mg/day NAC or placebo. Both groups performed WM-training. During pre- and post-test lab-visits, neural mechanisms of cue reactivity and WM, and cue-induced craving and WM performance were assessed. Additionally, exploratory whole brain analyses were performed. Overall, the hypotheses were not confirmed, possibly due to small sample size, low WM-training adherence and/or ongoing substance use.
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Affiliation(s)
- Mieke H J Schulte
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Faculty of Movement and Behavioral Science, Department of Clinical, Neuro-, and Developmental Psychology, Section of Clinical Psychology, VU University, Amsterdam, the Netherlands.
| | - Anne Marije Kaag
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Wouter J Boendermaker
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Department of Experimental Psychology, Utrecht University, the Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Anna E Goudriaan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, the Netherlands; Arkin Mental Health, Amsterdam, the Netherlands
| | - Reinout W Wiers
- Addiction, Development, and Psychopathology (ADAPT) lab, Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Japuntich SJ, Lee LO, Pineles SL, Gregor K, Joos CM, Patton SC, Krishnan-Sarin S, Rasmusson AM. Contingency management and cognitive behavioral therapy for trauma-exposed smokers with and without posttraumatic stress disorder. Addict Behav 2019; 90:136-142. [PMID: 30391774 DOI: 10.1016/j.addbeh.2018.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/25/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Trauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. METHODS Fifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. RESULTS Of the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). CONCLUSIONS Use of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD.
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Irons JG, Joachim BT, Stanley TB, Rininger AM, Jarvis BP. Assessing the Utility of a Brief Abstinence Test for Initiating Caffeine Abstinence. J Caffeine Adenosine Res 2019. [DOI: 10.1089/caff.2018.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica G. Irons
- Department of Psychology, James Madison University, Harrisonburg, Virginia
| | - Bradley T. Joachim
- Department of Psychology, James Madison University, Harrisonburg, Virginia
| | - Taylor B. Stanley
- Department of Psychology, James Madison University, Harrisonburg, Virginia
| | - Ashley M. Rininger
- Department of Psychology, James Madison University, Harrisonburg, Virginia
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Sloas L, Murphy A, Wooditch A, Taxman FS. Assessing the Use and Impact of Points and Rewards across Four Federal Probation Districts: A Contingency Management Approach. VICTIMS & OFFENDERS 2019; 14:811-831. [PMID: 33041726 PMCID: PMC7545962 DOI: 10.1080/15564886.2019.1656691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Contingency management (CM) is a well-acknowledged behavioral approach for incentivizing changes in behavior and attitudes. A version of CM was piloted in four federal probation districts to determine whether systematically awarding points and rewards for key behaviors could be implemented and impact recidivism rates. A case controlled match design was conducted with a CM sample (referred to as Justice Steps (JSTEPS)) (n=128) who were individually matched to a comparison sample (n=128) on six variables related to recidivism. Analyses compared the number of technical violations and new arrests between JSTEPS participants and a historical comparison sample. Using Kaplan-Meier survival analysis, results indicate JSTEPS sites using early CM rewarding strategies tend have delayed recidivism than others. A research agenda is outlined.
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Affiliation(s)
- Lincoln Sloas
- College for Design and Social Inquiry, School of Criminology and Criminal Justice, Florida Atlantic University, 777 Glades Road, SO 221, Boca Raton, FL 33431
| | - Amy Murphy
- Center for Advancing Correctional Excellence, George Mason University, Fairfax, VA 22030
| | - Alese Wooditch
- Temple University, Department of Criminal Justice, 529 Gladfelter Hall | 1115 Polett Walk, Philadelphia, PA 19122
| | - Faye S Taxman
- Criminology, Law & Society, Center for Advancing Correctional Excellence!, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030
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Wilfley DE, Hayes JF, Balantekin KN, Van Buren DJ, Epstein LH. Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice. AMERICAN PSYCHOLOGIST 2018; 73:981-993. [PMID: 30394777 PMCID: PMC6220709 DOI: 10.1037/amp0000293] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Obesity in adults has nearly doubled in the past 30 years and has risen similarly in children and adolescents. Obesity affects all systems of the body, and the serious health consequences of obesity include an increased risk for cardiovascular disease, such as Type 2 diabetes or high blood pressure, which are occurring at ever younger ages. The present article introduces traditional behavioral weight loss strategies designed to change energy-balance behaviors (i.e., dietary and physical activity behaviors) and the contexts within which these interventions have typically been delivered. The applicability of findings from behavioral economics, cognitive processing, and clinical research that may lead to more potent weight loss and weight loss maintenance interventions are also considered. Given the pervasiveness of obesity, this article concludes with a discussion of efforts toward wider scale dissemination and implementation of behavioral treatments designed to address obesity and to reduce the risk of cardiovascular disease. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
- Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine
| | - Jacqueline F Hayes
- Department of Psychological and Brain Sciences, Washington University in St. Louis
| | | | | | - Leonard H Epstein
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, University at Buffalo
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Schuster RM, Gilman J, Schoenfeld D, Evenden J, Hareli M, Ulysse C, Nip E, Hanly A, Zhang H, Evins AE. One Month of Cannabis Abstinence in Adolescents and Young Adults Is Associated With Improved Memory. J Clin Psychiatry 2018; 79:17m11977. [PMID: 30408351 PMCID: PMC6587572 DOI: 10.4088/jcp.17m11977] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/01/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Associations between adolescent cannabis use and poor neurocognitive functioning have been reported from cross-sectional studies that cannot determine causality. Prospective designs can assess whether extended cannabis abstinence has a beneficial effect on cognition. METHODS Eighty-eight adolescents and young adults (aged 16-25 years) who used cannabis regularly were recruited from the community and a local high school between July 2015 and December 2016. Participants were randomly assigned to 4 weeks of cannabis abstinence, verified by decreasing 11-nor-9-carboxy-∆⁹-tetrahydrocannabinol urine concentration (MJ-Abst; n = 62), or a monitoring control condition with no abstinence requirement (MJ-Mon; n = 26). Attention and memory were assessed at baseline and weekly for 4 weeks with the Cambridge Neuropsychological Test Automated Battery. RESULTS Among MJ-Abst participants, 55 (88.7%) met a priori criteria for biochemically confirmed 30-day continuous abstinence. There was an effect of abstinence on verbal memory (P = .002) that was consistent across 4 weeks of abstinence, with no time-by-abstinence interaction, and was driven by improved verbal learning in the first week of abstinence. MJ-Abst participants had better memory overall and at weeks 1, 2, 3 than MJ-Mon participants, and only MJ-Abst participants improved in memory from baseline to week 1. There was no effect of abstinence on attention: both groups improved similarly, consistent with a practice effect. CONCLUSIONS This study suggests that cannabis abstinence is associated with improvements in verbal learning that appear to occur largely in the first week following last use. Future studies are needed to determine whether the improvement in cognition with abstinence is associated with improvement in academic and other functional outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03276221.
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Affiliation(s)
- Randi Melissa Schuster
- Center for Addiction Medicine, Massachusetts General Hospital, 101 Merrimac St, Ste 320, Boston, MA 02114. .,Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodi Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David Schoenfeld
- Department of Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | - Maya Hareli
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Christine Ulysse
- Department of Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Emily Nip
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Ailish Hanly
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA;,University of Massachusetts Medical School, Worcester, MA
| | - Haiyue Zhang
- Department of Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Metrebian N, Weaver T, Pilling S, Hellier J, Byford S, Shearer J, Mitcheson L, Astbury M, Bijral P, Bogdan N, Bowden-Jones O, Day E, Dunn J, Finch E, Forshall S, Glasper A, Morse G, Akhtar S, Bajaria J, Bennett C, Bishop E, Charles V, Davey C, Desai R, Goodfellow C, Haque F, Little N, McKechnie H, Morris J, Mosler F, Mutz J, Pauli R, Poovendran D, Slater E, Strang J. Positive reinforcement targeting abstinence in substance misuse (PRAISe): Study protocol for a Cluster RCT & process evaluation of contingency management. Contemp Clin Trials 2018; 71:124-132. [PMID: 29908336 DOI: 10.1016/j.cct.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 10/14/2022]
Abstract
There are approximately 256,000 heroin and other opiate users in England of whom 155,000 are in treatment for heroin (or opiate) addiction. The majority of people in treatment receive opiate substitution treatment (OST) (methadone and buprenorphine). However, OST suffers from high attrition and persistent heroin use even whilst in treatment. Contingency management (CM) is a psychological intervention based on the principles of operant conditioning. It is delivered as an adjunct to existing evidence based treatments to amplify patient benefit and involves the systematic application of positive reinforcement (financial or material incentives) to promote behaviours consistent with treatment goals. With an international evidence base for CM, NICE recommended that CM be implemented in UK drug treatment settings alongside OST to target attendance and the reduction of illicit drug use. While there was a growing evidence base for CM, there had been no examination of its delivery in UK NHS addiction services. The PRAISe trial evaluates the feasibility, acceptability, clinical and cost effectiveness of CM in UK addiction services. It is a cluster randomised controlled effectiveness trial of CM (praise and financial incentives) targeted at either abstinence from opiates or attendance at treatment sessions versus no CM among individuals receiving OST. The trial includes an economic evaluation which explores the relative costs and cost effectiveness of the two CM intervention strategies compared to TAU and an embedded process evaluation to identify contextual factors and causal mechanisms associated with variations in outcome. This study will inform UK drug treatment policy and practice. Trial registration ISRCTN 01591254.
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Affiliation(s)
- N Metrebian
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - T Weaver
- Imperial College London, London, UK; Middlesex University, London, UK
| | - S Pilling
- University College London, London, UK
| | - J Hellier
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - S Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Shearer
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - L Mitcheson
- South London and Maudsley NHS Foundation Trust, London, UK
| | - M Astbury
- Dudley & Walsall Mental Health Partnership Trust, Dudley, UK
| | - P Bijral
- Change, Grow, Live Charity, Management Offices, London, UK
| | - N Bogdan
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - O Bowden-Jones
- Central and North West London NHS Foundation Trust, London, UK
| | - E Day
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Dunn
- Camden & Islington NHS Foundation Trust, London, UK
| | - E Finch
- South London and Maudsley NHS Foundation Trust, London, UK
| | - S Forshall
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - A Glasper
- Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - G Morse
- Turning Point Charity, London, UK
| | - S Akhtar
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - J Bajaria
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - C Bennett
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - E Bishop
- University College London, London, UK
| | - V Charles
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - C Davey
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - R Desai
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - F Haque
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - N Little
- University College London, London, UK
| | | | - J Morris
- Avon & Wiltshire Mental Health Partnership NHS Trust, Bristol, UK
| | - F Mosler
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - J Mutz
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - R Pauli
- Birmingham & Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | | | - E Slater
- South Essex Partnership NHS Foundation Trust, Essex, UK
| | - J Strang
- King's College London, National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Randall J, Cunningham PB, Henggeler SW. The Development and Transportability of Multisystemic Therapy-Substance Abuse: A Treatment for Adolescents with Substance Use Disorders. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017. [DOI: 10.1080/1067828x.2017.1411301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jeff Randall
- Medical University of South Carolina, Charleston, SC, USA
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43
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Alessi SM, Rash CJ, Petry NM. A Randomized Trial of Adjunct mHealth Abstinence Reinforcement With Transdermal Nicotine and Counseling for Smoking Cessation. Nicotine Tob Res 2017; 19:290-298. [PMID: 27613901 DOI: 10.1093/ntr/ntw155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022]
Abstract
Introduction Abstinence reinforcement is efficacious for improving smoking treatment outcomes, but practical constraints related to the need for multiple in-person carbon monoxide (CO) breath tests daily to verify smoking abstinence have limited its use. This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals' natural environment. Methods Eligible treatment-seeking smokers (N = 90) were randomized to (1) usual care and ecological monitoring with abstinence reinforcement (mHealth reinforcement) or (2) without reinforcement (mHealth monitoring). Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling. Following training, an interactive voice response system prompted participants to conduct CO tests 1-3 daily at pseudorandom times (7 am to 10 pm) for 4 weeks. When prompted, participants used a study cell phone and CO monitor to complete a CO self-test, video record the process, and submit videos using multimedia messaging. mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests. The interactive voice response generated preliminary earnings immediately. Earnings were finalized by comparing video records against participants' self-reports. Results mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests, longest duration of prolonged abstinence, and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring (p < .01, d = 0.8-1.3). Follow-up (weeks 4-24) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked (p ≤ .05); values were comparable by week 24. Conclusions mHealth reinforcement has short-term efficacy. Research on methods to enhance and sustain benefits is needed. Implications This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research, engage, and support smokers trying to quit that do not exist with conventional (not technology-based) reinforcement interventions.
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Affiliation(s)
- Sheila M Alessi
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
| | - Carla J Rash
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
| | - Nancy M Petry
- School of Medicine and Calhoun Cardiology Center - Behavioral Health, University of Connecticut, Farmington, CT
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44
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Alessi SM, Barnett NP, Petry NM. Experiences with SCRAMx alcohol monitoring technology in 100 alcohol treatment outpatients. Drug Alcohol Depend 2017; 178:417-424. [PMID: 28709081 PMCID: PMC5569301 DOI: 10.1016/j.drugalcdep.2017.05.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 05/02/2017] [Accepted: 05/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transdermal alcohol monitoring technology allows for new research on alcohol use disorders. This study assessed feasibility, acceptability, and adherence with this technology in the context of two clinical research trials. METHODS Participants were the first 100 community-based alcohol treatment outpatients enrolled in randomized studies that monitored drinking with the secure continuous remote alcohol monitor (SCRAMx®) for 12 weeks. Study 1 participants were randomized to usual care (n=36) or usual care with contingency management incentives for treatment attendance (CM-Att; n=30). Study 2 participants were randomized to usual care (n=17) or usual care with CM for each day of no drinking per SCRAMx (CM-Abst; n=17). After 12 weeks, participants completed a survey about the bracelet. RESULTS Nine percent of individuals screened (54 of 595) declined participation because of the bracelet. Of participants, 84% provided 12weeks of data, and 96% of bracelets were returned fully intact. Ninety-four equipment tampers occurred, affecting 2% of monitoring days; 56% (67) of tampers coincided with detected drinking. Common concerns reported by participants were skin marks (58%), irritation (54%), and interfered with clothing choices (51%), but severity ratings were generally mild (60%-94%). Eighty-one percent of participants reported that the bracelet helped them reduce drinking, and 75% indicated that they would wear it for longer. A common suggestion for improvement was to reduce the size of the bracelet. CONCLUSIONS Results support the viability of transdermal monitoring in voluntary substance abuse treatment participants for an extended duration. Issues to consider for future applications of this technology are discussed.
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Affiliation(s)
- Sheila M Alessi
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
| | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA.
| | - Nancy M Petry
- University of Connecticut School of Medicine and Calhoun Cardiology Center - Behavioral Health, 263 Farmington Avenue, Farmington, CT 06030-3944, USA.
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DeVito EE, Dong G, Kober H, Xu J, Carroll KM, Potenza MN. Functional neural changes following behavioral therapies and disulfiram for cocaine dependence. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:534-547. [PMID: 28714728 DOI: 10.1037/adb0000298] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A growing literature exists on neural correlates of treatment outcome. However, different types-or components of-treatment have distinct theorized mechanisms of action. And it is not yet known how changes in neural activity across treatment relate to engagement in different treatment components. Participants with cocaine use disorders in a randomized clinical trial received cognitive-behavioral therapy (CBT) plus, in a 2 × 2 design, contingency management (CM) or no CM, and disulfiram or placebo. Participants performed a functional MRI Stroop task, a measure of cognitive control, at the beginning of and after the 12-week treatment. Analyses assessed changes in Stroop-related neural activity within the sample overall and assessed how changes in Stroop-related activity correlated with measures of treatment process specific to each form of treatment (i.e., participation in CBT sessions, receipt of CM prizes, administration of disulfiram pills). Within the sample overall, compared with beginning of treatment, posttreatment Stroop-related neural activity was diminished in the hippocampus, thalamus, cingulate, precentral, post- and precentral gyrus, and precuneus and culmen regions (pFWE < .05). In separate whole-brain correlation analyses, greater reductions in Stroop-related activity were associated with more treatment engagement-"CBT sessions" with the precentral gyrus, inferior parietal lobule, and middle and medial frontal gyrus; "CM prizes" with the postcentral frontal gyrus. Disulfiram "medication days" were not associated with changes in Stroop-related activity. Findings suggest that key process indicators of CBT and CM may be associated with functional changes in cognitive-control-related neurocircuitry. (PsycINFO Database Record
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Affiliation(s)
- Elise E DeVito
- Department of Psychiatry, Yale University School of Medicine
| | - Guangheng Dong
- Department of Psychiatry, Yale University School of Medicine
| | - Hedy Kober
- Department of Psychiatry, Yale University School of Medicine
| | - Jiansong Xu
- Department of Psychiatry, Yale University School of Medicine
| | | | - Marc N Potenza
- Department of Psychiatry, Neurobiology, and Child Study Center, Yale University School of Medicine
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46
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Barnett NP, Celio MA, Tidey JW, Murphy JG, Colby SM, Swift RM. A preliminary randomized controlled trial of contingency management for alcohol use reduction using a transdermal alcohol sensor. Addiction 2017; 112:1025-1035. [PMID: 28107772 PMCID: PMC5407929 DOI: 10.1111/add.13767] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/22/2016] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
Abstract
AIMS We tested the efficacy of daily contingent reinforcement for reducing alcohol use compared with (yoked) non-contingent reinforcement (NR) using a transdermal alcohol sensor to detect alcohol use. DESIGN Pilot randomized controlled design with 1 baseline week, 3 intervention weeks and 1-month follow-up. SETTING New England, USA. PARTICIPANTS Heavy drinking adults (46.7% female) not seeking treatment were randomized to (1) an escalating schedule of cash reinforcement (CR; n = 15) for days on which alcohol was neither reported nor detected or (2) yoked NR (n = 15). INTERVENTION AND COMPARATOR Reinforcement for CR participants started at $5 and increased $2 every subsequent day on which alcohol was not detected or reported, to a maximum of $17. Participants received no reinforcement for days on which alcohol use was detected or reported, and the reinforcer value was re-set to $5 the day after a drinking day. NR participants were yoked to the daily reinforcer value of an individual in the CR condition, in order of enrollment. Paired participants in CR and NR therefore received the same amount of money, but the amount for the NR participant was not behavior-related. MEASUREMENTS The primary outcome was percentage of days without sensor-detected drinking. Secondary outcomes were number of consecutive days with no detected drinking, peak transdermal alcohol concentration (TAC), self-reported drinks per week and drinking below NIH low-risk guidelines. FINDINGS Controlling for baseline, CR had a higher percentage of days with no drinking detected (54.3%) than NR (31.2%) during intervention weeks [P = 0.05, Cohen's d = 0.74; 95% confidence interval (CI) = 0.007-1.47]. The longest period of consecutive days with no drinking detected was 8.0 for CR versus 2.9 for NR (P = 0.03, d = 0.85; 95% CI = 0.08-1.61). Peak TAC during intervention showed a non-significant group difference (P = 0.20; d = 0.48; 95% CI = 0.00-1.18); a similar result was found for drinks per week (P = 0.12; d = 0.59; 95% CI = 0.00-1.30). Four times more participants in CR drank below NIH low-risk drinking guidelines during intervention than did participants in NR: 31.1 versus 7.1% (P = 0.07; d = 0.71; 95% CI = -0.04 to 1.46). At 1-month follow-up, the highest number of consecutive days without drinking (self-report) did not differ significantly between conditions (P = 0.26), but showed a medium effect size (d = 0.44; 95% CI = -0.32 to 1.18). CONCLUSIONS Cash incentives linked to a transdermal alcohol sensor can reduce heavy alcohol consumption while the incentives are in operation.
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Affiliation(s)
- Nancy P. Barnett
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912
| | - Mark A. Celio
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912
| | - James G. Murphy
- Department of Psychology, University of Memphis, Memphis, TN 38152
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912
| | - Robert M. Swift
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912
- VA Medical Center, Providence RI 02908
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47
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A Comparison of Five Reinforcement Schedules for use in Contingency Management-Based Treatment of Methamphetamine Abuse. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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48
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Ndasauka Y, Wei Z, Zhang X. Received View of Addiction, Relapse and Treatment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1010:3-19. [PMID: 29098665 DOI: 10.1007/978-981-10-5562-1_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is important to highlight that attempts at understanding and explaining addiction have been made for centuries. It is, however, just five decades ago, with the growth of science and technology that more interest has been observed in this field. This chapter examines different views and theories that have been posited to understand and explain addiction. More attention will be given to prominent views that seem to draw consensus among researchers and medical practitioners. The first section of the chapter introduces the addiction debate, the different theories that have been provided to explain it from different perspectives and disciplines such as neurosciences, philosophy and psychology. Then, the chapter discusses different views on the role of relapse and what it entails in understanding addiction. The second section discusses different proposed and used forms of treating addiction. Thus, the chapter discusses the received view of addiction, the understanding of relapse as a critical element in addiction and treatments.
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Affiliation(s)
- Yamikani Ndasauka
- Chancellor College, University of Malawi, Zomba, Malawi.,School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, 230026, China
| | - Zhengde Wei
- Key Laboratory of Brain Function and Disease, Chinese Academy of Sciences, School of Life Sciences, University of Science & Technology of China, Hefei, Anhui, 230027, China
| | - Xiaochu Zhang
- Key Laboratory of Brain Function and Disease, Chinese Academy of Sciences, and School of Life Sciences, University of Science & Technology of China, Hefei, Anhui, 230027, China. .,School of Humanities & Social Science, University of Science & Technology of China, Hefei, Anhui, 230026, China. .,Centers for Biomedical Engineering, University of Science & Technology of China, Hefei, Anhui, 230027, China.
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49
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Hall EA, Prendergast ML, Warda U. A Randomized Trial of the Effectiveness of Using Incentives to Reinforce Parolee Attendance in Community Addiction Treatment. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616679828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was a randomized effectiveness trial of the use of incentives to improve treatment retention and post-treatment outcomes among parolees in community treatment. Parolees entering community treatment were randomized to incentives ( N = 104) or brief education ( N = 98). It was hypothesized that the use of incentives to increase treatment retention would result in improved post-treatment outcomes (i.e., arrest, employment, and drug use), but at 18 months post-intake, there were no group differences for any outcome. In secondary analyses, rearrest by 18 months post-intake was predicted by substance use, greater number or severity of psychological symptoms, treatment non-completion, unemployment, and younger age. Contrary to expectations, results indicated that participants who received incentives for attendance had arrest, employment, and drug use outcomes similar to those who received a brief education session. Our findings, in concert with those of several other researchers, suggest that there may be certain populations or settings where incentives may not be effective.
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Affiliation(s)
| | | | - Umme Warda
- University of California, Los Angeles, USA
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50
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Apel AB, Diller JW. Prison as Punishment: A Behavior-Analytic Evaluation of Incarceration. THE BEHAVIOR ANALYST 2016; 40:243-256. [PMID: 31976937 DOI: 10.1007/s40614-016-0081-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The USA currently imprisons over 2.2 million people (Glaze and Kaeble, 2014). Of those, about 70 % will be rearrested within 3 years of release (Durose, Cooper, & Synder, 2014). If prison is viewed as a large-scale intervention, it lacks empirical support of effectiveness. The present paper reviews criminological data related to incarceration and evaluates components of imprisonment in light of behavior-analytic research on punishment. These factors include elements such as the individual's learning history and aspects of the punisher (e.g., intensity and immediacy). Partnering with other professionals, behavior analysts interested in this area could apply their skills in research and practice to help mitigate a large-scale problem of great social significance.
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Affiliation(s)
- Alexis B Apel
- 1Department of Psychology, Eastern Connecticut State University, 83 Windham Street, Willimantic, CT 06226 USA.,2Boston College, Chestnut Hill, MA USA
| | - James W Diller
- 1Department of Psychology, Eastern Connecticut State University, 83 Windham Street, Willimantic, CT 06226 USA
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