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McCann DJ, Chen HH, Devine EG, Gyaw S, Ramey T. Results of a randomized, double-blind, placebo-controlled trial of lorcaserin in cocaine use disorder. Drug Alcohol Depend 2024; 255:111063. [PMID: 38163425 PMCID: PMC10872513 DOI: 10.1016/j.drugalcdep.2023.111063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Cocaine use disorder (CUD) is a major public health problem for which there is no approved pharmacotherapy. The primary purpose of this study was to evaluate the ability of lorcaserin, a 5-hydroxytryptamine2 C (5-HT2 C) receptor agonist, to facilitate abstinence in individuals seeking treatment for CUD. METHODS This was a 12-site, randomized, parallel arm study with a 13-week Treatment Phase that included a 1-week, single-blind run-in period when all participants received twice daily 15mg acetazolamide capsules (a medication adherence marker), followed by randomization to either twice daily 10mg lorcaserin or placebo capsules for the remaining 12 weeks. Pre-randomization data were utilized in an enrichment strategy aimed at achieving high levels of medication adherence and low placebo response rates in a subgroup of participants that qualified for the "efficacy population." For lorcaserin vs. placebo, the primary efficacy endpoint was the proportion of participants in the efficacy population achieving abstinence during the last three weeks of treatment, as evidenced by self-report of no cocaine use, confirmed by urine testing. RESULTS Within the efficacy population, 1.1% of 91 participants receiving lorcaserin and 4.3% of 92 receiving placebo achieved abstinence during the last 3 weeks of treatment. Among all randomized participants, 2.5% of 118 receiving lorcaserin and 5.6% of 124 receiving placebo achieved similar abstinence. Study participants receiving lorcaserin exhibited significantly greater reductions in body weight and BMI, indicating that medication adherence was sufficient to produce a pharmacological effect. CONCLUSIONS Twice daily 10mg lorcaserin failed to demonstrate efficacy in the treatment of CUD.
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Affiliation(s)
- David J McCann
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Hegang H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Eric G Devine
- Department of Psychiatry, Boston University Aram V. Chobanian & Edward Avedisian School of Medicine, Boston, MA, USA.
| | - Shwe Gyaw
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
| | - Tatiana Ramey
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD, USA.
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Devine EG, Pingitore AM, Margiotta KN, Hadaway NA, Reid K, Peebles K, Hyun JW. Frequency of concealment, fabrication and falsification of study data by deceptive subjects. Contemp Clin Trials Commun 2021; 21:100713. [PMID: 33604482 PMCID: PMC7876535 DOI: 10.1016/j.conctc.2021.100713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/29/2020] [Accepted: 01/15/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Many studies have found evidence that research subjects engage in deceptive practices while participating in health-related studies. Little is known, however, about how often subjects use deception and the percentage of studies a typical subject will contaminate with false data. This study examined the frequency of use of different types of deception among a sample of subjects who admit to using deception. Methods A sample of 59 subjects who had participated in at least two health-related studies in the past 12 months and admitted to using deception in at least one were interviewed. Subjects were asked a series of questions about concealing information and fabricating information to gain entry into studies. Subjects were also asked about falsifying data after being enrolled in a health-related study. All study data reported pertains to only subjects who reported using deception in health-related studies and is based on subjects’ study participation only within the last 12 months from the date of the interview. Results Subjects who conceal information in order to enroll in trials reported using concealment in about two thirds (67%) of the trials they participated in over the past 12 months. On average, these subjects’ use of concealment was highest for mental health information (58% of studies) and physical health information (57% of studies). The average frequency of fabricating information in order to enroll in trials was 53% with exaggerating health symptoms (45% of studies) and pretending to have a health condition (39% of studies) as the two most widely used strategies. Subjects who falsify study data after enrollment reported doing so 40% of the time. These subjects falsely reported improvement in the health condition being studied in 38% of the trials they took part in. Subjects who admitted to throwing away study medication to create the appearance of compliance reported doing so 32% of the time. Limitations Although this study provides evidence that subjects who admit to using deception contaminate a high percentage of studies, larger and more geographically diverse samples are needed to understand the full extent of the problem of deceptive subjects in research. Regional economic, cultural, or organizational factors may be related to the rate of subjects using deception. It is also possible that this sample underrepresents the use of deception as there are likely subjects who use deception that would be unwilling to admit the extent of this behavior. Conclusion Deceptive subject's behavior poses a threat to the integrity of research findings. Given that deceptive subjects contaminate a high percentage of studies they take part in by concealing information, fabricating information, and falsifying study data after enrollment, efforts to identify and exclude these subjects is important to the integrity of research findings. Strategies to exclude deceptive subjects from health research should be used to inform study designs. Widespread adoption of research subject identity registries could greatly reduce the scope of studies that a single deceptive subject could contaminate. Technological solutions that provide an objective measure of medication compliance may be valuable tools for limiting fraudulent reports of compliance.
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Affiliation(s)
- Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Alyssa M Pingitore
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn N Margiotta
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Natalia A Hadaway
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kathleen Reid
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Kristina Peebles
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Jae Won Hyun
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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Gewandter JS, Dworkin RH, Turk DC, Devine EG, Hewitt D, Jensen MP, Katz NP, Kirkwood AA, Malamut R, Markman JD, Vrijens B, Burke L, Campbell JN, Carr DB, Conaghan PG, Cowan P, Doyle MK, Edwards RR, Evans SR, Farrar JT, Freeman R, Gilron I, Juge D, Kerns RD, Kopecky EA, McDermott MP, Niebler G, Patel KV, Rauck R, Rice ASC, Rowbotham M, Sessler NE, Simon LS, Singla N, Skljarevski V, Tockarshewsky T, Vanhove GF, Wasan AD, Witter J. Improving Study Conduct and Data Quality in Clinical Trials of Chronic Pain Treatments: IMMPACT Recommendations. J Pain 2019; 21:931-942. [PMID: 31843583 DOI: 10.1016/j.jpain.2019.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 11/30/2022]
Abstract
The estimated probability of progressing from phase 3 analgesic clinical trials to regulatory approval is approximately 57%, suggesting that a considerable number of treatments with phase 2 trial results deemed sufficiently successful to progress to phase 3 do not yield positive phase 3 results. Deficiencies in the quality of clinical trial conduct could account for some of this failure. An Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials meeting was convened to identify potential areas for improvement in trial conduct in order to improve assay sensitivity (ie, ability of trials to detect a true treatment effect). We present recommendations based on presentations and discussions at the meeting, literature reviews, and iterative revisions of this article. The recommendations relate to the following areas: 1) study design (ie, to promote feasibility), 2) site selection and staff training, 3) participant selection and training, 4) treatment adherence, 5) data collection, and 6) data and study monitoring. Implementation of these recommendations may improve the quality of clinical trial data and thus the validity and assay sensitivity of clinical trials. Future research regarding the effects of these strategies will help identify the most efficient use of resources for conducting high quality clinical trials. PERSPECTIVE: Every effort should be made to optimize the quality of clinical trial data. This manuscript discusses considerations to improve conduct of pain clinical trials based on research in multiple medical fields and the expert consensus of pain researchers and stakeholders from academia, regulatory agencies, and industry.
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Affiliation(s)
| | | | | | | | | | | | - Nathaniel P Katz
- Analgesic Solutions, Natick, Massachusetts; Tufts University, Boston, Massachusetts
| | - Amy A Kirkwood
- CR UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | | | - John D Markman
- University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Daniel B Carr
- Tufts University School of Medicine, Boston, Massachusetts
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, & NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Penney Cowan
- American Chronic Pain Association, Rocklin, California
| | | | | | - Scott R Evans
- George Washington University, Washington, District of Columbia
| | - John T Farrar
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roy Freeman
- Brigham & Women's Hospital, Boston, Massachusetts
| | - Ian Gilron
- Queen's University, Kingston, Ontario, Canada
| | - Dean Juge
- Horizon Pharma, Lake Forest, Illinois
| | | | | | | | | | | | - Richard Rauck
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | | | | | - Neil Singla
- Lotus Clinical Research, Pasadena, California
| | | | | | | | - Ajay D Wasan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James Witter
- National Institutes of Health, Bethesda, Maryland
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Falk DE, Ryan ML, Fertig JB, Devine EG, Cruz R, Brown ES, Burns H, Salloum IM, Newport DJ, Mendelson J, Galloway G, Kampman K, Brooks C, Green AI, Brunette MF, Rosenthal RN, Dunn KE, Strain EC, Ray L, Shoptaw S, Ait-Daoud Tiouririne N, Gunderson EW, Ransom J, Scott C, Leggio L, Caras S, Mason BJ, Litten RZ. Gabapentin Enacarbil Extended-Release for Alcohol Use Disorder: A Randomized, Double-Blind, Placebo-Controlled, Multisite Trial Assessing Efficacy and Safety. Alcohol Clin Exp Res 2018; 43:158-169. [PMID: 30403402 DOI: 10.1111/acer.13917] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several single-site alcohol treatment clinical trials have demonstrated efficacy for immediate-release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended-release (GE-XR) (HORIZANT® ), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). METHODS Men and women (n = 346) who met DSM-5 criteria for at least moderate AUD were recruited across 10 U.S. clinical sites. Participants received double-blind GE-XR (600 mg twice a day) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were prespecified for the last 4 weeks of the treatment period. RESULTS The GE-XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs. 21.5, respectively, p = 0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol-related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side-effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. CONCLUSIONS Overall, GE-XR at 600 mg twice a day did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE-XR is not effective in treating AUD, at least not at doses approved by the U.S. Food and Drug Administration for treating other medical conditions.
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Affiliation(s)
- Daniel E Falk
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Megan L Ryan
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Joanne B Fertig
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
| | - Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Ricardo Cruz
- Section of General Internal Medicine, Department of Medicine, School of Medicine and Boston Medical Center, Section of General Internal Medicine, Boston University, Boston, Massachusetts
| | - E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather Burns
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ihsan M Salloum
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - D Jeffrey Newport
- Division of Alcohol and Substance Abuse, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Kyle Kampman
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Catherine Brooks
- Department of Psychiatry, Perelman School of Medicine, Center for Studies of Addiction, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan I Green
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Richard N Rosenthal
- Division of Addiction Psychiatry, Stony Brook University, Stony Brook, New York.,Mount Sinai St. Luke's Hospital, New York, New York
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric C Strain
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lara Ray
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Steven Shoptaw
- Department of Family Medicine and of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Erik W Gunderson
- Department of Psychiatry and Neurobehavioral Sciences and Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Janet Ransom
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Charles Scott
- Fast Track Drugs and Biologics, North Potomac, Maryland
| | - Lorenzo Leggio
- Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | | | - Barbara J Mason
- Department of Neuroscience, The Scripps Research Institute, La Jolla, California
| | - Raye Z Litten
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland
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Devine EG, Peebles KR, Martini V. Strategies to exclude subjects who conceal and fabricate information when enrolling in clinical trials. Contemp Clin Trials Commun 2016; 5:67-71. [PMID: 29740622 PMCID: PMC5936691 DOI: 10.1016/j.conctc.2016.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/14/2016] [Accepted: 12/12/2016] [Indexed: 11/17/2022] Open
Abstract
Clinical trials within the US face an increasing challenge with the recruitment of quality candidates. One readily available group of subjects that have high rates of participation in clinical research are subjects who enroll in multiple trials for the purpose of generating income through study payments. Aside from issues of safety and generalizability, evidence suggests that these subjects employ methods of deception to qualify for the strict entrance criteria of some studies, including concealing information and fabricating information. Including these subjects in research poses a significant risk to the integrity of data quality and study designs. Strategies to limit enrollment of subjects whose motivation is generating income have not been systematically addressed in the literature. The present paper is intended to provide investigators with a range of strategies for developing and implementing a study protocol with protections to minimize the enrollment of subjects whose primary motivation for enrolling is to generate income. This multifaceted approach includes recommendations for advertising strategies, payment strategies, telephone screening strategies, and baseline screening strategies. The approach also includes recommendations for attending to inconsistent study data and subject motivation. Implementing these strategies may be more or less important depending upon the vulnerability of the study design to subject deception. Although these strategies may help researchers exclude subjects with a higher rate of deceptive practices, widespread adoption of subject registries would go a long way to decrease the chances of subjects enrolling in multiple studies or more than once in the same study.
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Affiliation(s)
- Eric G. Devine
- Corresponding author. Department of Psychiatry, Boston University School of Medicine, Suite 1150, Doctors Office Building, 720 Harrison Avenue, Boston, MA, 02118, USA.
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6
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Devine EG, Ryan ML, Falk DE, Fertig JB, Litten RZ. An exploratory evaluation of Take Control: A novel computer-delivered behavioral platform for placebo-controlled pharmacotherapy trials for alcohol use disorder. Contemp Clin Trials 2016; 50:178-85. [PMID: 27521807 DOI: 10.1016/j.cct.2016.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/29/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
Placebo-controlled pharmacotherapy trials for alcohol use disorder (AUD) require an active behavioral platform to avoid putting participants at risk for untreated AUD and to better assess the effectiveness of the medication. Therapist-delivered platforms (TDP) can be costly and present a risk to study design because of the variability in therapist fidelity. Take Control is a novel computer-delivered behavioral platform developed for use in pharmacotherapy trials sponsored by the National Institute on Alcohol Abuse and Alcoholism Clinical Investigations Group (NCIG). This behavioral platform was developed with the goal of reducing trial implementation costs and limiting potential bias introduced by therapists providing TDP. This exploratory study is the first to compare Take Control with TDP on measures related to placebo response rate, medication adherence, and participant retention. Data were drawn from the placebo arms of four multisite, double-blind, randomized controlled trials (RCT) for AUD conducted by NCIG from 2007 to 2015. Data were compared from subjects receiving TDP (n=156) in two RCTs and Take Control (n=155) in another two RCTs. Placebo response rate, as represented by weekly percentage of heavy drinking days, was similar between groups. Subjects who received Take Control had a higher rate of medication adherence than those who received TDP. Subject retention was not significantly different between groups. The findings suggest that Take Control is comparable to TDP on measures of retention, medication adherence, and placebo response. Additional research is needed to evaluate Take Control directly against TDPs in a randomized trial.
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Affiliation(s)
- Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Megan L Ryan
- NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Daniel E Falk
- NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Joanne B Fertig
- NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
| | - Raye Z Litten
- NIAAA's Clinical Investigations Group (NCIG), Division of Medications Development, National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, USA
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Devine EG, Knapp CM, Sarid-Segal O, O'Keefe SM, Wardell C, Baskett M, Pecchia A, Ferrell K, Ciraulo DA. Payment expectations for research participation among subjects who tell the truth, subjects who conceal information, and subjects who fabricate information. Contemp Clin Trials 2014; 41:55-61. [PMID: 25530307 DOI: 10.1016/j.cct.2014.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 10/24/2022]
Abstract
Multiple models guide researchers' payment practices but few studies have assessed subjects' expectations for payment. Payments in excess of subjects' expectations may result in undue inducement, while payments below these expectations may be associated with exploitation. Data on subjects' payment expectations will help inform practices to avoid undue inducement and exploitation. This study examined subjects' expectations for payment for common research procedures and explored the relationship between subjects' honesty and payment expectations. One-hundred subjects who participated in two or more studies in the last year reported the minimum payment they expect for completing study procedures. They were also asked about their use of deception while screening for studies. Subjects expected $20 on average to complete the least risky and least burdensome procedure. Subjects' expectations for payment consistently increased with greater procedure risks. Subjects who denied using deception to enroll in studies refused more procedures than subjects who reported using deception. Among subjects who used deception, the rate of procedure refusal increased with procedure risks, suggesting that these subjects have some risk aversion and may act to protect themselves from undue inducement. Although subjects expect greater payments for more risky procedures, ethical considerations for limiting undue inducement may prevent researchers from meeting subjects' expectations. Subjects who use deceptive practices appear to be more risk-tolerant than subjects who deny using deception; nonetheless, these deceptive subjects also exercise some risk aversion when they refuse higher-risk procedures. These subjects may be able to protect themselves from undue inducement by refusing procedures that exceed their risk tolerance.
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Affiliation(s)
- Eric G Devine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
| | - Clifford M Knapp
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Ofra Sarid-Segal
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Sean M O'Keefe
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Cale Wardell
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Morgan Baskett
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Ashley Pecchia
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Katie Ferrell
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Domenic A Ciraulo
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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DeMartini KS, Devine EG, DiClemente CC, Martin DJ, Ray LA, O'Malley SS. Predictors of pretreatment commitment to abstinence: results from the COMBINE study. J Stud Alcohol Drugs 2014; 75:438-46. [PMID: 24766756 DOI: 10.15288/jsad.2014.75.438] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Patients entering treatment for alcohol problems do not have uniform treatment goals, and a pretreatment drinking goal has a significant impact on treatment outcome. The objective of this study was to understand better how an array of individual characteristics, including factors that affect treatment, are related to treatment goals before beginning alcohol treatment in the COMBINE (Combining Medications and Behavioral Interventions) Study. METHOD Participants were alcohol-dependent individuals (N = 1,156; 357 women) recruited at 11 outpatient academic alcoholism-treatment clinics across the United States to participate in a randomized, double-blind, placebo-controlled trial that combined behavioral intervention with acamprosate and/or naltrexone. Treatment goal was coded as controlled drinking, conditional abstinence, or total abstinence. Multinomial logistic regressions assessed whether there were significant relationships between predictor variables and pretreatment goal selection. RESULTS Lower levels of alcohol-related consequences, lower readiness to change, higher family income, more daily drinkers in social network, and lack of prior treatment or Alcoholics Anonymous engagement predicted choice of a controlled drinking goal over a total abstinence goal. Fewer alcohol-related consequences, lower readiness to change, and more daily drinkers in-network predicted choice of a conditional abstinence goal over a total abstinence goal. CONCLUSIONS Higher levels of functioning, lower levels of consequences, no prior involvement in treatment and Alcoholics Anonymous, and a more drinking-saturated social environment are associated with the choice of a non-abstinence goal.
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Affiliation(s)
- Kelly S DeMartini
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Eric G Devine
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Daniel J Martin
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, Martin Research and Consulting, Cambridge, Massachusetts
| | - Lara A Ray
- Department of Psychology, University of California Los Angeles, Los Angeles, California, Department of Psychiatry and Biobehavioral Sciences Brain Research Institute, University of California Los Angeles, Los Angeles, California
| | - Stephanie S O'Malley
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, Yale Cancer Center, New Haven, Connecticut
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9
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Devine EG, Waters ME, Putnam M, Surprise C, O'Malley K, Richambault C, Fishman RL, Knapp CM, Patterson EH, Sarid-Segal O, Streeter C, Colanari L, Ciraulo DA. Concealment and fabrication by experienced research subjects. Clin Trials 2013; 10:935-48. [PMID: 23867223 DOI: 10.1177/1740774513492917] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Subjects who enroll in multiple studies have been found to use deception at times to overcome restrictive screening criteria. Deception undermines subject safety as well as study integrity. Little is known about the extent to which experienced research subjects use deception and what type of information is concealed, withheld, or distorted. PURPOSE This study examined the prevalence of deception and types of deception used by subjects enrolling in multiple studies. METHODS Self-report of deceptive behavior used to gain entry into clinical trials was measured among a sample of 100 subjects who had participated in at least two studies in the past year. RESULTS Three quarters of subjects reported concealing some health information from researchers in their lifetime to avoid exclusion from enrollment in a study. Health problems were concealed by 32% of the sample, use of prescribed medications by 28%, and recreational drug use by 20% of the sample. One quarter of subjects reported exaggerating symptoms in order to qualify for a study and 14% reported pretending to have a health condition in order to qualify. LIMITATIONS Although this study finds high rates of lifetime deceptive behavior, the frequency and context of this behavior is unknown. Understanding the context and frequency of deception will inform the extent to which it jeopardizes study integrity and safety. CONCLUSION The use of deception threatens both participant safety and the integrity of research findings. Deception may be fueled in part by undue inducements, overly restrictive criteria for entry, and increased demand for healthy controls. Screening measures designed to detect deception among study subjects would aid in both protecting subjects and ensuring the quality of research findings.
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Affiliation(s)
- Eric G Devine
- aDepartment of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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10
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Devine EG, Rosenberg H. Understanding the relation between expectancies and drinking among DUI offenders using expectancy categories. J Stud Alcohol 2000; 61:164-7. [PMID: 10627111 DOI: 10.15288/jsa.2000.61.164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In the context of several recent studies that have found negative expectancies to predict drinking-related variables, the present study was designed to examine the relationships among positive expectancies, negative expectancies and drinking, in a sample of DUI offenders. METHOD Participants (N = 96; 75% male) recruited from a 3-day residential alcohol education program completed a demographic data sheet, the Negative Alcohol Expectancy Questionnaire (NAEQ), the Alcohol Expectancy Questionnaire (AEQ) and the Customary Drinking Record upon admission to treatment. At a 3-month follow-up assessment, these measures were re-administered to 49% of the sample. RESULTS Hierarchical multiple regression revealed that both positive and negative expectancies were related to number of drinks in the previous 30 days. Stepwise multiple regression revealed that baseline drinking and negative expectancies were both related to number of drinking days at the 3-month follow-up assessment. To assess the interplay of positive and negative expectancies as they relate to drinking, participants were categorized as "low" or "high" on both the AEQ and the NAEQ. The low positive/low negative group drank more than the low positive/high negative group. There was no statistically significant difference in drinking between the high positive/low negative and the high positive/high negative group. CONCLUSIONS This study provides additional evidence that negative alcohol expectancies are related to drinking. These findings suggest that the proposed restraining influence of negative expectancies on drinking may be reduced when a drinker has concurrent positive expectancies which are high.
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Affiliation(s)
- E G Devine
- Psychology Department, Boston Department of Veterans Affairs Medical Center, Massachusetts 02130, USA
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Devine EG, Gaehde SA, Curtis AC. Comparative evaluation of three continuous speech recognition software packages in the generation of medical reports. J Am Med Inform Assoc 2000; 7:462-8. [PMID: 10984465 PMCID: PMC79041 DOI: 10.1136/jamia.2000.0070462] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare out-of-box performance of three commercially available continuous speech recognition software packages: IBM ViaVoice 98 with General Medicine Vocabulary; Dragon Systems NaturallySpeaking Medical Suite, version 3.0; and L&H Voice Xpress for Medicine, General Medicine Edition, version 1.2. DESIGN Twelve physicians completed minimal training with each software package and then dictated a medical progress note and discharge summary drawn from actual records. MEASUREMENTS Errors in recognition of medical vocabulary, medical abbreviations, and general English vocabulary were compared across packages using a rigorous, standardized approach to scoring. RESULTS The IBM software was found to have the lowest mean error rate for vocabulary recognition (7.0 to 9.1 percent) followed by the L&H software (13.4 to 15.1 percent) and then Dragon software (14.1 to 15.2 percent). The IBM software was found to perform better than both the Dragon and the L&H software in the recognition of general English vocabulary and medical abbreviations. CONCLUSION This study is one of a few attempts at a robust evaluation of the performance of continuous speech recognition software. Results of this study suggest that with minimal training, the IBM software outperforms the other products in the domain of general medicine; however, results may vary with domain. Additional training is likely to improve the out-of-box performance of all three products. Although the IBM software was found to have the lowest overall error rate, successive generations of speech recognition software are likely to surpass the accuracy rates found in this investigation.
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Affiliation(s)
- E G Devine
- Boston Veterans Administration Medical Center, Boston, Massachusetts 02130, USA.
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Abstract
OBJECTIVE The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services. METHOD A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices. RESULTS Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients. CONCLUSIONS Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.
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Affiliation(s)
- H Rosenberg
- Psychology Department, Bowling Green State University, Ohio 43403, USA
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