To ensure we offer contemporary continuing education opportunities, the CE credit associated with this video is no longer available, however, the video remains available for viewing.
Presentation 1: The U.S. lags far behind other industrial countries on major markers of population health. When population health experts assess this situation, they identify unhealthy behavior patterns (e.g., cigarette smoking, other substance use disorders, physical inactivity and poor food choices, non-adherence with recommended medical regimens) as the largest contributor to the status quo. These behavior patterns increase risk for chronic disease (e.g., cardiovascular disease, site-specific cancers, type-2 diabetes) and associated premature death. Hence, identifying strategies to promote and sustain behavior change is critical to resolving this national problem. Because these risk behaviors are overrepresented in socioeconomically disadvantaged and other vulnerable populations, they also drive health disparities. In this report, we review research that focuses on identifying effective behavior change strategies for reducing drug use and other risk behaviors in vulnerable populations. An extensive body of experimental preclinical and clinical research demonstrates that the reinforcement process plays a fundamental role in the acquisition and maintenance of drug use and other unhealthy behavior patterns. The research discussed here illustrates how that same reinforcement process can be leveraged in the form of incentives and other strategies to promote and sustain behavior change. The overarching focus is on drug use, but we also review research with other types of health problems, illustrating the trans-disease influence of reinforcement and the broad generality of behavior-change strategies that leverage that process.
Presentation 2: Poverty is a pervasive risk factor underlying poor health, including drug addiction and HIV. This presentation will review research on the utility of operant conditioning to address the interrelated problems of poverty, drug addiction, and HIV. Our research has shown that operant reinforcement using financial incentives can promote abstinence from cocaine and heroin in low-income adults with long histories of drug addiction and adherence to antiretroviral medications in low-income adults living with HIV. Our research has also shown that financial incentives are most effective when high-magnitude incentives are used, and that long-duration abstinence reinforcement can serve as an effective maintenance intervention. The utility of operant conditioning to promote behaviors needed to escape poverty is less clear, but research on an operant employment-based intervention called the therapeutic workplace shows some promise. In the therapeutic workplace, low-income or unemployed adults are hired and paid to work. To promote drug abstinence and/or medication adherence, employment-based reinforcement is arranged in which participants are required to provide drug-free urine samples and/or take prescribed medication to maintain access to the workplace and maximum pay. Because many low-income adults lack skills needed for gainful employment, the therapeutic workplace offers job-skills training and employment phases through which participants progress sequentially. Our research has shown that employment-based reinforcement within the therapeutic workplace can promote and maintain drug abstinence, medication adherence, work, and other adaptive behaviors that people need to move out of poverty. The therapeutic workplace could serve as a model anti-poverty program, particularly for people with histories of drug addiction or other health problems, although more