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| Developing behavior analytic interventions for medical application: Examples and lessons from the treatment of drug addiction. |
| Sunday, May 24, 2009 |
| 3:30 PM–4:50 PM |
| North 226 C |
| Area: BPH/CBM; Domain: Applied Behavior Analysis |
| Chair: Anthony L. DeFulio (Johns Hopkins University School of Medicine) |
| CE Instructor: Lauren C. Wasano, M.A., B.C.B.A., M.A. |
| Abstract: Contingency management interventions for the treatment of drug addiction are based on the principles of operant psychology and are part of the practice of applied behavior analysis. However, much of the work in contingency management has been conducted in departments of psychiatry, behavioral medicine, and in general medical settings rather than in traditional settings such as psychology departments on university campuses. Even when working in traditional settings, investigators working to develop contingency management interventions for the treatment of drug addiction have necessarily concerned themselves with the medical community, often in the interest of widespread dissemination of their interventions and in pursuit of federal funding from agencies such as the National Institutes of Health, including the National Institute on Drug Abuse. This symposium offers examples and lessons learned from working in these novel settings that may be adopted by any behavior analysts who wish to advocate for the adoption of behavior analytic interventions in medical settings. |
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| By any means necessary: Substance abuse interventions as a case study in radicalizing behaviorism. |
| ANTHONY L. DEFULIO (Johns Hopkins University School of Medicine) |
| Abstract: Contingency management interventions for the treatment of substance abuse are firmly rooted in the principles of operant psychology. From its inception, operant psychology has been guided by the philosophy of radical behaviorism espoused by B. F. Skinner, but it is equally true that the philosophy was constructed on the basis of the substantive aspects of operant psychology. This latter point was identified by E. F. Malagodi in a call-to-arms published in The Behavior Analyst in 1986 that described the unfulfilled promise of behavior analysis as a source of solutions for social problems, and offered strategies for rectifying the situation by “radicalizing behaviorism.” While Malagodi’s sage advice has gone largely unheeded, contingency management interventions for substance abuse stand as a particularly lucent example of the successful radicalization of our behaviorism. This presentation reviews Malagodi’s suggestions and describes how behavioral scientists working in the area of substance abuse have unknowingly adjusted their own practices to accord with those advocated by Malagodi. When viewed as a case study in radicalizing behaviorism, the lessons learned in the development of contingency management interventions for substance abuse are potentially applicable to any social problems addressed by behavior analysts. |
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| Using contingent incentives to reduce smoking in people with schizophrenia: From laboratory to treatment interventions. |
| JENNIFER TIDEY (Center for Alcohol & Addiction Studies, Brown University) |
| Abstract: There is an unusually high rate of cigarette smoking among people with schizophrenia (= 70%). Furthermore, these smokers have very low smoking cessation rates, even when they are motivated to quit and enroll in supportive smoking treatment programs. These smokers are likely to require a combination of pharmacological and behavioral treatments to produce significant changes in their smoking behavior. Contingency management interventions have been effective at reducing cigarette smoking in short-term laboratory-based studies, but few such interventions have been translated into treatment interventions for smoking. In a series of studies, we have examined the effects of alternative monetary reinforcement on smoking behavior in smokers with schizophrenia under laboratory and real-world conditions. Results from these studies indicate that (1) smoking by people with schizophrenia is orderly behavior that responds systematically to changes in environmental variables; (2) smoking by people with schizophrenia is reduced when access to an alternative reinforcer is contingent upon smoking abstinence; (3) combining a medication (bupropion) with abstinence-contingent reinforcement appears to be a feasible and effective method of reducing smoking in people with schizophrenia. Future directions and challenges of this research will also be addressed. |
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| Using the internet to overcome barriers to contingency management: Applications and extensions. |
| BETHANY R. RAIFF (University of Florida), Jesse Dallery (University of Florida) |
| Abstract: Contingency management interventions are highly effective at increasing drug abstinence and are becoming increasingly popular; however, in some cases it is impractical to employ such interventions because frequent monitoring is necessary to ensure treatment integrity. For example, smoking abstinence is often verified by breath carbon monoxide, but because of the short half-life of carbon monoxide it is necessary to collect at least two carbon monoxide samples per day. We recently developed an internet and web-camera based contingency management intervention to overcome the barriers to applying the treatment with this population (e.g., accessibility, fidelity, acceptability, and efficacy). The system has been effective at increasing smoking abstinence and participants report that the intervention is easy to use and convenient. Importantly, this internet-based system can be applied to any behavior that can be observed directly or that results in a visible outcome measure (e.g., breathalyzer testing with alcoholics, medication adherence, etc). As an example, details regarding how internet-based contingency management can be extended to diabetics who do not adhere with self-monitoring of blood glucose testing will discussed. |
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| Delay discounting by adolescents experimenting with cigarette smoking. |
| BRADY A. REYNOLDS (Department of Pediatrics, The Ohio State University) |
| Abstract: Delay discounting is an index of impulsive choice, and research has shown that adolescent daily smokers discount more by delay than adolescent nonsmokers (Reynolds et al., 2007). However, it is not known if the more extreme delay discounting seen in smokers predates their regular use of nicotine; or, alternatively, if high levels of nicotine use increase delay discounting. The current cross-sectional group-design study compared delay discounting in three demographically matched samples of adolescents: daily smokers (n = 50), never smokers (n = 50), and experimenters (n = 41; reporting initial experimentation with smoking within three months of participation). Daily smokers had significantly higher cotinine levels (metabolite of nicotine) than nonsmokers and experimenters, but the latter two groups did not differ in cotinine level. The daily smokers and experimenters both discounted more by delay than the never smokers [p = .001 and p = .047, respectively]; however, the daily smokers and experimenters did not differ [p = .153]. These findings indicate that adolescents who are experimenting with cigarettes are similar to daily smokers with respect to delay discounting; suggesting delay discounting may be a behavioral risk factor for the initiation of smoking that predates any significant use of nicotine. |
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