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| Complements and Extensions to Contingency Management Interventions to Promote Healthy Behavior |
| Saturday, May 29, 2010 |
| 2:00 PM–3:20 PM |
| Crockett A/B (Grand Hyatt) |
| Area: CBM/BPH; Domain: Applied Behavior Analysis |
| Chair: Steven E. Meredith (University of Florida) |
| CE Instructor: Gina Green, Ph.D. |
| Abstract: Contingency management (CM) has been used to increase drug abstinence in substance abusers by delivering desirable consequences, such as money, contingent on objective evidence of abstinence. The following symposium highlights new complements and extensions to CM for promoting healthy behavior. Erin McClure will discuss how varenicline (Chantix) can be used to enhance the efficacy of CM interventions with treatment seeking smokers. Kelly Dunn will talk about CM in the context of a therapeutic workplace to increase adherence with naltrexone, an opioid antagonist that can decrease opioid abuse when taken as prescribed. The last two talks will discuss extensions of CM to non-drug abusing populations. Bethany Raiff will present the results of an Internet-based CM intervention to increase adherence with blood glucose testing recommendations in teens diagnosed with Type 1 diabetes, and Kristin Hustyi will describe a CM intervention used to increase physical activity in overweight and obese preschool children. This collection of studies illustrates the versatility and utility of CM as a means of promoting healthy behavior. |
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| The Effects of Behavioral and Pharmacological Interventions on Relapse to Smoking Following Experimental Lapse Exposure |
| ERIN A. MCCLURE (Johns Hopkins University School of Medicine), Ryan Vandrey (Johns Hopkins University School of Medicine), Maxine Stitzer (Behavioral Pharmacology Research Unit) |
| Abstract: Retrospective data collected during clinical trials along with anecdotal reports suggest that one mechanism by which varenicline (Chantix) aids in smoking cessation is by reducing the likelihood of relapse following a slip or lapse episode during a quit attempt. The current study investigated this effect in a prospective laboratory model. Smokers were randomly assigned to receive varenicline or placebo during a quit attempt in which an experimentally induced lapse occurred after a supervised period of abstinence. Smoking behavior was then assessed for four weeks following the programmed lapse with financial incentives provided during the first week to increase abstinence. Results showed that smoking decreased for both placebo and varenicline groups, but was lower upon completion of the study for those receiving varenicline. Complete abstinence from smoking in either group was rare despite the monetary incentives. While incentives along with behavioral counseling were successful in decreasing smoking behavior in the placebo group, they were not as powerful as the combination of incentives, counseling, and varenicline treatment. Findings suggest that varenicline decreased smoking dramatically in a context where smokers were motivated to achieve abstinence, which may reflect one mechanism of varenicline’s previously demonstrated efficacy as a smoking cessation aid. |
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| Employment-Based Reinforcement of Naltrexone Compliance in Unemployed Heroin-Dependent Adults |
| KELLY DUNN (Johns Hopkins University School of Medicine), Anthony DeFulio (Johns Hopkins University School of Medicine), Jeffrey J. Everly (Johns Hopkins University School of Medicine), Annie Umbricht (Johns Hopkins University School of Medicine), Michael Fingerhood (Johns Hopkins University School of Medicine), George Bigelow (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University), Wendy Donlin-Washington (University of North Carolina, Wilmington) |
| Abstract: Naltrexone is an opiate antagonist that effectively prevents relapse to opioid use; however rates of compliance are notoriously poor. In a randomized controlled trial of employment-based contingencies to promote naltrexone compliance, heroin-dependent injection drug users were randomly assigned to a Naltrexone Contingency (NC) or Work Only (WO) group. NC participants are required to ingest oral naltrexone thrice weekly to gain entry into the workplace and WO participants receive a take-home prescription and can work independently of naltrexone compliance. In the workplace participants earn hourly wages and productivity pay. Outcome measures include monthly naltrexone, opioid and cocaine urinalysis results. Data show access to the workplace successfully reinforces compliance with naltrexone. Mean percent naltrexone-positive samples are 74% and 28% in the NC and WO groups, respectively. Mean opiate-negative samples are higher among NC versus WO participants (74% and 58%, respectively); however no effect is observed on cocaine use. Overall, this study provides evidence that an employment-based behavioral treatment can successfully reinforce compliance with a medication and has important implications for use with other medications. |
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| Using an Internet-Based Contingency Management Intervention to Increase Adherence With Blood Glucose Testing Recommendations in Adolescents Diagnosed With Type 1 Diabetes |
| BETHANY R. RAIFF (National Development Research Institutes), Jesse Dallery (University of Florida) |
| Abstract: Diabetes can lead to a number of life-threatening health complications if unmanaged. A critical component of diabetes management, for adolescents diagnosed with Type 1 diabetes, involves blood glucose testing at least four times per day. The current study evaluated the effects of using an Internet-based contingency management intervention to increase adherence with blood glucose testing recommendations in non-adherent adolescents. Four adolescents diagnosed with Type 1 diabetes could earn vouchers for submitting blood glucose testing videos, over a secure website, during the intervention. During an initial baseline condition participants did not meet the minimum of four recommended tests per day (mean number of tests per day = 1.7). However, when the Internet-based CM intervention was introduced, an increase in the daily frequency of testing occurred, with every participant meeting the minimum during all five days of the intervention (mean number of tests per day = 5.7). Removing the intervention corresponded with a decrease in the daily frequency of testing (mean number of tests per day = 3.1). Participants and their parents rated the program favorably on a number of dimensions. The results suggest that Internet-based contingency management interventions are feasible and acceptable for use with adolescents diagnosed with Type 1 diabetes. |
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| Shaping Physical Activity in Overweight and Obese Children |
| KRISTIN M. HUSTYI (University of the Pacific), Matthew P. Normand (University of the Pacific), Tracy Larson (University of the Pacific), Scott B Greenberg (University of the Pacific) |
| Abstract: The Observational System for Recording Physical Activity in Children (OSRAC-P, Brown et al., 2009) is a discontinuous measurement system for recording physical activity. We validated the OSRAC system with continuous measurement systems (pedometers and heart rate monitors), finding that increased heart rate and steps taken correlated with activity level codes. We also measured changes in physical activity in obese and overweight pre-school children when a package intervention including goal setting and feedback was introduced according to an ABAB reversal design. Multiple measures were used to assess physical activity level, including the OSRAC-P system and pedometers. Percentile schedules of reinforcement were used to set performance goals. The intervention produced elevated levels of physical activity and the activity level codes and pedometer records were highly correlated. Implications for future activity research will be discussed. |
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