|Advances in the Operant and Pharmacological Treatment of Drug Abuse
|Sunday, May 30, 2010
|9:00 AM–10:20 AM
|Travis C/D (Grand Hyatt)
|Area: BPH/CBM; Domain: Applied Behavior Analysis
|Chair: Anthony DeFulio (Johns Hopkins University School of Medicine)
|CE Instructor: Kathleen McCabe-Odri, Ed.D.
|Abstract: Operant approaches to the treatment of drug abuse have been studied for over thirty years. Within the substance abuse treatment community these interventions are known as “contingency management.” Decades of randomized controlled trials have demonstrated the success of contingency management interventions in treating a wide variety of drug dependence disorders across a variety of patient populations. The success of these trials has produced a situation in which the effectiveness of contingency management is so well established that the approach is now being adopted and recommended by health organizations on a global scale. The presentations offered in this symposium describe advances in the operant approach to the treatment of drug abuse. Specifically, these presentations will describe novel ways of tailoring interventions to individuals to facilitate the initiation of abstinence, and ways in which operant procedures can enhance the effectiveness of new pharmacotherapies for drug abuse. A variety of drug abuse problems will be discussed, including cigarette smoking, snorting and injecting heroin, and recreational use of pain pills such as oxycodone.
|Using Shaping to Improve Contingency Management in Hard-to-Treat Smokers
|R.J. LAMB (University of Texas HSC-H)
|Abstract: Contingency management (CM) can promote smoking cessation. However, CM is frequently unsuccessful. Most often, CM is unsuccessful for those not swiftly stop their smoking and coming into contact with the programmed abstinence incentives. That those who do not contact the programmed incentive fail to stop their smoking is not surprising. Not only is this definitionally true, but because reinforcement of abstinence is the presumed active ingredient of CM, this is theoretically predictable. Percentile schedules can be used to provide incentives for behavior nearest to the abstinence criterion and thus, theoretically percentile schedules could shape better outcomes in hard-to-treat smokers not readily initiating abstinence. These theoretical predictions appear to hold true. Smokers not readily initiating abstinence in CM do not do well, while those who readily initiate abstinence do well. When hard-to-treat smokers receive CM incorporating a percentile schedule, many of them show improved outcomes. Those readily initiating abstinence generally do well regardless of whether shaping is incorporated into CM. These results indicate that the experimental analysis of behavior provides a vantage point from which ways to improve treatments can be developed. These results also indicate other aspects to which this vantage point might be applied to further improve treatment.
|Using Contingency Management to Enhance Success in Outpatient Detoxifications Among Prescription Opioid Abusers
|KATHRYN A. SAULSGIVER (University of Vermont), Mollie Patrick (University of Vermont), Kelly Dunn (University of Vermont), Stacey C. Sigmon (University of Vermont), Sarah H. Heil (University of Vermont), Stephen T. Higgins (University of Vermont)
|Abstract: Abuse of prescription opioids (POs) has become a significant public health problem in recent years. The annual number of new initiates increased >400% between 1990 and 2000 (SAMHSA, 2003) and PO abuse now represents the largest group of new drug initiates, even surpassing marijuana (NSDUH, 2006). In a previous clinical trial (study 1), we examined the efficacy of an intervention that included pharmacotherapy, individual behavioral therapy, and observed, on-site urine toxicology testing across three buprenorphine taper durations. This trial was moderately successful in tapering opioid-dependent individuals and transitioning them to naltrexone, an opioid-blocker (33% of all participants and 47% of participants exposed to the 4-week taper duration). In an attempt to enhance outcomes we will experimentally examine whether adding voucher-based CM may improve treatment success among PO abusers (Study 2). Individuals who failed to successfully taper and transition to >1 50 mg dose of naltrexone during Study 1 will serve as participants. The longest taper duration (4 weeks) will be used during Study 2 and all subjects will be randomized to Contingent and Noncontingent experimental groups. We will compare retention and percent opioid abstinence between Contingent and Noncontingent experimental groups.
|Reinforcing Acceptance of Long-Acting Opiate Antagonist Medication With Access to Paid Job Training
|ANTHONY DEFULIO (Johns Hopkins University School of Medicine), Jeffrey J. Everly (Johns Hopkins University School of Medicine), George Bigelow (Johns Hopkins University School of Medicine), Annie Umbricht (Johns Hopkins University School of Medicine), Michael Fingerhood (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University)
|Abstract: Naltrexone is an opiate antagonist that could be an effective treatment for opiate addiction, but its utility has been limited by poor patient acceptance. Recently developed extended-release depot formulations of naltrexone provide opiate antagonism for up to 4 weeks and should simplify naltrexone adherence. However, given the rejection of oral naltrexone by most patients, concurrent behavioral treatment will probably be needed to encourage patients to take the depot medication consistently. A randomized controlled trial was designed to determine if employment-based reinforcement could increase acceptance of depot naltrexone injections in unemployed opiate dependent adults. For participants assigned to the naltrexone contingency group, access to paid job training was contingent upon acceptance of depot naltrexone. For participants assigned to the naltrexone prescription group, depot naltrexone injections were available at no cost to the participants, but access to paid job training was independent of acceptance of the injections. Methods and results of two studies in which different formulations of depot naltrexone were used will be discussed. The data suggest that employment-based contingency management greatly improves adherence to depot naltrexone treatment.
|Using Functional, Competitive Antagonists as Pharmacotherapies for Drug Abuse: Unmet Needs in Drug Discovery
|JAMES H. WOODS (University of Michigan)
|Abstract: Drug abuse is a major health problem in the United States, with over 22 million individuals classified with substance dependence or abuse according to recent government statistics (SAMHSA, 2008). Pharmacotherapy and behavioral approaches are among the most effective treatments for drug abuse. New competitive antagonist pharmacotherapies are on the horizon, but past experience indicates that behavioral complements will be required in order to produce the greatest impact for these medications. Three case histories dealing with drug abuse problems and how they have been approached will be discussed. These case histories describe the treatment of a variety of drug abuse problems, including the use of opiates, cocaine, and nicotine. After the three case histories have been described, current research in drug abuse treatment will be reviewed. The combined case histories and reviewed research have been selected specifically to bring the audience to expect real progress in the next decade for pharmacotherapies that can be meshed with behavioral complements for the effective treatment of drug abuse.