Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

Substance Use and Addiction Conference; Washington DC; 2018

CE by Type: PSY


 

Invited Paper Session #2
CE Offered: PSY/BACB/NASP/AAHCPAD/NAADAC
Basic Behavioral Processes: Delay Discounting
Monday, November 19, 2018
8:30 AM–11:00 AM
Independence Hall A
Domain: Service Delivery
Instruction Level: Basic
CE Instructor: Mark Galizio, Ph.D.
Chair: Mark Galizio (University of North Carolina Wilmington)
Discussant: Leonard Green (Washington University)
 

Experimental Manipulations of Delay Discounting

GREGORY J. MADDEN (Utah State University)
Gregory J. Madden received his Ph.D. from West Virginia University and currently holds the position of professor at Utah State University, having previously held faculty positions at the University of Kansas and the University of Wisconsin–Eau Claire. Dr. Madden’s program of research has been aimed at understanding the basic mechanisms of reinforcement in humans and other animals, a topic of broad conceptual and applied significance in the field of psychology. He is an internationally known researcher in the field of behavioral economics, with special emphases on impulsive choice in gambling and drug addiction. Collectively, his work has merited more than $3 million of federal funding, and his peer-reviewed papers have been cited more than 3,500 times. Since 2010 he has been active in translational efforts, particularly in applications of behavioral economics to influencing childhood dietary decision-making. Dr. Madden has held several key editorial positions, and has served in leadership roles in professional societies and organizations, including the Executive Council of ABAI, Division 25 (Behavior Analysis) of the American Psychological Association (APA), and the Society for the Experimental Analysis of Behavior (SEAB). Especially noteworthy was his appointment as editor in chief of the Journal of the Experimental Analysis of Behavior. Dr. Madden has also co-edited two important and influential books, Impulsivity: The Behavioral and Neurological Science of Discounting and the APA Handbook of Behavior Analysis, Volumes I and II, both published by APA.
Abstract:

Many behaviors posing significant risks to public health are characterized by repeated decisions to forego better long-term outcomes for immediate temptations. This steep discounting of delayed outcomes is correlated with addictions (e.g., substance abuse, obesity) and impactful behaviors such as seatbelt use and early sexual activity. As evidence accumulates that steep delay discounting plays a causal role in these maladaptive behaviors, researchers have begun identifying experimental methods for reducing discounting. This presentation will provide a systematic review of this literature, highlighting successes and areas in which further research is needed.

 

Delay Discounting and Genetics of Impulsivity

SUZANNE H. MITCHELL (Oregon Health & Science University)
Suzanne H. Mitchell, Ph.D., is a Professor at Oregon Health & Science University (OHSU) in the Department of Behavioral Neuroscience, with secondary appointments in Psychiatry and in the Oregon Institute for Occupational health Science. She obtained her B.Sc. and M.Sc. degrees at the University of Hull, England and her Ph.D. at SUNY-Stony Brook, USA. Her dissertation focused on the economics of foraging behavior of rats, examining the role of the energetic costs and benefits in feeding. Her committee was chaired by Howard Rachlin, whose influence made her sensitive to the role of temporal costs as well as energetic costs in determining the value of food rewards. During a post-doctoral fellowship at the University of Chicago, Dr. Mitchell worked with Harriet de Wit, Ph.D. using behavioral economics as an explanation for use of alcohol, nicotine/cigarettes, and amphetamine in humans. During that time she also began collaborating with Jerry Richards, Ph.D. on delay discounting studies with rats. Following her postdoctoral work, Dr. Mitchell was an assistant professor at the University of New Hampshire, where she continued to explore recreational drug use using behavioral economic models. She moved her lab to OHSU in 2001 from the University of New Hampshire to devote more time to research, particularly looking into why drug users tend to be more impulsive than non-drug users using human and animal models. Most recently she has returned to her earlier interests in energetic costs and her research has increased its scope to include effort-related decision-making in clinical populations. She has received funding from various NIH institutes (NHLBI, NIAAA, NIDA and NIH), has served on several study sections as a member and as an ad hoc participant, and has received awards for education and mentoring.
Abstract:

High levels of impulsivity (delay discounting [DD], relative preference for smaller but immediate rewards over larger but delayed rewards) are associated with various psychopathologies including alcohol use disorder. Data indicate that there are genetic influences on DD and on the development of alcohol use disorder, but the genetic relationships amongst DD and alcohol consumption and other heritable features of alcohol response are unclear. This presentation will describe several techniques used to examine the role of genetics in behavior in animal models and a series of studies using them to examine the genetically-based co-relationships between excessive alcohol use and steep delay discounting. In these studies, male mice were exposed to the adjusting amount procedure (Richards et al. 1997, J Exp Anal Behav, 67, 353-366). This procedures requires mice to choose between a small, immediate sucrose-solution reward and a larger sucrose-solution reward that is delayed 0, 2, 4, 8 or 12 s on different sessions. In one study, behavior for 11 inbred strains was assessed, and genetic correlations with ethanol-associated endophenotypes derived. Other studies assessed DD in lines selected for differing levels of ethanol withdrawal symptomatology or ethanol consumption, and correlations between DD and responses to passively administered ethanol in a heterogeneous mouse stock to identify novel phenotypic targets. Data suggest that DD has a heritable component in mice, and is genetically associated with chronic withdrawal and consumption, but that effect sizes are small. Implications for human alcohol use and delay discounting will be discussed and knowledge gaps identified.

 
Target Audience:

Board certified behavior analysts; licensed psychologists; graduate students.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) discuss the delay discounting process; (2) understand how delay discounting may underlie decisions leading to addictions; (3) list at least 3 interventions that have proven successful in reducing delay discounting; (4) describe two procedures used in basic research to demonstrate the role of genetics in behavior; (5) explain the difference between a genotype, phenotype, and endophenotype; (6) discuss the data indicating that an individual’s level of delay discounting can be classified as an endophenotype; (7) describe behavioral procedures to assess alcohol-related phenotypes in mice; (8) assess the genetic-basis of the relationship between delay discounting and the potential for alcohol abuse.
 
 
Invited Paper Session #3
CE Offered: PSY/BACB/NASP/AAHCPAD/NAADAC
Models of Addiction and Treatment
Monday, November 19, 2018
12:30 PM–3:00 PM
Independence Hall A
Domain: Applied
Instruction Level: Intermediate
CE Instructor: Mark Galizio, Ph.D.
Chair: Mark Galizio (University of North Carolina Wilmington)
Discussant: Amy Odum (Utah State University)
 
Reinforcer Pathology: A Conceptual Model of Addiction
WARREN K. BICKEL (Addiction Recovery Research Center, Virginia Tech Carilion Research Institute )
Dr. Bickel joined the Virginia Tech Carilion Research Institute in 2011 and serves as Director for the Addiction Recovery Research Center and Co-Director of the Center for Transformative Research on Health Behaviors. He has appointments as professor in the Department of Psychology at Virginia Tech; professor in the Department of Psychiatry, Virginia Tech Carilion School of Medicine; and Virginia Tech Faculty of Health Sciences. In recognition of his extraordinary contributions to research and scholarship achievements, Dr. Bickel recently was awarded the Virginia Tech Carilion Behavioral Health Research Endowed Professorship. He received his Ph.D. in developmental and child psychology from the University of Kansas and completed post doctoral training at Johns Hopkins University School of Medicine. Dr. Bickel then joined the faculty at the Albert Einstein College of Medicine where he taught and led a research program. He next relocated to the University of Vermont where he became a Professor in the Departments of Psychiatry and Psychology and Interim-Chair of the Department of Psychiatry. While in Vermont, he contributed to the public debate about treating opioid-dependent individuals and was the Founding Director of the first methadone treatment program in the State of Vermont. Dr. Bickel’s next appointment was at the University of Arkansas for Medical Sciences (UAMS). While at UAMS, he held the Wilbur D. Mills Chair of Alcoholism and Drug Abuse Prevention and was the Director of the Center for Addiction Research. He also served as Director of the College of Public Health’s Center for the Study of Tobacco Addiction and was the Associate Director of the Psychiatric Research Institute. Dr. Bickel is an accomplished scholar and researcher whose accolades include being named a 2014 Fellow in the Academy of Behavioral Medicine Research; the 2012 Brady-Schuster Award for Outstanding Behavioral Science Research in Psychopharmacology and Substance Abuse, Division 28 of the American Psychological Association (APA); and the 2011 APA International Don Hake Translational Research Distinguished Contributions to Basic Research Award. In 2012, he was selected by the APA Science Directorate and Board of Scientific Affairs as a Distinguished Scientist Lecturer. Dr. Bickel was honored to be the recipient of the 2016 Nathan B. Eddy Award from the College on Problems of Drug Dependence. Additionally, he has received an NIH MERIT Award from NIDA and NIH has funded Dr. Bickel’s work continuously since 1987. He has served as President of CPDD, President of APA Division 28 - Psychopharmacology and Substance Abuse, and President of APA Division 50 - Society of Addiction Psychology. Dr. Bickel was Editor of the journal, Experimental and Clinical Psychopharmacology, has co-edited five books, and has published over 340 papers and chapters. Dr. Bickel’s work frequently is cited and receives national and international recognition.
Abstract: Reinforcer pathology, a recent development in the field of behavioral economics, specifies that (1) reinforcers are integrated over time, (2) that length of the window of integration can vary, and, in turn, (3) alter the valuation of different reinforcers. Short temporal windows of integration will tend to increase the value of intense, reliable and brief reinforcers such as drugs while leading to a decline in the value of reinforcers that are less intense, variable and accrue value over longer time frames such as prosocial reinforcers. Conversely, long temporal windows of integration should result in a reversal in the valuation of drug and prosocial reinforcers. Importantly, reinforcer pathology provides an understanding of the "anhedonia" that often occurs in the development of addiction and suggests a novel approach to treatment; namely, to increase the length of the temporal integration window. In this presentation, this model and data supporting it will be reviewed.
 
Self-Sustaining Treatments for Drug Addiction and Incubation of Craving Leading to Relapse
MARILYN CARROLL (University of Minnesota)
Dr. Marilyn Carroll received her BS in Psychology and BA in Pre-Law from Penn State University in 1968. After working in Washington DC for 3 years on government research projects with the Office of Economic Opportunity, she completed her Ph.D. in Psychobiology and Neuroscience from Florida State University from 1971–75 with Dr. James C. Smith as her mentor on a T32 Psychobiology training fellowship. From 1975–76 she taught Psychology and Statistics courses at Macalester College in St. Paul, and from 1976–1980 she conducted postdoctoral research at the University of Minnesota with Dr. Richard A. Meisch under a T31 training fellowship from NIDA on animal models of addiction using rats and rhesus monkeys. She continued on in the Psychiatry Department in Minnesota in 1980 as an Assistant Professor, Associate Professor, and since 1993 has been Professor in Psychiatry and Neuroscience, and adjunct Professor in Psychology. Dr. Carroll’s research interests have been focused on biological factors in drug addiction (Sex and hormonal, impulsivity, sweet preference, and stress) and behavioral economic factors. Currently she focuses on treatments for addiction that are sex-specific, sensitive to hormonal influences, novel, environmentally enriching, self-sustaining over long periods that cover craving during abstinence (e.g., exercise, vaccines), target underlying behaviors (anxiety, impulsivity), and combination therapies.
Abstract: The goal of my research is to model various forms of human drug addiction in animals, taking into account factors that increase or decrease addiction potential and severity such as sex, hormonal factors, impulsivity, sweet preference, and other genetic factors. My students, colleagues, and I have also developed self-sustaining treatments to reduce or eliminate incubation of craving and subsequent drug-seeking over long periods of time. My research has been involved in the development of novel methods of modeling drug addiction in rats and nonhuman primates, with self-administration of opioids, stimulants, alcohol, and with several routes of self-administration used by humans, such as intravenous, drinking (oral), and smoking. Behavioral economic methods and analyses of demand for drug self-administration and behavioral patterns have been compared in humans and nonhuman animals to better understand factors that increase and treatments that reduce demand for drugs. Recent work has focused on self-motivated novel treatments for drug addiction such offering concurrent, nondrug rewards like physical exercise that reduce initiation, acceleration of drug use, and prevent relapse. Self-motivated alternative behaviors, such as physical exercise, also reduce long-term drug craving. That is important because animal models indicate that craving continues for months after standard treatments end. Current studies are also extending these findings to prevention models and to models of binge eating and food addiction in animals.
 
Target Audience:

Board certified behavior analysts; licensed psychologists; graduate students.

Learning Objectives: At the conclusion of the presentation, participants with be able to: (1) describe two procedures used in basic research to demonstrate the role of genetics in behavior; (2) explain the difference between a genotype, phenotype, and endophenotype; (3) discuss the data indicating that an individual�s level of delay discounting can be classified as an endophenotype; (4) describe behavioral procedures to assess alcohol-related phenotypes in mice; (5) assess the genetic-basis of the relationship between delay discounting and the potential for alcohol abuse.
 
 
Invited Paper Session #4
CE Offered: PSY/BACB/NASP/AAHCPAD/NAADAC
Contingency Management for Drug Problems
Monday, November 19, 2018
3:30 PM–6:00 PM
Independence Hall A
Domain: Service Delivery
Instruction Level: Basic
CE Instructor: Mark Galizio, Ph.D.
Chair: Mark Galizio (University of North Carolina Wilmington)
Discussant: Maxine Stitzer (Behavioral Pharmacology Research Unit)
 

An Overview of Contingency Management Interventions in Substance Abuse Treatment: With Whom is it Effective and Where is it Applied?

CARLA J. RASH (UConn Health)
Carla Rash earned a Ph.D. in clinical psychology from Louisiana State University in 2007. She is currently an assistant professor in the Department of Medicine at UConn Health. Her research interests focus on extending and evaluating addictions treatments, including contingency management interventions, in underserved and health disparity populations. Her work is funded by the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and by a career development award from the Connecticut Institute for Clinical and Translational Science.
Abstract:

Contingency management (CM) interventions are efficacious options for substance abuse treatments, but they are rarely implemented in clinical, non-research settings. In this presentation, we briefly review the evidence support for CM and introduce prize-based CM. We will highlight work that supports CM’s generalizability across diverse patient characteristics and settings. We will conclude with a discussion of potential implementation barriers and examples of real-world implementation efforts.

 

Contingency Management in the 21st Century: Technology and the Future

JESSE DALLERY (University of Florida)
Jesse is a Professor in the Department of Psychology at the University of Florida, a Licensed Psychologist in the state of Florida, and Deputy Director of the Treatment Development and Implementation Core at the Center for Technology and Behavioral Health at Dartmouth. Jesse received his Ph.D. in Clinical Psychology at Emory University, and completed a postdoctoral fellowship at the Johns Hopkins University School of Medicine in Behavioral Pharmacology. Jesse’s research focuses on integrating information technologies with behavioral interventions for cigarette smoking and other health-related behavior (e.g., physical activity, medication adherence). Jesse also conducts translational research on choice and decision making in the human laboratory, with a special emphasis on quantitative models of operant behavior. He has published over eighty articles in a diverse range of peer-reviewed journals, and he has received grant support from the National Institutes of Health and from the National Science Foundation. He is co-editor of the book Behavioral Health Care and Technology: Using Science-Based Innovations to Transform Practice. Jesse is a former Associate Editor for The Behavior Analyst and Behavioural Processes, and Special Topics Associate Editor (substance abuse) for the Journal of Applied Behavior Analysis. In 2014, Dr. Dallery was named a Teacher of the Year in the College of Liberal Arts and Sciences.
Abstract:

Contingency management is one of the most efficacious interventions to promote drug abstinence. Traditionally, contingency management has been delivered in person so that clinicians can confirm drug abstinence and provide access to additional therapeutic services. Now, new technologies not only permit remote confirmation of abstinence, but also remote delivery of incentives. I will discuss several technology-based tools to assess substance use, and new ways to deliver contingency management to promote tobacco and alcohol abstinence. These new tools have the potential to dramatically increase access while maintaining high levels of treatment fidelity. They also allow new ways of arranging contingencies that harness natural, online communities and consequences. Overall, there are unprecedented opportunities to link technology with contingency management to promote drug abstinence.

 
Target Audience:

Board certified behavior analysts; licensed psychologists; graduate students.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) summarize the efficacy literature related to CM interventions for the treatment of substance use disorders; (2) describe the populations and settings appropriate for CM interventions; (3) list potential barriers to dissemination; (4) describe real-world implementation efforts; (5) describe how sensors can be used to obtain objective evidence of at least two different drugs of abuse; (6) describe how information technology can be used to deliver immediate incentives for abstinence; (7) describe how social networks have been used to promote smoking cessation using information technology.
 
 
Invited Paper Session #6
CE Offered: PSY/BACB/NASP/AAHCPAD/NAADAC
Verbal Behavior Approaches to Treatment
Tuesday, November 20, 2018
8:00 AM–10:30 AM
Independence Hall A
Domain: Service Delivery
Instruction Level: Basic
CE Instructor: Mark Galizio, Ph.D.
Chair: Mark Galizio (University of North Carolina Wilmington)
Discussant: Jonathan Bricker (University of Washington)
 
Acceptance and Commitment Therapy: Understanding and Treating Addiction
KELLY WILSON (University of Mississippi)
Kelly G. Wilson, Ph.D., is a Professor of Psychology at the University at Mississippi. He is Past President of the Association for Contextual Behavioral Science, Representative-at-Large of the Society for a Science of Clinical Psychology, and is one of the co-founders of Acceptance and Commitment Therapy. Dr. Wilson received his B.A. Summa Cum Laude from Gonzaga University and his Ph.D. at the University of Nevada, Reno. After running a National Institutes on Drug Abuse clinical trial in Reno, he joined the faculty at the University of Mississippi in 2000 where he established the Mississippi Contextual Psychology Lab. Dr. Wilson is a devoted mentor a university-wide Elsie M. Hood Award for undergraduate teaching and also the University of Mississippi Award for Excellence in Graduate Teaching and Mentoring. Dr. Wilson has devoted himself to the development and dissemination of Acceptance and Commitment Therapy, Relational Frame Theory, and their underlying theory and philosophy for the past 28 years, publishing 53 articles, 37 chapters, and 10 books. He has central interests in the application of behavioral principles to understanding topics such as purpose, meaning, values, therapeutic relationship, and present moment focused work. Dr. Wilson has presented his research in 32 countries, and has participated as co-investigator in a wide range of research projects in the U.S. and internationally.
Abstract: Substance use disorders remain among the most difficult to treat psychological problems. Psychologists often avoid this area. They frequently have minimal training in the treatment of substance use disorders and relapse rates remain high even using our best-developed treatments. In this presentation, we will examine recovery from addiction and barriers to recovery through the lens of the psychological flexibility model. A broadly contextual model will be contrasted with narrow disease-oriented perspective. The application of behavioral principles to a verbally established sense of self and life-purpose will be examined.
 
Cognitive Behavioral Therapy for Substance Use Disorders: Development and Evaluation of a Computerized CBT Program
BRIAN KILUK (Yale School of Medicine )
I received my Ph.D. in clinical psychology in 2009 from the University of Maryland, Baltimore County, completed postdoctoral training at Yale through a National Institute on Drug Abuse T32 Fellowship, and ultimately joined the faculty ranks in the Department of Psychiatry in 2012. My area of research includes an emphasis on three major topics: (1) the evaluation and enhancement of a web-based version of cognitive behavioral therapy for alcohol and drug use disorders (CBT4CBT); (2) exploration of the mechanisms of cognitive behavioral therapy (CBT) for substance use disorders, and (3) the identification of clinically meaningful outcome indicators of clinical trials for illicit drug use disorders. I have received research grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, and my work has been featured at national scientific meetings. As an expert in CBT for substance use disorders, I have consulted with treatment facilities across the U.S. to provide workshop training in manual-guided CBT, as well as ongoing fidelity monitoring and coaching.
Abstract: Cognitive behavioral therapy (CBT) has strong empirical support for the treatment of various substance use disorders, yet it has been difficult to successfully implement in community treatment centers despite considerable effort toward dissemination. Technology-based interventions offer the potential to close the gap between research and clinical practice by providing a broadly accessible, standardized, cost-effective, and engaging method of delivering evidence-based treatments directly to clients, while also freeing up clinician time to address clients’ various psychosocial and case management needs. Moreover, from a research standpoint, the standardized delivery of treatment ingredients offers the potential for more precise evaluation of the interventions’ mechanisms of behavior change, compared to prior investigations that have been hindered by therapist variability with respect to fidelity, dose and quality of delivery. This session will focus on the development, evaluation, and implementation of one such technology-based intervention for substance use disorders, “Computer Based Training for Cognitive Behavioral Therapy” (CBT4CBT). Data will be presented from two completed randomized controlled trials supporting the efficacy of CBT4CBT as an adjunct to standard substance abuse treatment (Carroll et al., 2008; Carroll et al., 2014), as well as two recently completed trials supporting the safety and efficacy of CBT4CBT as a stand-alone treatment (Kiluk et al., 2016; Kiluk et al., under review). Factors considered during the design/development phase of the intervention, as well as the characteristics of ongoing trials that are intended to advance the understanding of mechanisms will be discussed. Finally, the session will conclude with a discussion of the future directions of CBT4CBT, which include attempts to improve treatment outcomes and dissemination strategies.
 
Target Audience:

Board certified behavior analysts; licensed psychologists; graduate students.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe how operant conditioning can be used to promote drug abstinence and adherence to medications; (2) describe parameters of operant conditioning that are critical to promoting drug abstinence in refractory patients and maintaining drug abstinence over time; (3) describe the main features of the therapeutic workplace; (4) describe how the therapeutic workplace uses contingent access to employment (i.e., employment-based reinforcement) to promote drug abstinence, medication adherence, work, and productivity; (5) describe three models for arranging long-term exposure to employment-based reinforcement in the treatment of drug addiction; (6) describe the theoretical link between mindfulness and acceptance processes and behavioral principles; (7) describe the theoretical link between values and behavioral activation processes and behavioral principles; (8) describe methods of directly linking valued action to mindfulness practices in the treatment of addiction.
 
 
Invited Paper Session #7
CE Offered: PSY/BACB/NASP/AAHCPAD/NAADAC
Behavioral Analysis, Drug Use, and Society
Tuesday, November 20, 2018
12:00 PM–2:30 PM
Independence Hall A
Domain: Service Delivery
Instruction Level: Intermediate
CE Instructor: Mark Galizio, Ph.D.
Chair: Mark Galizio (University of North Carolina Wilmington)
Discussant: Kevin Volpp (University of Pennsylvania)
 
Changing Drug Use and Other Health-Related Behavior in Vulnerable Populations
STEPHEN T. HIGGINS (University of Vermont)
Stephen T. Higgins, Ph.D., is Director of the University of Vermont’s (UVM) Center on Behavior and Health, and Principle Investigator on five NIH grants on the general topic of behavior and health, including two center grants, two research grants, and an institutional training award. He is the Virginia H. Donaldson Endowed Professor of Translational Science in the Departments of Psychiatry and Psychology and serves as Vice Chair of Psychiatry. He has held many national scientific leadership positions, including terms as President of the College on Problems of Drug Dependence and the American Psychological Association’s Division on Psychopharmacology and Substance Abuse. He is the author of more than 300 journal articles and invited book chapters and editor of a dozen volumes and therapist manuals in the area of behavior and health.
Abstract: 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.
 

Application of Operant Conditioning to Address the Interrelated Problems of Poverty, Drug Addiction, and HIV

KENNETH SILVERMAN (Johns Hopkins University)
Kenneth Silverman has been in the Department of Psychiatry and Behavioral Sciences in the Johns Hopkins University School of Medicine since 1989 and is currently a Professor in the department. His research has focused on developing operant treatments to address the interrelated problems of poverty, drug addiction, and HIV. His primary research has focused on the development and evaluation of abstinence reinforcement interventions for the treatment of heroin and cocaine addiction in low-income, inner city adults; financial incentives to promote adherence to antiretroviral medications and viral suppression in people living with HIV; the development of the therapeutic workplace intervention and the use of employment-based reinforcement in the long-term maintenance of drug abstinence, adherence to addiction treatment medications, and employment; and the development of computer-based training to establish critical academic and job skills that unemployed adults need to gain and maintain employment and escape poverty.
Abstract:

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 research on the therapeutic workplace is needed that targets poverty directly.

 
Target Audience:

Board certified behavior analysts; licensed psychologists; graduate students.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe how operant conditioning can be used to promote drug abstinence and adherence to medications; (2) describe parameters of operant conditioning that are critical to promoting drug abstinence in refractory patients and maintaining drug abstinence over time; (3) describe the main features of the therapeutic workplace; (4) describe how the therapeutic workplace uses contingent access to employment (i.e., employment-based reinforcement) to promote drug abstinence, medication adherence, work, and productivity; (5) describe three models for arranging long-term exposure to employment-based reinforcement in the treatment of drug addiction; (6) the central role that lifestyle and the reinforcement process more specifically contributes to risk for chronic disease and premature death; (7) discuss how the reinforcement process can be leveraged to promote behavior change and improved health; (8) the reinforcement process can be leveraged to promote behavior change at the level of clinical interventions directed at individuals and policies directed at populations.
 

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