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| Contingency Management in the Treatment of Drug Abuse |
| Sunday, May 25, 2008 |
| 4:00 PM–5:20 PM |
| Boulevard B |
| Area: CBM/BPH; Domain: Applied Research |
| Chair: Jeffrey J. Everly (Johns Hopkins University School of Medicine) |
| Discussant: James S. MacDonall (Fordham University) |
| CE Instructor: Mary Louise E. Kerwin, Ph.D. |
| Abstract: Contingency management (CM) is the differential reinforcement of clinically relevant behaviors. This symposium will include several data-based presentations of how CM is successfully used in the treatment of substance abuse. Among the issues addressed will be how varying reinforcement contingencies affects multiple target behaviors in an employment-based treatment setting, the use of group CM to reinforce behaviors necessary for cocaine abstinence and methadone treatment, and the use of individual CM to reduce cigarette smoking in pregnant and recently post-partum women. |
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| Reinforcing Attendance and Skills Training in Employment-Based Substance Abuse Treatment. |
| JEFFREY J. EVERLY (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University) |
| Abstract: Research in our laboratory has focused on using a therapeutic workplace to treat substance abuse. Access to the therapeutic workplace is used as a reinforcer for clinically relevant behaviors. While in the workplace, participants work on typing training programs. Participants are paid a combination of base pay for attending the workplace, and productivity pay for work on the training programs. Although a flat hourly wage may be sufficient to maintain all relevant workplace behaviors, it may be necessary to selectively reinforce each target behavior to ensure regular attendance and efficient completion of the training programs. This issue is addressed in the present study by paying participants in one of two ways that will be alternated across experimental conditions. In one condition, participants will be paid the standard combination of base and productivity pay. In the other condition, participants will be paid a flat wage based on the average hourly base and productivity pay from previous conditions. Next, participants’ preference for the two payment methods will be assessed. The presented results will focus on how various measures of training performance and attendance are affected by the two payment methods, and which method, if any, the participants prefer. |
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| Group Contingency Management for Cocaine Abstinence with Methadone Maintenance Clients. |
| MARY LOUISE E. KERWIN (Rowan University), Kimberly C. Kirby (Treatment Research Institute), Carolyn M. Carpenedo (Treatment Research Institute), Beth J. Rossenwasser (Treatment Research Institute), Molly Coyle (Temple University) |
| Abstract: Individual contingency management (CM) is among the most effective methods for initiating and maintaining drug abstinence; however, it is inconsistent with group therapy, the most common mode of treatment delivery in community drug treatment settings. Group CM, which has been used effectively in other settings with natural groups (e.g., classrooms, workplaces, hospital wards), has both a positive effect on target behaviors and is associated with corollary or “nontargeted” cooperative and supportive behaviors among group members. This paper describes the development and application of group CM interventions for drug abstinence and other behaviors among clients in methadone maintenance. The intervention consisted of a dependent subgroup CM contingency in which the behavior of a single, randomly selected, anonymous individual would determine reinforcement delivery for the entire group. Using a prize bowl method to determine the schedule of reinforcement; the group contingency was placed on a single behavior (cocaine abstinence) or one of four therapeutic behaviors (abstinence, outpatient attendance, group CM attendance, and medication compliance) selected randomly. Results indicate that a dependent subgroup CM intervention increased targeted behaviors. A preliminary analysis of direct observation of positive and negative behaviors of group members during group CM meetings is also provided. |
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| Voucher-Based Reinforcement Therapy for Cigarette Smoking Cessation in Pregnant and Recently Postpartum Women. |
| RANDALL E. ROGERS (University of Vermont), Sarah H. Heil (University of Vermont), Stephen T. Higgins (University of Vermont), Ira M. Bernstein (University of Vermont), Laura J. Solomon (University of Vermont), Colleen S. Thomas (University of Vermont) |
| Abstract: Smoking during pregnancy is a leading preventable cause of poor pregnancy outcomes in the U. S. Effective interventions exist for promoting smoking abstinence during pregnancy, but cessation rates are often low (< 20%). The following results are from a study of voucher-based reinforcement therapy (VBRT) for smoking cessation during pregnancy and postpartum. Fifty-eight female smokers entering prenatal care were recruited to participate and assigned to either contingent or non-contingent voucher conditions. In the contingent condition, vouchers were earned for biochemically-verified smoking abstinence; in the non-contingent condition, vouchers were earned independent of smoking status. Vouchers were available during pregnancy and for 12 weeks postpartum. Contingent vouchers significantly increased 7-day point-prevalence abstinence at the end-of-pregnancy (37% vs. 9%), 12-week postpartum (33% vs. 0%), and 24-week postpartum (27% vs. 0%) assessments. The magnitude of the treatment effects exceeded levels usually observed with this population. Furthermore, the effects were sustained 12 weeks after discontinuation of the vouchers. These results provide evidence that VBRT has a contribution to make to efforts to decrease smoking. Additional controlled studies should be conducted to determine how to optimize this treatment with this population and to examine treatment effects on fetal health. |
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