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

Event Details

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Invited Paper Session #7
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.

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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