Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N  =  29) or an opiate-cocaine contingency (one draw for each urine negative for opiates or cocaine, four draws if negative for both, N  =  38). There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM. Opiate abstinence was greater in the opiate-cocaine group post-CM, and heroin craving was reduced in this group during and post-CM. Draws earned per cocaine-negative urine (four vs. one) did not affect cocaine use.     

A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.     

Attendance Rates in A Workplace Predict Subsequent Outcome of Employment-Based Reinforcement of Cocaine Abstinence in Methadone Patients

This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N  =  111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction period, participants provided urine samples but could work independent of their urinalysis results. After the induction period, participants had to provide urinalysis evidence of cocaine abstinence to work and maintain maximum pay. A multiple regression analysis showed that induction period attendance was independently associated with urinalysis evidence of cocaine abstinence under the employment-based abstinence reinforcement contingency. Induction period attendance may measure the reinforcing value of employment and could be used to guide the improvement of employment-based abstinence reinforcement.     

VOUCHER‐BASED CONTINGENT REINFORCEMENT OF SMOKING ABSTINENCE AMONG METHADONE‐MAINTAINED PATIENTS: A PILOT STUDY

This study evaluated the efficacy of a contingency management (CM) intervention to promote smoking cessation in methadone‐maintained patients. Twenty participants, randomized into contingent (n = 10) or noncontingent (n = 10) experimental conditions, completed the 14‐day study. Abstinence was determined using breath carbon monoxide and urine cotinine levels. Contingent participants received voucher‐based incentives for biochemical evidence of smoking abstinence. Noncontingent participants earned vouchers independent of smoking status. Contingent participants achieved significantly more smoking abstinence and longer durations of continuous smoking abstinence than did noncontingent participants. These results support the potential efficacy of using voucher‐based CM to promote smoking cessation among methadone‐maintained patients.     

CONTINGENT REINFORCEMENT OF ABSTINENCE WITH INDIVIDUALS ABUSING COCAINE AND MARIJUANA

Two males diagnosed with cocaine dependence received a behavioral intervention comprised of contingency management and the community reinforcement approach. During the initial phase of treatment, reinforcement was delivered contingent on submitting cocaine-free urine specimens. The community reinforcement approach involved two behavior therapy sessions each week. Almost complete cocaine abstinence was achieved, but regular marijuana use continued. During a second phase, reinforcement magnitude was reduced, but remained contingent on submitting cocaine-free specimens. Behavior therapy was reduced to once per week. Cocaine abstinence and regular marijuana use continued. Next, reinforcement was delivered contingent on submitting cocaine- and marijuana-free specimens. This modified contingency resulted in an abrupt increase in marijuana abstinence and maintenance of cocaine abstinence. One- and 5-month follow-ups indicated that cocaine abstinence continued, but marijuana smoking resumed. These results indicate that the behavioral intervention was efficacious in achieving abstinence from cocaine and marijuana; maintenance, however, was achieved for cocaine only.     

The Relative Contribution of Economic Valence to Contingency Management Efficacy: A Pilot Study

We investigated the extent to which a contingency management (CM) procedure that deducted money from a grand total available at the end of the study compared to a procedure in which money accumulated with continued abstinence from cigarette smoking. Results suggested that the procedure in which money increased contingent on abstinence resulted in a significantly greater likelihood of obtaining a clinically relevant (i.e., 48-hr) period of abstinence. In terms of attendance, participants in the condition in which monetary reinforcement accrued with consecutive instances of abstinence were significantly less likely to miss consecutive appointments than those in which money was deducted for failure to abstain.     

CONTINGENT REINFORCEMENT FOR BENZODIAZEPINE-FREE URINES: EVALUATION OF A DRUG ABUSE TREATMENT INTERVENTION

This study evaluated contingent reinforcement for benzodiazepine-free urines as a therapeutic intervention for promoting reduced use of supplemental benzodiazepine drugs among methadone maintenance outpatients. Ten methadone maintenance patients were selected for participation on the basis of positive urinalysis results. During a 12-week intervention period these patients were offered clinic privileges, including monetary payments or methadone take-home doses, contingent on benzodiazepine negative urinalysis test results. Eight of ten participants responded to the intervention with at least 2.5 weeks of consecutive clean urines. An increase in benzodiazepine-negative tests during the contingent reinforcement period was significant for the group as a whole. The results suggest that more widespread application of contingent reinforcement procedures may be warranted in drug abuse treatment clinics.     

CONTINGENCY MANAGEMENT INTERVENTIONS: EFFECTS ON TREATMENT OUTCOME DURING METHADONE DETOXIFICATION

We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.     

Contingency Management for Attendance to Group Substance Abuse Treatment Administered by Clinicians in Community Clinics

Contingency management (CM) is effective in enhancing retention in therapy. After an 8-week baseline, four community-based substance abuse treatment clinics were exposed in random order to 16 weeks of standard care with CM followed by 16 weeks of standard care without CM or vice versa. In total, 75 outpatients participated. Patients who were enrolled in the clinics when the CM treatment phase was in effect attended a significantly greater percentage of therapy sessions than patients who were enrolled in treatment when CM was not in effect. This study is one of the first to investigate CM in community settings implemented entirely by community clinicians, and results suggest that CM is effective in improving therapy attendance.     

Mood Management Mail Intervention Increases Abstinence Rates for Spanish-Speaking Latino Smokers

A self-administered mood management intervention program for smoking cessation provided through the mail to Spanish-speaking Latinos resulted in a 23% abstinence rate at 3 months compared to an 11% abstinence rate for a smoking cessation guide alone. Participants (N = 136) were randomly assigned to receive either the cessation guide (the Guía), or the Guía plus a mood management intervention (Tomando Control de su Vida) presented in writing and in audiotape format. At 3 months after random assignment, 16 out of 71 of those assigned to the Guía-plus-mood management condition reported being abstinent (not smoking for at least 7 days) compared to 7 out of 65 in the Guía-only condition (z = 1.8; p = .04, one-tailed). Moreover, those with a history of major depressive episodes, but not currently depressed, reported an even higher abstinence rate in the Guía-plus-mood management condition, compared to the Guía-only condition (31 vs. 11%, z = 1.8, p = .04, one-tailed). We conclude that the mood management mail intervention substantially increases abstinence rates, especially for those with a history of major depressive episodes.     

Individualized behavior therapy for alcoholics: a third year independent double-blind follow-up.

An independently conducted double-blind study providing third year follow-up data for 53 of 70 male alcoholics who served as subjects in an experiment evaluating “Individualized Behavior Therapy (IBT)” techniques is reported. In the original study, subjects were initially assigned to either a controlled drinking or non-drinking (abstinence) treatment goal, and were then randomly assigned to either an experimental group receiving IBT or a control group receiving conventional state hospital treatment oriented towards abstinence. Previously reported results showed that IBT subjects functioned significantly better than control subjects throughout the first year of follow-up. Second year follow-up results found that IBT subjects treated with a controlled drinking goal functioned significantly better than their respective control subjects on a variety of measures, including drinking behavior. Differences between IBT subjects treated with a non-drinking goal and their control subjects did not retain statistical significance during the second year of follow-up. The independently determined follow-up data showed that during the third post-treatment year, subjects in the experimental groups generally functioned better than their respective control subjects. Comparison of the controlled drinking experimental group with its control group showed the significantly better functioning of subjects in the experimental condition on a number of drinking and other life functioning measures. Comparison of the non-drinking groups indicated only one possible difference on the drinking related measures involving a trend for subjects in the experimental condition to abstain more than those in the non-drinker control group. On other life functioning measures, however, subjects in the non-drinking experimental condition showed consistent improvement over their respective control subjects. Both of the controlled drinking groups reported more controlled drinking days than the non-drinking groups throughout the third year follow-up period.     

A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients

Background/ObjectiveContingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.MethodA total of 80 participants (75.8% males; M_age = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.ResultsAdding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).ConclusionsCM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.     

Individual characteristics and response to Contingency Management treatment for cocaine addiction

Voucher-based contingency management (CM) research has demonstrated efficacy for treating cocaine addiction, but few studies have examined associations between individual baseline characteristics and response to CM treatments. The aim of this study, involving 50 cocaine outpatients receiving CM for cocaine addiction, was to assess the impact of baseline characteristics on abstinence outcomes after six months of treatment. Patients who were abstinent after six months of treatment accounted for 58% of the sample. Patients with higher scores on the Alcohol area of the EuropASI and patients that were non-abstinent during the first month of treatment were less likely to achieve abstinence. These outcome predictors have implications both for treatment research and for clinical practice. Patients who do not respond early to treatment may need a more intensive intervention, and concomitant problematic alcohol use should be detected and treated. The remaining baseline variables examined were not statistically significant predictors of abstinence. This finding is important for the generalizability of CM across the range of individual characteristics of treatment-seeking cocaine abusers.     

AN EXPERIMENTAL COMPARISON OF THREE DIFFERENT SCHEDULES OF REINFORCEMENT OF DRUG ABSTINENCE USING CIGARETTE SMOKING AS AN EXEMPLAR

The efficacy of three different schedules of reinforcement for promoting and sustaining drug abstinence was compared in this study. Cigarette smoking was studied as an exemplar of stimulant drug self-administration. Sixty cigarette smokers were assigned to one of three groups (progressive rate of reinforcement, fixed rate of reinforcement, and yoked control). Participants in all three groups were asked to refrain from smoking for 1 week. Participants in the progressive and fixed groups achieved greater mean levels of abstinence than those in the control group. Participants in the progressive group were significantly less likely to resume smoking when they became abstinent than participants in the other groups.     

Using Acceptance and Commitment Therapy During Methadone Dose Reduction: Rationale,Treatment Description,and a Case Report

Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and Commitment Therapy (ACT)–based methadone detoxification program are presented. The program consisted of a 1-month stabilization and 5-month gradual methadone dose reduction period, combined with weekly individual ACT sessions. Urine samples were collected twice weekly to assess for use of illicit drugs. The participant successfully completed the program and had favorable drug use outcomes during the course of treatment, and at the 1-month and 1-year follow-ups. Innovative behavior therapies, such as ACT, that focus on acceptance of the inevitable distress associated with opiate withdrawal may improve methadone detoxification outcomes.     

The effect of contemplation and meditation on ‘great compassion’ on the psychological well-being of adolescents

This study aimed to evaluate the effect of contemplation and meditation (CM) training, with a focus on developing great compassion, on the psychological well-being (PWB) of adolescents. Participants (N = 51, mean age = 15.8) were randomly allocated to either CM training (n = 26) or a comparison group (n = 25). Both groups completed measures of PWB before and after the intervention. Adolescents who received CM training showed statistically significant increases in environmental mastery and personal growth, as well as decreased negative affect compared to the comparison group. Girls in the experimental group also showed a significant decrease in negative affect compared with boys in the experimental group. Both the experimental and comparison groups demonstrated increased life satisfaction, environmental mastery, self-acceptance, autonomy, and purpose in life. There were no changes in positive affect and positive relations with others for both groups.     

Live interactive group-specific normative feedback reduces misperceptions and drinking in college students: a randomized cluster trial.

This research evaluated the efficacy of a live and interactive group-specific normative feedback intervention designed to correct misperceptions of alcohol-related group norms and subsequently reduce drinking behavior. Campus organizations (N = 20) containing 1,162 college students were randomly assigned to intervention or assessment-only control conditions. Participants in the intervention condition attended an intervention during their organization's regular standing meeting. Data were gathered in vivo using computerized handheld keypads into which participants entered personal responses to a series of alcohol-related questions assessing perceptions of normative group behavior as well as actual individual behavior. These data were then immediately presented in graphical form to illustrate discrepancies between perceived and actual behavioral group norms. Results indicated that compared with the control group, the intervention group reduced drinking behavior and misperceptions of group norms at 1-month and 2-month follow-ups. Changes in perceived norms mediated the reductions in drinking. Results demonstrate the effectiveness of a novel, technologically advanced, group-based, brief alcohol intervention that can be implemented with entire groups at relatively low cost.     

Reducing playground bullying and supporting beliefs: an experimental trial of the steps to respect program

Six schools were randomly assigned to a multilevel bullying intervention or a control condition. Children in Grades 3-6 (N=1,023) completed pre- and posttest surveys of behaviors and beliefs and were rated by teachers. Observers coded playground behavior of a random subsample (n=544). Hierarchical analyses of changes in playground behavior revealed declines in bullying and argumentative behavior among intervention-group children relative to control-group children, increases in agreeable interactions, and a trend toward reduced destructive bystander behavior. Those in the intervention group reported enhanced bystander responsibility, greater perceived adult responsiveness, and less acceptance of bullying/aggression than those in the control group. Self-reported aggression did not differ between the groups. Implications for future research on the development and prevention of bullying are discussed.     

计算机心理干预在物质成瘾中的应用

针对物质成瘾者的计算机心理干预以传统心理干预理论为基础,通过计算机和网络对成瘾者进行干预。该方法通过提高成瘾者的自我效能感、应对技能、戒断动机等,达到帮助其戒断并预防复吸的目的。计算机心理干预对成瘾者虽有一定效果,但也存在一些问题,如其能否够弥补传统干预的不足,测量方法是否有效等。未来研究应进一步提高计算机干预的有效性,比较不同计算机干预方法对不同成瘾物质的适用性及有限性,并结合计算机干预与认知训练,推动计算机心理干预在物质成瘾中的应用。     

Positive psychotherapy for smoking cessation: Treatment development,feasibility, and preliminary results

Low positive and high negative affect (NA) predict low rates of smoking abstinence among smokers making a quit attempt. Positive psychotherapy can both increase positive affect (PA) and decrease NA and, therefore, may be a useful adjunct to behavioral smoking counseling. The purpose of the present study was to assess the feasibility and acceptability of a positive psychotherapy for smoking cessation (PPT-S) intervention that integrates standard smoking cessation counseling with nicotine patch and a package of positive psychology interventions. We delivered PPT-S to 19 smokers who were low in PA at baseline. Rates of session attendance and satisfaction with treatment were high, and most participants reported using and benefiting from the positive psychology interventions. Almost one-third of the participants (31.6%) sustained smoking abstinence for six months after their quit date. Future studies to assess the relative efficacy of PPT-S compared to standard smoking cessation treatment are warranted.