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.     

The effects of a cooperation contingency on behavior in a continuous three-person environment

Five groups of three subjects resided for 10 or 15 days within a continuously programmed environment. Subjects followed a programmatic arrangement of required and optional private and social activities that determined the individual and group baseline behaviors into which experimental operations were introduced and withdrawn. A cooperation condition was in effect when all three subjects were required to select simultaneous access to a group area before it became available for use. A noncooperation condition was in effect when access to a group area could be selected by individual subjects, without regard to the other subjects' selections. For all groups, the effects of these two conditions on individual and group behaviors were investigated in reversal designs where several successive days occurred under each condition. Groups 1, 4, and 5 had the noncooperation condition interposed between cooperation conditions. Groups 2 and 3 had the cooperation condition interposed between noncooperation conditions. Durations of triadic activities, per cent of time in triadic activities, intercom use, and intersubject program synchronization were greater during cooperation conditions than during noncooperation conditions. These data show that a cooperation contingency within the behavioral program affected both social behavior and the collateral individual behavior necessary to execute the cooperation response.     

Maintaining disulfiram ingestion among outpatient alcoholics: a security-deposit contingency contracting procedure

Disulfiram is frequently prescribed to alcoholic patients as a deterrent to drinking. Although ingestion of ethanol by a disulfiram patient quickly results in an intense dysphonc reaction, the drug is not generally credited with significant value in alcoholism treatment (Mottin, 1973). It is suggested that most alcoholics simply stop taking the medication (Gerrein et al., 1973). and review articles conclude that motivation for abstinence is the crucial variable involved in successful disulfiram treatment (Ditman, 1966: Mottin, 1973).Motivation may be a characteristic of environmental contingencies rather than of individuals. If so, environmental contingencies should permit one to design into a disulfiram treatment progrim the requisite motivation to achieve therapeutic success. Contingency management procedures supporting disulfiram ingestion reported to date (Liebson et al., 1973: Haynes, 1973) have been of the sort to be imposed upon difficult populations rather than offered to general treatment applicants. Contingency contracting may represent a technique for supporting disulfiram ingestion appropriate to the broader general population of voluntary alcoholism treatment applicants. Contingency contract treatment (Homme, 1969; Stuart, 1971) is a procedure in which client and therapist mutually agree to establish an incentive for the client to achieve a behavioral goal. Contingency contracts can be viewed as a form of self-control therapy, and have been applied in a wide variety of problem areas, including school problems (Homme, 1969: Cantrell, et al., 1969). delinquency (Stuart, 1971),weight control (Mann, 1972). smoking reduction (Elliott and Tighe, 1968: Winett, 1973), drug abuse (Boudin, 1972), and alcoholism (Miller, 1972).Frequently contingency contracting involves the client's posting of a financial security deposit to serve as his incentive for achieving the agreed-upon therapeutic goal (Tighe and Elliot, 1968). This security deposit can be earned back consequent upon achieving specific goals, or sacrificed consequent upon failure. Controlled studies by Mann (1972) and by Winett (1973) have demonstrated this security-deposit procedure to be effective in enhancing weight loss and smoking reduction, respectively.We report here on our experience with application of the security deposit contracting procedure to maintaining routine disulfiram ingestion among outpatients in an alcoholism treatment program.     

Fixed-ratio reinforcement of spaced responding

Responses by rats were reinforced with food under a second-order schedule involving fixed-ratio reinforcement of temporally spaced responses. Requirements of 20, 8, and 3 responses were examined. The typical characteristic of spaced responding was maintained under the ratio schedules: interresponse time distributions were similar to those typically seen, and were not noticeably affected by the ratio value. Comparison of total response rate, correct response rate, and accuracy showed correct response rate to be the most consistently affected by changes in the ratio value. Substantial evidence of schedule control was seen only for correct responses. Incorrect response records were erratic, but rates generally declined as reinforcement was approached. Correct response records were characterized by increasing rate as reinforcement was approached. It was suggested that the pattern of fixed-ratio performance revealed may be affected by the behavioral unit examined.     

An administrative model for close monitoring and managing high risk individuals.

The public expects central government to have immediate knowledge of the condition and circumstances of certain vulnerable or dangerous individuals such as insanity acquittees, and to take action in individual cases to protect the individual and the public. Therefore, such persons conditionally released to community settings require an unusual degree of close monitoring and management. Being immediately aware of the condition and circumstances of its assignees, together with other duties of a board or commission responsible for that monitoring and management, is largely an information management function. The Psychiatric Security Review Board in Oregon is used to illustrate this unique mission, operations, and information management. In this paper, the Psychiatric Security Review Board is described in terms of its core and secondary businesses, together with a model information system that is based on information and information management processes actually employed by the Board.