3/21/2015. Leonardo Andrade, Ph.D. Westfield State University

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1 Leonardo Andrade, Ph.D. Westfield State University Evidence based behavioral treatment for drug abuse Theoretical foundation of CM is based on operant conditioning principles Contingencies associated with drug use are manipulated to reduce the frequency of drug use Core tenets of CM (Petry, ) (1) The target behavior is objectively monitored (2) Tangible reinforcers are delivered contingent upon the detection of the target behavior (3) Reinforcers are withheld when the target behavior is not emitted Patients earn vouchers contingent upon submission of drug negative specimens Vouchers are worth a certain monetary amount Exchangeable for items of monetary value (e.g., clothing, sports equipment, etc.) 1

2 Treatment retention 14 Duration of continuous abstinence CM STD Average weeks CM STD Weeks Weeks Cocaine (Higgins et al., 1994, ; Silverman et al.1998) Opioids (Bickel et al., 1997; Preston et al., 1998, ) Benzodizepines (Stitzer et al.,1992) Marijuana (Budney et al., ; 6) Nicotine (Stitzer & Bigelow 1984; Roll et al., 1996) A meta analyses of psychosocial treatments for substance use disorders concluded that CM is the most efficacious intervention (Dutra et al. 8) Voucher CM has been rarely implemented in clinical practice Patients can earn up to $1, over 12 week treatment period Higgins et al. (1991, 1993, 1994); Silverman et al. (1996) On average patient s earning are about $ Higgins et al. (1994), Silverman (1996) 2

3 Petry et al. () developed a prize based CM intervention Also known as the fishbowl technique Every time the target behavior is objectively demonstrated, patients earn the opportunity to draw from a bowl and earn prizes Roughly 5 nonwinning Remaining slips: Small prizes ~ $1 (41.8) Large prizes ~ $ (8.) Jumbo prize ~ $ (.2) Maximal reinforcement is on average $25 to $ over 12 weeks Patient s earn about half maximum reinforcement Abstinence throughout treatment Prize CM SC Percent relapse to heavy drinking by the end of the study Prize CM SC The National Institute on Drug Abuse Clinical Trials Network (CTN) evaluated prize CM in community based treatment clinics across the country. Methadone clinics (Peirce et al., 6) and Outpatient psychosocial treatment clinics (Petry et al., 5) Treatment programs are now implementing prize CM in the context of clinical care (Kellogg et al., 5; Ledgerwood et al., 8; Lott & Jencius, 9; Squires et al., 8) The Department of Veterans Affairs (VA) Mental Health Services sponsored the largest known nationwide implementation effort of CM in 11 (Petry et al., 14) 3

4 Over 92 clinics have initiated CM Clinicians have been preparing success stories. The VA is investing in the continuation of CM due to the positive response by clinicians and patients Nutrition Consumption of fruits and vegetables in children Jones et al. (14); Lowe et al. (4); Lowe & Horne (9) Medication adherence E.g., Antiretroviral medication, hypertension, tuberculosis, hepatitis, schizophrenia, substance abuse. DeFulio & Silverman (12); Petry et al. (12) Exercise Walking in healthy, overweight, and older adults Andrade et al (14); Normand (8); Petry et al. (13) Weight loss Petry et al (11); Volpp et al. (8) 4

5 New technology facilitates CM implementation, enhance its treatment effects, and improve its dissemination (Dallery & Raiff, 11). Minimizes the delay between behavior and reinforcement. Minimizes the inconveniences associated with frequent clinic attendance. Widens the range of behaviors that can be objectively monitored. Internet based CM program to promote nicotine abstinence and diabetes monitoring Dallery, Glenn, & Raiff (7); Dallery & Raiff (11); Raiff & Dallery () CM with cellphones to promote alcohol abstinence and medication adherence Alessi & Petry (12); Petry et al. (under review) P3 DA23918, R1 DA27615, R1 DA22739, R1 DA13444, P5 DA9241, P AA35, R1 HD7563, R1 AA21446, T32 AA729 5