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44th Annual Convention; San Diego, CA; 2018

Event Details

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Symposium #33
Novel Behavioral Economic Approaches to Assessing and Treating Substance Abuse
Saturday, May 26, 2018
10:00 AM–11:50 AM
Manchester Grand Hyatt, America's Cup A-D
Area: CBM/BPN; Domain: Applied Research
CE Instructor: Tyler Nighbor, Ph.D.
Chair: Sarah Martner (University of Florida)
Discussant: Shrinidhi Subramaniam (Johns Hopkins University)
Abstract: Substance abuse is a major public health crisis that is costly both in terms of health care expenditures and the resulting poor health outcomes for individuals and their families. In the current symposium, a series of talks will address different behavioral economic approaches to assessing and treating health behavior related to substance abuse. Strategies that will be presented include 1) the use low-risk behavioral economic assessments to predict treatment outcomes among pregnant women undergoing smoking-cessation treatment, 2) improving effective contraceptive use among opioid-maintained women of reproductive age using financial incentives, 3) assessing whether electronic cigarettes are viable behavioral substitutes to cigarettes, and 4) the use of a soft-commitment approach to reducing cigarette use. All presentations highlight the use of established principles of behavioral economics to address serious health concerns.
Instruction Level: Intermediate
Keyword(s): health behavior, incentives, smoking cessation, technology
Target Audience: Board certified behavior analysts; licensed psychologists; graduate students.
Learning Objectives: they are optional for those requesting BACB or QABA.
Remote Delivery of a Soft Commitment Approach to Smoking Cessation
DIANN GAALEMA (University of Vermont), Irene Pericot-Valverde (University of Vermont), Howard Rachlin (Stony Brook University)
Abstract: As technology continues to permeate the market the opportunity to disseminate interventions remotely increases as well. In the current study the use of “soft commitment” was tested to support smokers interested in quitting. Smokers were enrolled for 60 days and were randomized to either a control condition where they reported their smoking daily online or to an experimental condition. In the experimental condition smokers also reported smoking online but were alternated between “free days” where they chose how much to smoke and “matching days” where they were asked to smoke the same number of cigarettes they had in the prior “free day.” Currently 30 participants have been randomized in this protocol. The intervention has been well-received with most people successfully logging their smoking online and returning for the follow-up assessment. Reductions in cigarettes per day in the experimental condition is twice that of control (4.3 vs. 2.1). However, the difference is not significant due to the small sample size and high variability. Additional participants are being enrolled. Also, behavioral economic measures were used to predict quitting outcomes. Overall, Delay Discounting predicted quit attempts (duration and number) while Cigarette Purchase Task indices (pmax and omax) predicted confidence and intention to quit.
Real-Time Measures of Electronic Cigarette Use and Smoking: How Do Vaping and Smoking Interact?
SARAH MARTNER (University of Florida), Jesse Dallery (University of Florida)
Abstract: Whether electronic cigarette use promotes smoking cessation is still hotly debated. We measured smoking and electronic cigarette use (“vaping”) in real-time during a quit attempt. During a one-month period, 12 smokers interested in quitting submitted twice-daily breath CO samples. Additionally, vaping was measured with an electronic nicotine delivery system (ENDS) that recorded puffs per day and duration of puffs. During monitoring, participants were instructed to smoke as usual 2-8 days. Participants were then given a quit date and told to use the ENDS as needed. Half of the participants were instructed to use the ENDS and received a contingency management intervention for smoking during the 14 days following monitoring (i.e., they received vouchers contingent on negative breath samples), then used the ENDS without contingency management for 14 days. The other half of participants used the ENDS alone for 14 days, followed by ENDS plus contingency management. Frequent use of ENDS was associated with lower CO values. The results of this study suggest that electronic cigarettes may serve as an imperfect substitute for conventional cigarettes.
Examining Interrelationships Between Delay Discounting and Simulated Demand for Cigarettes Among Pregnant Women
TYLER NIGHBOR (University of Vermont), Ivori Zvorsky (University of Vermont), Stephen T. Higgins (University of Vermont)
Abstract: Cigarette smoking is overrepresented among economically disadvantaged women, and smoking during pregnancy is the leading cause of poor pregnancy outcomes in the U.S. Two common low-risk experimental arrangements used in the study of cigarette smoking among pregnant women are the Cigarette Purchase Task (CPT) and delay discounting (DD). Few studies have evaluated whether combining CPT and DD may enhance understanding of smoking beyond observations with either alone. The current investigation evaluated the interrelationship between CPT and DD performance of pregnant women by examining associations with the likelihood of making antepartum quit attempts, a strong predictor of response to formal smoking-cessation treatment. Data from 114 women enrolled in an ongoing smoking-cessation clinical trial were analyzed. Intensity, Omax, and breakpoint were significantly and inversely associated with antepartum quit attempts. DD by itself was not significantly associated with antepartum quit attempts nor was it associated with the CPT indices. Considering the predictive CPT indices and DD together revealed a conditional relationship wherein associations between DD and quit attempts were conditional on Intensity and Omax level. That is, among those with relatively high demand Intensity or Omax DD was not associated with quit attempts, while among those with relatively low demand Intensity or Omax steep discounting was associated with a lower proportion of quit attempts. These results suggest that the influence of DD among pregnant smokers is mostly limited to lighter smokers or, said differently, heavy smoking appears to override any influence of DD on quitting smoking during pregnancy.
Increasing Effective Contraceptive Use Among Opioid-Maintained Women at Risk for Unintended Pregnancy
CATALINA REY (University of Vermont), Sarah Heil (University of Vermont), Alexis Matusiewicz (University of Vermont), Heidi Melbostad (University of Vermont), Stacey C. Sigmon (University of Vermont), Gary J. Badger (University of Vermont), Stephen T. Higgins (University of Vermont)
Abstract: Nearly 80% of opioid-exposed pregnancies are unintended, due in part to alarmingly low rates of effective contraceptive use among opioid-using women (<10%). We developed and are evaluating an intervention to increase prescription contraceptive use by opioid-maintained (OM) women. Usual care in many OM clinics involves distribution of contraceptive information and referrals to community family planning providers. The intervention adds (1) the World Health Organization’s (WHO) contraception protocol and (2) financial incentives for attendance at follow-up visits. Pilot data strongly supported the initial efficacy of this intervention, with 5-fold higher rates of self-reported prescription contraceptive use in the experimental vs. control conditions at the end of the 6-month intervention (94% vs. 13%). A fully randomized controlled Stage II trial is now ongoing to rigorously evaluate the efficacy of the different components of this innovative intervention. Preliminary results suggest a graded effect, with 13% vs. 39% vs. 59% verified prescription contraceptive use at 6 months across the three conditions, respectively. Preliminary results suggest both experimental interventions increase prescription contraceptive use and decrease pregnancy, but that financial incentives provide added efficacy.



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