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| Recent Applications of Contingency Management to Promote Healthy Behavior Change |
| Saturday, May 25, 2019 |
| 10:00 AM–11:50 AM |
| Swissôtel, Lucerne Ballroom Level, Alpine 1/2 |
| Area: BPN/EAB; Domain: Translational |
| Chair: August F. Holtyn (Johns Hopkins University School of Medicine) |
| Discussant: Shrinidhi Subramaniam (California State University, Stanislaus) |
| CE Instructor: Shrinidhi Subramaniam, Ph.D. |
| Abstract: Many chronic health conditions could be prevented, delayed, or improved through healthy behavior change. However, promoting and maintaining health behaviors can be challenging, particularly when reinforcement for an unhealthy choice (e.g., drug use) is available immediately and benefits of a healthy choice (e.g., drug abstinence) are delayed. Contingency management interventions, which arrange for the direct and immediate reinforcement of therapeutically important target behaviors, have been highly effective in promoting a wide range of health behaviors in diverse populations. The presentations delivered in this symposium will cover recent applications of contingency management in the treatment of chronic health problems. Specific topics will include treatment of opioid and cocaine use disorder in chronically unemployed adults, use of a smartphone-based approach to promote adherence to antiretroviral medications in people living with HIV, examination of individual differences in response to treatment for cocaine use disorder, and evaluation of cardiac rehabilitation participation and hospital utilization among low-income cardiac patients. In sum, this symposium offers an overview of interventions that apply behavior analytic principles to promote healthy behavior change. |
| Instruction Level: Intermediate |
| Keyword(s): contingency management, health, incentives |
| Target Audience: Board certified behavior analysts; licensed psychologists; graduate students |
| Learning Objectives: At the conclusion of the symposium, participants will be able to: (1) describe how operant conditioning can be used to promote therapeutic behavior change; (2) identify key features of contingency management interventions; (3) discuss recent applications of contingency management to promote healthy behavior change. |
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| A Long-Term Treatment for Drug Addiction and Unemployment: Interim Results |
| (Applied Research) |
| AUGUST F. HOLTYN (Johns Hopkins University School of Medicine), Kenneth Silverman (Johns Hopkins University) |
| Abstract: Poverty, unemployment, and drug addiction are co-occurring problems. This ongoing study is evaluating whether abstinence-contingent wage supplements can promote drug abstinence and employment in chronically unemployed adults with opioid use disorder. In Phase 1 (3 months), participants can earn up to $200/week for engaging in job-skills training. To promote drug abstinence, participants must provide opiate- and cocaine-negative urine samples to maintain maximum pay. In Phase 2 (1 year), participants are randomly assigned to receive Individual Placement and Support (IPS) supported employment (IPS Only) or IPS with abstinence-contingent wage supplements (IPS + ACWS). Participants in the IPS + ACWS group can earn up to $320/week for maintaining opiate- and cocaine-abstinence and for seeking and maintaining employment. Participants complete assessments every 30 days throughout Phases 1 and 2. Interim results show that participants in the IPS + ACWS group provided significantly more opiate- and cocaine-negative urine samples, and were significantly more likely to gain employment than participants in the IPS Only group. This intervention could be an effective long-term treatment for drug addiction and unemployment. |
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| Increasing Adherence to Life-Saving Medicine with Contingencies and Technology |
| (Applied Research) |
| HAILY TRAXLER (Western Michigan University), Amanda Devoto (Western Michigan University), David William Sottile (Western Michigan University), Anthony DeFulio (Western Michigan University) |
| Abstract: Antiretroviral therapy (ART) improves life expectancy and quality of life for individuals living with HIV. ART adherence of >95% drastically decreases the likelihood of transmission to others, but many people with a history of drug use do not maintain this level of adherence. The purpose of this study was to develop a mobile contingency management (CM) intervention for promoting medication adherence in people with a history of drug use. Fifty participants with a history of opioid or cocaine use were enrolled in the study for six months and randomly assigned to either a control (n=25) or treatment (n=25) group. Treatment group participants received a smartphone loaded with a CM intervention app that allowed for (1) direct observation of medication consumption through video selfies, (2) easy tracking of incentive earnings, (3) easy access to adherence-related resources, and (4) a dosing reminder texting system. The proportion of individuals who achieved 95% adherence increased over time in the treatment group and decreased over time in the control group, and was significantly different in the final study month (55% vs. 19%; p=0.015). Usage data showed high levels of intervention engagement and correct usage, and self-reports showed a high level of intervention acceptability. |
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Baseline Characteristics and Initial Abstinence During Contingency Management Among Methadone Patients With Cocaine Use Disorder |
| (Applied Research) |
| MAGGIE SWEENEY (Johns Hopkins University School of Medicine), Tanyaradzwa Chikosi (Johns Hopkins University School of Medicine), Tyrone Scales (Johns Hopkins University School of Medicine), Kelly Dunn (Johns Hopkins University School of Medicine), Maxine Stitzer (Behavioral Pharmacology Research Unit) |
| Abstract: Contingency management (CM) promotes drug abstinence using monetary incentives contingent upon drug negative urine samples, but only about half or fewer of substance users exposed to CM respond by initiating abstinence. Thus, there is a need to understand individual differences in abstinence initiation. We are conducting a randomized, placebo-controlled trial evaluating whether the medication bupropion (Wellbutrin®) enhances response to CM for cocaine abstinence among methadone patients with cocaine use disorders. Data collection for the effects of medication is ongoing, but we have conducted preliminary analyses to determine whether individuals who initiate early abstinence differ systematically from individuals who fail to initiate early abstinence. Thus far, 25% of the sample achieved six consecutive cocaine-negative urines within the first six weeks of CM (i.e., prior to randomization; early abstainers). Early abstainers were not distinguishable from other participants according to cocaine use disorder severity, demographics, or performance on neurocognitive assessments. Early abstainers showed significantly greater proportion of cocaine-negative urine samples post-randomization relative to those who did not initiate early abstinence. These data emphasize that considerable and persistent differences exist in response to CM. In addition, cocaine use disorder severity, demographics, and other baseline characteristics may be insufficient to predict early abstinence during CM. |
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Increasing Cardiac Rehabilitation Participation Among Medicaid Enrollees: Effects on Hospital Utilization |
| (Applied Research) |
| DIANN GAALEMA (University of Vermont), Eline van den Broek-Altenburg (University of Vermont), Stephen T. Higgins (University of Vermont), Phillip Ades (University of Vermont) |
| Abstract: Attendance at cardiac rehabilitation significantly reduces the risk of morbidity and mortality following a cardiac event. However, certain populations of patients, such as lower-socioeconomic status patients, are unlikely to attend or complete the recommended course of rehabilitation. In a clinical trial, 130 participants were randomized to either usual care control or to earn incentives on an escalating schedule for completing up to 36 outpatient rehabilitation sessions. Incentivized participants completed significantly more sessions of cardiac rehabilitation and were twice as likely to complete the program. In this secondary analysis of the trial, we estimated the impact of the intervention on ED, Inpatient and Outpatient expenditures, number of visits and length of stay (LOS). Group differences were evaluated 12 months after patients’ qualifying event. Expenditures were modeled using a two-part model (TPM), since we expected that the probability of incurring any expenditure was independent of the amount of expenditure; number of visits and LOS were modeled by using negative binomial regressions. Models controlled for sociodemographic factors, smoking status, and severity of illness. Preliminary results indicate that the intervention group had, compared to the control group, lower mean expenditures for ED and outpatient, but not inpatient services. |
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