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 Creative Strategies for Getting, and Keeping, People in Treatment for Substance Use Disorders |
| Monday, May 27, 2024 |
| 3:00 PM–4:50 PM |
| Marriott Downtown, Level 4, Franklin Hall 12-13 |
| Area: CBM/BPN; Domain: Applied Research |
| Chair: Bethany R. Raiff (Rowan University) |
| Discussant: Jesse Dallery (University of Florida) |
| CE Instructor: Bethany R. Raiff, Ph.D. |
| Abstract: Getting people to enter treatment for substance use disorders is a challenge unto itself, but once they do make the decision to enter treatment, creative solutions to keeping them in treatment are sorely needed. In this symposium, the speakers will discuss creative solutions, as well as patient-related barriers, to getting people to enter and stay in treatment for substance use disorders. Kim Kirby will discuss a novel, web-based Community Reinforcement and Family Training intervention for helping people enter treatment. Next, Forrest Toegel will talk about their recent findings with Abstinent-Contingent Wage Supplements and how this relates to future employment. Shelby Goodwin will then discuss how contingency management may overcome patient-related financial barriers related to buprenorphine treatment engagement. Fourth, Lexi Knerr will talk about a novel, personalized contingency management approach to promoting nicotine vaping abstinence. Finally, Dr. Jesse Dallery will serve as a discussant, closing out the symposium with insights about where we are and where we may continue to go in improving substance use treatment engagement. |
| Instruction Level: Intermediate |
| Keyword(s): contingency management, CRAFT, low income, SUDs treatment |
| Target Audience: This will be most appropriate for an intermediate level. Attendees should have an interest in learning about how behavior analysis can be applied to the topic of treatment for substance use disorders. |
| Learning Objectives: At the conclusion, participants should be able to:
(1) Describe how a web-based community reinforcement and family training approach impacted treatment entry.
(2) What is meant by abstinent-contingent wage supplements and how these they relate to later employment
(3) How financial incentives may help to overcome barriers to buprenorphine treatment in low-income patients
(4) The benefits of personalizing different treatment elements for contingency management |
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| Community Reinforcement and Family Training Goes Digital |
| KIMBERLY C. KIRBY (Rowan University & We The Village, Co.), Jane Macky (We the Village), Ben Fitzpatrick (Tempest Technologies
Loyola Marymount University), Jaime Kishpaugh (Public Health Management Corporation), Calum Handley (We the Village), Robert J. Meyers (Robert J. Meyers, Ph.D. & Associates) |
| Abstract: Community Reinforcement and Family Training (CRAFT) is an empirically-supported treatment that teaches concerned significant others (CSOs) of individuals with substance use problems (IP) to use behavior analytic techniques to reduce IP drug use and increase new treatment entry. Previous web-based CRAFT programs have not replicated the primary outcome of IP treatment entry. We developed two online CRAFT programs and tested their efficacy. CSOs were primarily white, non-Hispanic adult females concerned about the opiate use of a partner or child. We block randomized 45 (15/arm) to receive 12 weeks of (a) web-based peer support (PEER); or weekly web-based CRAFT modules with (b) videoconference group (CRAFT-G), or (c) individual coaching (CRAFT-I). We administered online assessments of new IP treatment entry and CSO physical health, mood, and relationship satisfaction. The proportion of CSOs reporting IP treatment entry was higher in CRAFT-G (76.9%; n=13, p = 0.028) and CRAFT-I (72.7%; n=11, p = 0.053) compared to the PEER (40.0%; n=15). CRAFT-G showed significant improvements in CSO health (p = 0.013) and mood (p = 0.008) and both CRAFT groups showed significant improvements in relationship satisfaction relative to PEER. This study is the first to produce IP treatment entry suggesting that online CRAFT programs can replicate the effects of in person CRAFT. |
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| Employment Outcomes of Abstinence-Contingent Wage Supplements for Adults Experiencing Homelessness and Alcohol Use Disorder |
| FORREST TOEGEL (Northern Michigan University), Mackenzie Baranski (Northern Michigan University), Matthew Novak (University of Maryland, Baltimore County), August F. Holtyn (National Institutes of Health), Kenneth Silverman (Johns Hopkins University) |
| Abstract: Alcohol use disorder is concentrated among people who live in poverty. Abstinence-Contingent Wage Supplements (ACWS) is an employment-based intervention that addresses interrelated problems of poverty, unemployment, and drug use. The present talk provides a detailed analysis of employment outcomes from 62 ACWS participants in a study conducted in the Center for Learning and Health (Novak et al., 2023). The analysis includes types and patterns of employment and characteristics of participants who became employed. Most participants who received the ACWS intervention (n=41; 66%) obtained employment during the intervention year. The most common type of employment was sales and related occupations (e.g., cashier, sales representative; 20%). The length of employment varied by employed participant (2-26 weeks), as did average hours worked while employed (M=27 hr/week, SD=14 hr/week) and average earnings per week (M=$314.98, SD=$324.30). ACWS participants who became employed lived above the poverty line for an average of 11.32 weeks (SD=9.29 weeks) during the study period. Details related to patterns and characteristics of employment and escape from poverty will be discussed. Understanding the effects of the ACWS intervention on alcohol use, employment, and poverty may be useful in providing targeted support to people at increased risk of poverty-related health disparities. |
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| Contingency Management Increases Buprenorphine Engagement in the Context of Financial Barriers for Patients With Opioid Use Disorder |
| SHELBY GOODWIN (Rowan University), Harris Khan (Rowan University), Nicolas Samson (Rowan University), Arriana Swiderski (Rowan University), Indu Madhuranthakam (Rowan University), Matthew Salzman (Cooper University Hospital), Bethany R. Raiff (Rowan University) |
| Abstract: Contingency management (CM) has promise for increasing engagement with buprenorphine treatment for opioid use disorder; however, it remains understudied and underutilized. This study examined the impact of CM on early buprenorphine engagement in the context of patient-related treatment barriers. New patients at an outpatient opioid clinic were randomized to Treatment as Usual (TAU, n=30), consisting of regular clinic procedures, or CM (n=30), consisting of regular procedures plus financial incentives for attending visits and adhering to treatment (positive for buprenorphine and negative for other opioids). Groups were compared on attendance and adherence at first, second, and third follow-up visit after intake. The sample was 36.7% female, 48.3% Black, and 41 years on average (SD±10.15). One-third reported an annual household income under $10,000 and 75.0% were unemployed, representing a low-income population. CM increased attendance relative to TAU at first, second and third visit, respectively: (1) 70% vs 45%; (2) 60% vs 45%, (3) 48% vs 32%. CM also increased adherence relative to TAU: (1) 40% vs 21% (2) 30% vs 24%, and (3) 31% vs 21%. This study shows prospective stakeholders that CM may be uniquely poised to both increase engagement and offset financial treatment barriers related to low income. |
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| Personalized Contingency Management for Vaping Cessation |
| ALEXANDRA KNERR (University of Florida), Jesse Dallery (University of Florida) |
| Abstract: E-cigarette use has rapidly increased over the last decade, especially among young adults. Contingency management (CM) is an incentive-based intervention that has been effective in promoting abstinence from e-cigarettes, tobacco products, and a variety of other drugs of abuse. CM is effective for diverse populations, when delivered either in person or remotely, and with a variety of different incentives. Some have suggested tailoring the treatment components of CM to increase both the effectiveness and acceptability of the intervention, but few empirical studies have explored the effects of tailored CM methods. Guidelines on how to best tailor a CM intervention for an individual client are lacking. This study evaluated tailored CM to promote abstinence from nicotine-containing e-cigarettes (i.e., vaping abstinence) among young adults. Tailored components included the quit date, incentive, incentive delivery system, meeting frequency, meeting format, and additional supports. Participants also provided and managed their own incentive. Preliminary results have been promising: one participant successfully quit vaping through eight weeks with a personal intervention plan using TikTok as the incentive, and a second quit vaping for four weeks using a deposit contract before relapsing. These tailoring methods may afford lower cost and more clinically practical CM delivery. |
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