Stopping illicit drug use
Dominic Upton, Katie Thirlaway in Promoting Healthy Behaviour, 2013
Contingency management is one form of behavioural therapy in which patients receive incentives for achieving specific behavioural goals. These approaches are based on operant conditioning whereby appropriate behaviour is rewarded with positive consequences and therefore more likely to be repeated. These forms of intervention have particularly strong and robust empirical support. For example, allowing a patient the privilege of taking home methadone doses, contingent on the patient’s providing drug-free urine specimens, is associated with significant reductions in illicit drug use (Stitzer et al., 1992). Similarly, Budney et al. (1998) demonstrated the efficacy of vouchers redeemable for goods and services, contingent on the patient’s providing cocaine-free urine specimens, in reducing targeted drug use and enhancing retention in treatment.
Topic 6 Addictions and Substance Misuse
Melvyn W.B. Zhang, Cyrus S.H. Ho, Roger C.M. Ho, Basant K. Puri in Get Through, 2016
Psychosocial interventions based on NICE guidance: Contingency management: Offering incentive contingent on each drug-negative test, such as giving vouchers that can be exchanged for goods or privileges, that allow the person taking methadone home.For people on naltrexone: They have to receive contingency management with behaviour family intervention for the person and a non-drug-misusing family member.Psychological methods: Therapeutic outcome is improved if substitute prescribing is combined with various forms of behaviour therapy.Motivational interviewing: Motivational interviewing is a cognitive behaviour approach that takes into account the patient’s stage of preparedness for change and prompts the patient to consider favourable reasons to change.Prognosis: The mortality rate for intravenous drug abusers is 20 times that of their non-drug-using peers. Since the 1980s, the prevalence of HIV infection amongst intravenous drug users has increased to approximately 50%–60% in some groups, and mortality amongst this group has increased further.
Cannabis Use Disorder
James MacKillop, George A. Kenna, Lorenzo Leggio, Lara A. Ray in Integrating Psychological and Pharmacological Treatments for Addictive Disorders, 2017
Behavioral therapies (BTs) for CUD including motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), and abstinence-based contingency management (CM) are efficacious psychotherapeutic approaches with outcomes comparable to treatments for other substance use disorders [41, 42]. MET addresses ambivalence and seeks to improve motivation to make changes in substance use or other problem behaviors [43]. Most METs incorporate personalized feedback on an individual’s cannabis use delivered in a nonconfrontational manner, typically in two individual sessions of 50 minutes [44]. CBT views substance dependence as learned behavior that is used to cope with problems or to meet needs, and therefore considers the acquisition of coping skills as essential [45]. Contingency management is based on frequent monitoring of the target behavior (e.g., abstinence) and the provision of tangible incentives (e.g., prizes or cash vouchers) when the target behavior occurs [18, 46].
Correlates of co-occurring eating disorders and substance use disorders: a case for dialectical behavior therapy
Published in Eating Disorders, 2020
Kimberly Claudat, Tiffany A. Brown, Leslie Anderson, Gina Bongiorno, Laura A. Berner, Erin Reilly, Tana Luo, Natalia Orloff, Walter H. Kaye
The present findings that patients with ED-SUD report higher reward sensitivity to highlight the importance of assessing for and addressing temperament in this treatment population. Reward sensitivity may be an underlying mechanism that drives an individual’s substance use and ED behaviors. For instance, substance use and ED behaviors may be highly rewarding in the moment; hence, patients seek the short-term rewards of addictive behaviors despite their long-term, negative consequences. Furthermore, a potential obstacle to abstinence from ED behaviors and substances of abuse is the non-rewarding aspect of abstinence (e.g., physiological discomfort associated with withdrawal, increased emotional discomfort, finding activities less enjoyable). Several skills taught in DBT for SUDs target these barriers. Contingency management strategies to reduce cues and access to substances and behaviors (e.g., Burning Bridges), as well as reinforcement of adaptive behavior, are essential to treatment. Specifically, Community Reinforcement (e.g., mindfully observing positives in relationships when abstinent, generally seeking environments that support and reinforce abstinence), and Abstinence Sampling (committing to shorter periods of sobriety to reach rewarding milestones) focus on the reinforcement of healthy behaviors.
Pregabalin Misuse: Motives, Pattern, and Knowledge about Its Risks among Patients in Methadone Maintenance Treatment
Published in Journal of Psychoactive Drugs, 2021
Einat Peles, Anat Sason, Shaul Schreiber, Miriam Adelson
In a recent study of methadone maintenance treatment (MMT) patients in Israel (Sason et al. 2018), we found a high prevalence of pregabalin misuse (17.7%). MMT is a chronic treatment modality that is effective for a majority of individuals with opioid use disorder (Mattick et al. 2014). In MMT, monitoring for illicit and non-prescribed drug use is a routine part of treatment. Based on urine tests, patients’ improvement and success is determined as well as methadone dose adjustment and possible risk. ‘Privileges’ (i.e. take-home doses and treatment payment discounts) are part of the accompanying contingency management treatment, and may be achieved by patients with negative drug screenings over a period of time. According to the regulations and procedures in the US and in Israel usage of opiates, cocaine, benzodiazepines (BDZ), amphetamines, and cannabinoids (THC) are routinely monitored (THC may no longer be monitored everywhere, but still is in Israel). Over the years, other substances or medications not routinely monitored were suspected to be abused or misused among our MMT patients. We define misuse for any drug without prescription, or when prescribed but not approved by the clinic’s medical director. This was the case for tricyclic antidepressants abuse (Peles, Schreiber, and Adelson 2008), for methylphenidate (Peles et al. 2015), and most recently for pregabalin (Sason et al. 2018). The abuse/misuse of these drugs was confirmed by a point prevalent one-month urine test evaluation study to present 15.8%, 14.7% and 17.7% abuse or misuse, respectively.
Uncovering Naturalistic Rewards and their Subjective Value in Forensic Psychiatric Patients
Published in International Journal of Forensic Mental Health, 2018
Johanna C. Glimmerveen, Inti A. Brazil, B. H. (Erik) Bulten, Joseph H. R. Maes
It is important to keep in mind that determining which reinforcers to use during treatment of offenders with mental disorders is a complex undertaking. To illustrate, reinforcers can be classified as implicit (e.g., personal attention of the therapist) or explicit (e.g., vouchers), short-term (i.e., those effectuated during treatment) or long-term (i.e., the positive effects of successful treatment), and these dimensions will always interact and can even be in conflict. The reinforcers used in reinforcement-based treatments in correctional settings most often involve short-term, explicit, low-effort rewards (Gendreau et al., 2014). Contingency management programs that focus on short-term rewards help promote discipline and structure in prison settings (Webb, 2003), and are effective in the treatment of substance dependence in community settings (Secades-Villa et al., 2013). Regarding long-term behavioral change, our findings are in line with the GLM (Ward, 2002; Ward & Gannon, 2006) and suggest that it may be more beneficial to focus on rewards or goals that increase personal growth and social functioning, which will likely provide more opportunities for success in the future.
Related Knowledge Centers
- Alcoholism
- Applied Behavior Analysis
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Operant Conditioning
- Three-Term Contingency
- Stimulus Control
- Clinical Behavior Analysis
- Substance Use Disorder
- Reinforcement