Reinforcement Schedule Effects on Long-Term Behavior Change.

OBJECTIVE: The primary aim of this study was to determine whether different schedules of contingency management (CM), in conjunction with psychosocial treatment, produced different rates of abstinence and treatment attendance among individuals dependent on methamphetamine. METHODS: Individuals were randomized into 1 of 3 conditions that sought to equate total potential reinforcer magnitude while varying the frequency with which reinforcement was delivered, and comparing these results to those obtained when psychosocial support alone was used. RESULTS: Results indicate that all 3 CM schedules occasioned more abstinent attendance than the group only receiving psychosocial treatment. However, the 3 CM conditions did not differ in any appreciable way. CONCLUSIONS: These results suggest that treatment providers may be able to decrease the frequency of reinforcer delivery in CM paradigms while retaining efficacy to treat psychostimulant use disorders.

Biochemical marker of use is a better predictor of outcomes than self-report metrics in a contingency management smoking cessation analog study.

BACKGROUND AND OBJECTIVES: This investigation compared cotinine (primary metabolite of nicotine) at study intake to self-report metrics (e.g., Fagerstrom Test of Nicotine Dependence [FTND]) and assessed their relative ability to predict smoking outcomes. METHODS: We used data from an analog model of contingency management for cigarette smoking. Non-treatment seeking participants (N = 103) could earn money in exchange for provision of a negative carbon monoxide (CO) sample indicating smoking abstinence, but were otherwise not motivated to quit. We used intake cotinine, FTND, percent of friends who smoke, and years smoked to predict longitudinal CO and attendance, time-to-first positive CO submission, and additional cross-sectional outcomes. RESULTS: Intake cotinine was consistently predictive (p < .05) of all outcomes (e.g., longitudinal CO and attendance, 100% abstinence, time-to-first positive CO sample), while years smoked was the only self-report metric that demonstrated any predictive ability. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Cotinine could be more informative for tailoring behavioral treatments compared to self-report measures.

Duration effects in contingency management treatment of methamphetamine disorders.

The primary aim of this study was to determine whether different durations of contingency management (CM) in conjunction with psychosocial treatment produced different rates of abstinence among methamphetamine dependent individuals. Participants were randomized to one of the four 16-week treatment conditions: standard psychosocial treatment or psychosocial treatment plus one of the three durations of CM (one-month, two-month, or four-month). A total of 118 participants were randomized to the four treatment conditions. There were significant differences across treatment conditions for number of consecutive days of methamphetamine abstinence (p<0.05). These differences were in the hypothesized direction, as participants were more likely to remain abstinent through the 16-week trial as CM duration increased. A significant effect of treatment condition (p<0.05) and time (p<0.05) on abstinence over time was also found. Longer durations of CM were more effective for maintaining methamphetamine abstinence.

Investigating reinforcer magnitude and reinforcer delay: a contingency management analog study.

The influence of reinforcer magnitude and reinforcer delay on smoking abstinence was studied using an analog model of contingency management. Participants (N = 103, 74% men) visited our laboratory 3 times daily for 5 days and received money for providing a breath sample that indicated smoking abstinence (carbon monoxide level ≤6 parts per million). Using a factorial design, we assigned participants randomly to 1 of 4 groups that could earn a total of either $207.50 (high-magnitude condition) or $70.00 (low-magnitude condition), and received earnings either at each visit (no-delay condition) or in a single lump sum 1 week following the study (delay condition). High-magnitude reinforcement, regardless of delay, was associated with higher rates of abstinence than was low-magnitude reinforcement. High magnitude of reinforcement provided immediately but in incremental amounts was associated with longer intervals to relapse during treatment in comparison with high-magnitude reinforcement provided in a single lump sum after a delay. Low rates of responding in the low-magnitude conditions made interpretation of the impact of delay in those conditions difficult. These findings further demonstrate that high magnitude of reinforcement results in better outcomes than does low magnitude of reinforcement, and that a delay to reinforcement can be detrimental-even when a high magnitude of reinforcement is provided.

Voucher-based reinforcement for alcohol abstinence using the ethyl-glucuronide alcohol biomarker.

This study assessed the effects of a contingency management (CM) intervention for alcohol consumption in 10 alcohol-dependent participants. An ABCA design was used. Vouchers were provided contingent on results of ethyl glucuronide (EtG) urine tests (an alcohol biomarker with a 2-day detection period) and alcohol breath tests during the C phase. The percentage of negative urines was 35% during the first baseline phase, 69% during the C phase, and 20% during the return-to-baseline phase. Results suggest that EtG urine tests may be a feasible method to deliver CM to promote alcohol abstinence.

Drinking trajectories from adolescence to the fifties among alcohol-dependent men.

OBJECTIVE: Although it has been recognized that the course of alcoholism may differ across individuals, little work has characterized drinking trajectories from drinking onset to midlife. METHOD: The current study examined trajectories of alcohol dependence from adolescence to the mid-50s in a sample of 420 men with a lifetime diagnosis of alcohol dependence. Men from the Vietnam Era Twin Registry were given the Lifetime Drinking History, which assesses the patterns of alcohol consumption and diagnostic symptoms for self-defined drinking phases. Phase data were converted into person-year data, with alcohol-dependence diagnosis coded as present or absent for each of 13 age groupings, starting with up to age 20 and ending with ages 54-56. RESULTS: Latent growth mixture modeling was used to define four drinking trajectories: young-adult, late-onset, severe-nonchronic, and severe-chronic alcoholics. Further analyses with other diagnostic variables, other drinking variables, alcohol expectancies, personality scales, and religiousness scores were completed to differentiate men best categorized by each trajectory. CONCLUSIONS: Extension of Latent Growth Mixture Modeling (LGMM) into the mid-50s revealed that, although some individuals remain chronic alcohol users, others decline in alcohol problem use. Differences seen among these groups may help in the treatment of alcohol dependence, such that more energy can be spent treating those likely to be in the more severe trajectories.

Paternal alcoholism and offspring ADHD problems: a children of twins design.

OBJECTIVE: A recent Children-of-Female-Twin design suggests that the association between maternal alcohol use disorder and offspring ADHD is due to a combination of genetic and environmental factors, such as prenatal nicotine exposure. We present here a complementary analysis using a Children-of-Male-Twin design examining the association between paternal alcoholism and offspring attention deficit hyperactivity problems (ADHP). METHODS: Children-of-twins design: offspring were classified into 4 groups of varying genetic and environmental risk based on father and co-twin's alcohol dependence status. RESULTS: Univariate results are suggestive of a genetic association between paternal alcohol dependence and broadly defined offspring ADHP. Specifically, offspring of male twins with a history of DSM-III-R alcohol dependence, as well as offspring of non-alcohol dependent monozygotic twins whose co-twin was alcohol dependent, were significantly more likely to exhibit ADHP than control offspring. However, multivariate models show maternal variables independently predicting increased risk for offspring ADHP and significantly decreased support for a genetic mechanism of parent-to-child transmission. CONCLUSIONS: In support of earlier work, maternal variables (i.e., maternal ADHD and prenatal exposure) were strongly associated with child ADHP; however, the role of paternal alcohol dependence influences was not definitive. While genetic transmission may be important, the association between paternal alcohol dependence and child ADHP is more likely to be indirect and a result of several pathways.

Reliability of Lifetime Drinking History among alcohol dependent men.

Information regarding patterns and correlates of problem drinking over the life course is important for both clinical and research purposes although few retrospective, psychometrically adequate instruments to collect data of this kind are available. In the current study, the authors report 5-year test-retest reliabilities of the Lifetime Drinking History (LDH). Analyses were based on 49 male participants with a lifetime diagnosis of alcohol dependence who were residing within intact families and who were not seeking treatment at time of initial assessment. Overall, the LDH was found to reflect adequate stability over this long retest interval for a number of relevant drinking measures, with results providing further support for the instrument's psychometric strengths. Limits on the generalizability of these findings and future research needs are discussed.

Drinking trajectories from adolescence to the mid-forties among alcohol dependent males.

OBJECTIVE: Identifying differing developmental trajectories of alcohol behavior is fundamental in building theories of alcoholism etiology and course. The purpose of this study was to identify differences in developmental pathways of alcoholism from onset of drinking into middle adulthood. METHOD: Alcohol-related behaviors and psychiatric status were assessed in 330 men from the Vietnam Era Twin Registry having a lifetime diagnosis of alcohol dependence (AD). Using a modified version of Skinner's Lifetime Drinking History, distinct drinking phases were identified that differed in terms of quantity, frequency and context of drinking. Person-year data were created to indicate whether AD criteria were or were not met for each year between drinking onset and age 41. RESULTS: Using Latent Growth Mixture Modeling, a four-class model was identified: Severe Chronic Alcoholics; Severe Non-Chronic Alcoholics (SNCA); Late Onset Alcoholics; and Young Adult Alcoholics. Counterparts for three trajectories could be found in the larger alcoholism literature, whereas the fourth type (SNCA) has not been described, notwithstanding its seeming importance and prevalence. CONCLUSIONS: Present findings support the existence of different alcoholism trajectories and provide a more complete understanding of the variability of alcohol dependence over time. Findings build on the larger alcoholism literature identifying alcoholic subgroups and provide important information regarding alcoholism trajectories and associated features. Future studies are needed with regard to better understanding of the psychosocial influences related to the different alcoholism trajectories, as well as characterizing the different trajectories as individuals transition into older age.

The Addiction Severity Index medical and psychiatric composite scores measure similar domains as the SF-36 in substance-dependent veterans: concurrent and discriminant validity.

BACKGROUND: Recently attention has focused on the assessment of functional health status in substance-dependent individuals. The addiction severity index (ASI) is a widely used assessment instrument that includes scales to reflect current medical and psychiatric status. This study examines the concurrent validity of these ASI composite scores in relation to the short form 36-item health survey (SF-36), a well-established measure of health-related quality of life/functional health status. METHODS: Veterans (n=674) were assessed at admission to substance dependence treatment. Correlations were performed between ASI composite scores and SF-36 scales and the physical and mental summary components (PSC and MSC, respectively). Areas under receiver operating characteristic (ROC) curves determined the descriminative ability of the ASI composites to ascertain impairment. RESULTS: The ASI medical composite score demonstrated robust correlations with the four SF-36 scales that relate to physical health and with the PCS. The ASI psychiatric composite score had robust correlations with the four SF-36 scales related to mental health and with the mental component summary (MCS). ROC curves indicated that the ASI medical (AUC=0.83) and psychiatric composites (AUC=0.90) accurately detected subjects with impairment. CONCLUSIONS: ASI medical and psychiatric composite scores provide effective initial screening for patients with impaired functional status as measured by the corresponding SF-36 component summary scores.