Contingency Management Alcohol Marijuana Studies Term Paper

Pages: 41 (11354 words)  ·  Bibliography Sources: 1+  ·  Level: College Senior  ·  Topic: Sports - Drugs

Contingency Management

ALCOHOL & MARIJUANA STUDIES

The purposes of this review are to gain an understanding of the controlled studies using contingency management (CM) in the substance abuse field, and where applicable emphasize those studies that incorporate CM with community reinforcement approach (CRA). This paper should offer a critical review of the literature with an eye toward identifying important and unresolved theoretical and research questions. Logan (1972) holds that there is much evidence that animals also respond to operant contingencies with psychoactive substances.

The New York Times reports in the work entitled: "Toward a Behavioral Economic Understanding of Drug Dependence: Delay Discounting Processes" (2006) states that many times those who are addicted to alcohol or drugs do not stay clean because they either "won't go to or won't stay in treatment." The work of "Scott Kellogg, Ph.D., and Mary Jeanne Kreek, M.D., at the Rockefeller University, and colleagues at the New York City Health and Hospitals Corporation (HHC) and at Johns Hopkins University, show that a treatment approach called contingency management improves patients' motivation to stay in treatment and increases their therapeutic progress." (New York Times, 2006) According to the report "Contingency management is designed to reinforce small steps, especially at the beginning, like celebrating each attendance at a group meeting or each drug-free test result. Later, patients can move on to larger achievements like stable housing. Easy-to-earn material goods, such as movie passes and food vouchers, help to both initiate and maintain positive changes. The program is not thought of as a substitute for counseling or pharmacotherapy, but something that adds to the therapy." (New York Times, 2006) According to Kellogg: "We did have some opposition at first from the staff, people who come from different therapeutic traditions...in general we tend to punish people for doing things that are wrong, so it's not necessarily intuitive to reinforce positive behavior when it does occur in our patients. But once the patients began to respond to the reinforcements, it changed the counselors. The counselors want the patients to get better, and when they saw the patients get better, it was really persuasive." (New York Times, 29006)

Key Terms

1. Contingency Management: "Contingency Management rewards abstinence or punishes drug taking (e.g. By notification of courts, employers or family members) as measured by random, supervised urine, saliva, or hair-follicle monitoring. Is inclusive of cue exposure and relaxation techniques to expose a patient to cues that induce craving while preventing actual substance abuse in order to facilitate extinction of classically conditioned craving. (Treating Substance Use Disorders, 2006; paraphrased)

2.. Vouchers: Awards given to participants that can be used for purchasing all types of merchandise.

3. CRs - Conditioned response.

4. ARCs - Alcohol related cues.

5. SDs - Discriminative Stimuli

Background of the Study

The work entitled "Pathways of Addiction: Opportunities in Drug Abuse Research" (1996) published by the Institute of Medicine (IOM) states that "A major contribution of behavioral research has been an understanding of the ways in which basic principles of learning and conditioning can be used to modify drug-taking behavior. These principles have been precisely defined so that they can be studied and replicated across conditions and species. For example, research on drug effect expectancies suggests that learned beliefs and attitudes may serve as risk factors for the initiation and use of drugs (Brown, 1993). Further, epidemiological research has pointed to the importance of social modeling and attitudes as having strong impacts on drug use and abuse. Research on learning and conditioning has led to successful treatment models for drug abusers, including relapse prevention, community reinforcement, and focused techniques such as extinction training, relaxation training, contingency management, and job skills training. Two well-studied behavioral interventions are discussed below: contingency management and relapse prevention." (1996) it is additionally stated that: "Contingency management research is based on the fact that, although drugs are potent reinforcers, there are non-drug reinforcers that can compete with drug use (see discussion of behavioral economics, below). Manipulation of the environment can shift the focus toward or away from drug reinforcers (e.g., Azrin et al., 1966; Barrett and Witkin, 1986). In the laboratory, monkeys will choose saccharine over phencyclidine if they are required to work substantially harder for the drug (Carroll and Rodefer, 1993)" (IOM, 1996)

Stitzer and Petry (2006) in the work entitled: "Contingency Management for Treatment of Substance Abuse" published in the Annual Review of Psychology state that: "Clinical research trials demonstrate the efficacy of contingency management procedures in treating substance use disorders. Usually, reinforcement, in the form of vouchers exchangeable for retail goods and services, is provided for drug abstinence in patients treated in psychosocial or methadone maintenance clinics. Recently, the types of reinforcers have been adapted to include lower cost alternatives, and reinforcement is being expanded to alter other target behaviors such as attendance at treatment, adherence to treatment goals, and compliance with medication."

The work of Kirby and Bickel (1995) entitled: "Implications of Behavioral Pharmacology Research for Applied Behavior Analyses: Jeab's Special Issue Celebrating the Contributions of Joseph V. Brady" states that: "Kelly et al. And other studies assessing the reinforcing effects of drugs (e.g., Chait & Zacny, 1992; Foltin & Fischman, 1992) have indicated that multiple dependent measures are necessary for a more complete understanding of a drug's function. The importance of this methodological consideration is underscored by understanding that assessment of a drug's reinforcing effects predicts its abuse liability, and this, in turn, can influence regulation and availability of new medication agents. If Kelly et al.'s data represented the results of an abuse liability assessment of a new medication, and number of self- administrations taken was the only dependent measure examined, one might conclude that the medication was unlikely to be abused. However, if drug choice and ratings of drug liking had been the only dependent measures collected, one could conclude that the medication had a high abuse potential. Abuse liability assessment research has only recently begun to appreciate the complex relations among different operant and to investigate their implications. Although assessment of abuse liability is a socially relevant application of multiple operant methodology, there are many nonpharmacological applications of equal social relevance." (1995) Additionally stated by Kirby and Bickel is: "DeGrandpre et al. studied the effects of different response requirements on two operants: self-administration of cigarette puffs and self-administration of money. The response requirement for these operants was also manipulated by systematically varying the fixed- ratio (FR) schedule for one operant (FR 100, FR 1,000, and FR 2,500) while keeping the schedule for the other operant stable (FR 100). Increasing the FR size for either operant decreased its consumption, with a greater decrease occurring for money. The effects of FR size also differed across the two operants. Although greater responding occurred for money at the lowest ratio employed, increases in FR size decreased responding for money and increased responding for cigarette puffs such that at the higher ratios examined, greater responding occurred for cigarette puffs. Finally, increasing the FR size for one reinforcer had little effect on the consumption of the other concurrently available reinforcer. This study has two important implications for applied research. First, it demonstrates the need to examine responding maintained in multiple contexts. If the two reinforcers employed in this study were examined only at the lowest ratio, one might conclude that money was a more potent reinforcer than cigarette puffs. However, the opposite conclusion would be reached if they were examined only at the higher ratio. As a concrete applied example, imagine that during the early spring, a manager determines that the employees on the loading dock maintain higher work rates when offered financial bonuses contingent on work rate than when offered time off. The manager implements bonuses as a standard procedure for reinforcing high work rates. This procedure works well until summer arrives and the temperature and humidity on the loading dock climb. Now the response cost of the work has increased and the financial bonuses do not seem to be working as well. In this new context, time off may serve as the more effective reinforcer for maintaining higher work rates. Besides evaluating the relative efficacy of reinforcers in different contexts, the procedure used by DeGrandpre et al. provides a useful context for evaluating interactions between concurrently available reinforcers. Such analysis may, for example, have some utility for studying treatments of drug dependence that engage patients in alternative activities to drug use (e.g., Higgins et al., 1993)." (1995) Kirby and Bickel (1995) state that "During discrimination training, subjects were administered 30 mg of d-amphetamine or placebo and told that they could earn extra money by pressing the green lever if they received Drug a (d-amphetamine) or by pressing the red lever if they did not receive Drug a. In addition to this nonverbal operant, subject report measures were collected before and after drug administration. These measures were computer administered and involved a well-established questionnaire (Addiction Research Center Inventory, ARCI) asking the subjects whether or not they were experiencing specific drug effects that have been found… [END OF PREVIEW]

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