Monitoring Cocaine Use and Abstinence Among Cocaine Users for Contingency Management Interventions

Abstract

During contingency management interventions, reinforcement of cocaine abstinence is arranged by delivering an incentive when a urine sample tests cocaine-negative. The use of qualitative versus quantitative urinalysis testing may have important implications for effects on cocaine abstinence. Qualitative testing (i.e., testing that solely identifies whether a particular substance is present or absent) may not detect short-term cocaine abstinence because a single instance of cocaine use can result in cocaine-positive urine over many days. Quantitative testing (i.e., testing that identifies how much of a substance is present) may be more sensitive to short-term cocaine abstinence; however, the selection of a criterion for distinguishing new use versus carryover from previous use is an important consideration. The present study examined benzoylecgonine concentrations, the primary metabolite of cocaine, in urine samples collected three times per week for 30 weeks from 28 cocaine users who were exposed to a cocaine abstinence contingency. Of the positive urine samples (benzoylecgonine concentration >300 ng/ml), 29%, 21%, 14%, and 5% of the samples decreased in benzoylecgonine concentration by more than 20%, 40%, 60%, and 80% per day, respectively. As the size of the decrease increased, the likelihood of that sample occurring during a period leading to a cocaine-negative urine sample (benzoylecgonine concentration ≤300 ng/ml) also increased. The number of days required to produce a cocaine-negative sample following a positive sample ranged from 1 to 10 days and was significantly correlated with the starting benzoylecgonine level (r = 0.43, p

Wed, 31 May 2017, 5:00 pm


One of Us

Wed, 31 May 2017, 5:00 pm


The Use of Health Coaching to Improve Health Outcomes: Implications for Applied Behavior Analysis

Abstract

Chronic health conditions are predominant in the USA. Health coaching has demonstrated significant results in increasing health-promotion behaviors that impact the development or progression of chronic health conditions (Simmons & Wolever, 2011). Behavior analysis has also contributed to this body of research with effective behavior-change procedures (Allen & Hine, 2015). While often not cited, the methodology used in health coaching utilizes many principles that align with applied behavior analysis. The current paper serves several purposes: (1) introduces health coaching and the potential for application within a behavior analytic framework, (2) discusses commonalities and areas behavior analysis could impact, (3) suggests implications for future research and practice, and finally, (4) urges collaboration between behavior analysts, health coaches, physicians and other professionals practicing within fields that focus on improving individual health and healthcare.


Wed, 31 May 2017, 5:00 pm


Differences in Delay, but not Probability Discounting, in Current Smokers, E-cigarette Users, and Never Smokers

Abstract

Steeper delay discounting in substance abuse populations, compared to non-abusing populations, has been well-established in prior studies. Despite the growing interest in e-cigarettes as a novel and relatively understudied form of nicotine consumption, relatively little is known as to how e-cigarette users discount rewards compared to traditional cigarette smokers and never smokers. In the present study, we measured delay and probability discounting rates, as well as perceived risk inherent to a delayed reward, in current traditional cigarette smokers, e-cigarette users, and never smokers. We found that traditional cigarette smokers and e-cigarette users discounted delayed rewards at a similar rate—and both were steeper than never smokers. However, no differences were observed in probability discounting or in perceived risk inherent in reward delay.


Wed, 31 May 2017, 5:00 pm



The Opportunity to Choose the Activity Context Does Not Increase Moderate-to-Vigorous Physical Activity Exhibited by Preschool Children

Abstract

Physical activity is essential for children and adults to counteract the negative health outcomes related to a sedentary lifestyle. Despite widely publicized recommendations and information about physical activity, the problem of excessive physical inactivity prevails in our society. The purpose of this study was to conduct a context functional analysis to identify outdoor activity contexts that engendered higher levels of moderate-to-vigorous physical activity (MVPA) using an ABAB reversal design to determine if the opportunity to choose the activity context would influence MVPA exhibited by six preschool-aged children. Results of the context functional analysis showed that fixed equipment and open space engendered highest levels of MVPA in most participants. Levels of MVPA in the reversal design indicated that choice did not significantly influence levels of MVPA and that active and sedentary choices varied between and within participants. These results suggest that related to levels of MVPA the type of outdoor activity context chosen is more important than the individual who chooses it.


Wed, 31 May 2017, 5:00 pm


Cross-Commodity Delay Discounting of Alcohol and Money in Alcohol Users

Abstract

Despite real-world implications, the pattern of delay discounting in alcohol users when the commodities now and later differ has not been well-characterized. In this study, 60 participants on Amazon’s Mechanical Turk completed the Alcohol Use Disorder Identification Test (AUDIT) to assess severity of use and completed four delay discounting tasks between hypothetical, equivalent amounts of alcohol and money available at five delays. The tasks included two cross-commodity (alcohol now-money later and money now-alcohol later) and two same-commodity (money now-money later and alcohol now-alcohol later) conditions. Delay discounting was significantly associated with clinical cutoffs of the AUDIT for both of the cross-commodity conditions but not for either of the same-commodity delay discounting tasks. The cross-commodity discounting conditions were related to severity of use wherein heavy users discounted future alcohol less and future money more. The change in direction of the discounting effect was dependent on the commodity that was distally available suggesting a distinctive pattern of discounting across commodities when comparing light and heavy alcohol users.


Wed, 31 May 2017, 5:00 pm


Saliva Cotinine as a Measure of Smoking Abstinence in Contingency Management – A Feasibility Study

Abstract

The present study investigated the feasibility of using twice-weekly monitoring of saliva cotinine in a prize-based contingency-management program for smoking cessation. Saliva samples were tested using semi-quantitative NicAlert™ cotinine test strips. Smokers (N = 20) who reported smoking at least five cigarettes per day were randomly assigned to either a contingent or a non-contingent reinforcement group. A five-day baseline phase was followed by a four-day shaping phase during which participants were asked to gradually decrease smoking. During the subsequent three-week abstinence phase, participants submitted breath CO and saliva samples twice per week. For those in the contingent reinforcement group, prize draws could be earned for negative samples or, on the first day of the abstinence phase and after a relapse, for saliva samples one semi-quantitative level below the previous sample. On each visit participants in both groups were given feedback on their saliva cotinine and breath CO levels, and were given instructions for how much to reduce smoking in order to meet the next smoking criteria. Saliva cotinine measures significantly correlated with breath CO measures and aligned with self-reports of smoking. Attendance in both groups decreased after the shaping phase. Cotinine and CO levels decreased in participants, but there were no significant group differences. Although the present study failed to demonstrate a treatment effect for the prize contingency (possibly due to the relatively low net payment), it appeared that using NicAlert™ saliva cotinine test strips was a relatively easy and effective way to monitor smoking throughout a contingency-management program.


Wed, 31 May 2017, 5:00 pm


Probability Discounting and Cardiovascular Risk: The Effect of Side-Effect Severity and Framing

Abstract

An expectation of healthcare delivery is that patients can make informed decisions about whether and how to treat chronic health conditions. Decisions are complex because treatment is not always 100% effective and side effects can occur without a beneficial outcome. It is important, therefore, to understand the drivers of individual choices about whether to accept a treatment, particularly, how people respond to the probabilities of being well or unwell with or without the treatment. The current project investigated this using a probability discounting framework. Participants indicated whether they would take a drug that reduced their chance of having a heart attack or a stroke from a baseline probability that varied across trials. We told participants that they would always experience a side effect and manipulated its severity (i.e. either frequent headaches or persistent cold hands and feet). We also manipulated whether probabilities were framed negatively—in terms of heart attack or stroke—or positively—in terms of continued good heart health. We observed systematic discounting as a function of probability of heart attack or stroke without treatment. Discounting was shallower when the side effect was less severe. There was no significant effect of framing at the group level. Overall, probability discounting offers a useful approach to investigating the drivers of decisions about whether to accept medical treatment.


Wed, 31 May 2017, 5:00 pm


Diet and Exercise Failures: A Theoretical Extension of Relapse

Abstract

Obesity is a non-communicable disease that is associated with an increased risk of heart disease, stroke, diabetes, musculoskeletal disorders, and cancer (WHO, 2016). While there are many ways to treat obesity, approximately 80% of those who attempt a diet or exercise program fail to achieve and/or maintain their weight loss (Wing & Phelan, 2005). This article assesses the problem of obesity and the failure to maintain treatment outcomes through a conceptual analysis of relapse. This includes analyzing not only the behaviors of individuals who are obese, but their surrounding environments. This article includes a discussion of resurgence, renewal, reinstatement, and behavioral momentum theory, which may provide additional information and guidance when creating treatment plans related to obesity and obesity-related disorders. Assessing obesity through a behavior analytic lens of relapse may lead to better adherence and maintenance of obesity treatment programs, but also decrease the burden that obesity and obesity relapse has on the health-care system.


Wed, 31 May 2017, 5:00 pm


Behavioral Economic Predictors of Alcohol and Sexual Risk Behavior in College Drinkers

Abstract

Heavy alcohol use among college students is a major public health concern. Alcohol use commonly occurs with sexual risk behaviors, but etiology remains unclear. Behavioral economics has yielded insights into decision-making processes underlying problematic health choices, including alcohol use and sexual risk behavior. In particular, the reinforcer pathologies framework has integrated behavioral economic demand and delay discounting to improve our understanding of addiction, but has yet to be extended to the study of sexual risk. In order to account for past sexual risk behavior and alcohol consumption, the current study examined college students’ demand for alcohol, money delay discounting, alcohol delay discounting, and sexual partners delay and probability discounting. Results revealed that behavioral economic variables (i.e., demand intensity, sexual partners delay discounting, alcohol delay discounting, and money delay discounting) were significant predictors of sexual risk and alcohol consumption levels. Additionally, consistent with the reinforcer pathologies model, an inability to delay sexual gratification (sexual delay discounting) and overvaluation of alcohol (demand intensity) interacted to account for significant variance in alcohol consumption and sexual risk. These findings highlight the importance of considering both sexual and alcohol decision making in research and intervention with college students.


Wed, 31 May 2017, 5:00 pm


An Initial Investigation of the Effects of Tanning-Related Cues on Demand and Craving for Indoor Tanning

Abstract

Melanoma and other skin cancers have become the most commonly diagnosed cancers in the United States. Despite the well-established link between skin cancer and indoor tanning, approximately 30 million Americans report engaging in indoor tanning each year, and the majority of these users are white females aged 16 to 29 years. Although some studies have suggested that exposure to ultraviolet radiation may produce reinforcing effects in frequent tanners paralleling the characteristic features of substance use disorders, no previous study has explored the impact of tanning-related cues on demand for tanning. The aim of the present study was to examine the effects of tanning-related cues on participants’ behavioral economic demand and craving for indoor tanning. Participants were 23 undergraduate students (22 females, one male), each of whom underwent a cue-exposure procedure consisting of experiencing neutral- and tanning-related cues. Results suggest that participants exhibited an increase in behavioral economic demand and self-reported craving in the condition associated with tanning-related cues relative to neutral-cues. We conclude by discussing notable limitations and offering directions for future research.


Wed, 31 May 2017, 5:00 pm


Earning, Spending, and Drug Use in a Therapeutic Workplace

Abstract

Drug addiction is a chronic, relapsing health problem that is associated with the degree to which individuals choose small, immediate monetary outcomes over larger, delayed outcomes. This study was a secondary analysis exploring the relation between financial choices and drug use in opioid-dependent adults in a therapeutic workplace intervention. Sixty-seven participants were randomly assigned to a condition in which access to paid job training was contingent upon naltrexone adherence (N = 35) or independent of naltrexone adherence (N = 32). Participants could earn approximately $10 per hour for 4 hours every weekday and could exchange earnings for gift cards or bill payments each weekday. Urine was collected and tested for opiates and cocaine thrice weekly. Participants’ earning, spending, and drug use were not related to measures of delay discounting obtained prior to the intervention. When financial choices were categorized based on drug use during the intervention, however, those with less frequent drug use or frequent use of one drug spent a smaller proportion of their daily earnings and maintained a higher daily balance than those who frequently tested positive for both drugs (i.e., opiates and cocaine). Several patterns described the relation between cumulative earning and spending including no saving, periods of saving, and sustained saving. One destructive effect of drug use may be that it creates a perpetual zero-balance situation in the lives of users, which in turn prevents them from gaining materials that could help to break the cycle of addiction.


Wed, 31 May 2017, 5:00 pm


A Longitudinal Behavioral Economic Analysis of Non-medical Prescription Opioid Use Among College Students

Abstract

Despite the growing opioid epidemic in the US, few studies have identified theoretically based risk factors for non-medical prescription opioid (NMPO) use among young adults. The goal of the current study was to evaluate the behavioral economic hypotheses that NMPO use would be associated with lower levels of reinforcement from substance-free activities and future time orientation. Participants were 71 undergraduate students (62% women, 52.1% Caucasian, 35.2% African American) who either reported past-year NMPO use or demographically similar control participants with no past-year drug use. Participants provided information on alcohol and drug use, completed three measures of substance-free reinforcement (time allocation to exercise and academic activities, hedonic response to substance-free pleasant images, and self-report anhedonia), and a measure of future orientation, at baseline, 6-month, and 12-month follow-up. Consistent with nationwide trends, most NMPO users also reported use of marijuana (94%) and alcohol (80%). Compared to no drug use, NMPO use was associated with lower time allocation to academic activities, lower hedonic response to pleasant images, greater self-reported anhedonia, and lower future orientation across the 12-month study period. Among NMPO users, greater positive hedonic response to substance-free pleasant images predicted less alcohol use at 12-month follow-up, and greater baseline future orientation predicted less marijuana and NMPO use at 12-month follow-up. These findings provide partial support for behavioral economic models that link substance misuse to diminished levels of substance-free reinforcement and lower consideration of the future.


Wed, 31 May 2017, 5:00 pm


Smokers’ Elevated Rates of Delay Discounting are Independent of Differences in Primary Personality Dimensions

Abstract

Although smokers have higher rates of delay discounting, the extent to which this depends on smoking habit and nicotine use is unclear. Because personality factors are correlated with both delay discounting and smoking, we assessed the extent to which the effect size for smoking and delay discounting was attenuated by using the primary dimensions of personality in Eysenck’s system – extraversion, neuroticism, and psychoticism – as covariates. Smokers (n = 367) and non-smokers (n = 421) completed the Eysenck Personality Questionnaire-Revised (EPQ-R) and the Monetary Choice Questionnaire (MCQ) to measure delay discounting. Smokers had higher rates of delay discounting (d = .315). Although extraversion and psychoticism scores were higher for smokers than non-smokers, and were positively correlated with delay discounting, the effect size for smokers decreased only marginally when personality variables were used as covariates (d = .295). A stepwise regression analysis identified 7 EPQ-R items that best predicted delay discounting (R = .281); controlling for a subscale based on these items only reduced the effect size to d = .252, and among the smokers, nicotine dependence remained a significant predictor of delay discounting. Overall results indicate that smokers’ elevated delay discounting is independent of primary personality dimensions, and although correlational, are most consistent with the view that smoking habit and nicotine dependence are causally linked to changes in impulsive decision making.


Wed, 31 May 2017, 5:00 pm


The Value of Clean Air: Comparing Discounting of Delayed Air Quality and Money Across Magnitudes

Abstract

The detrimental health effects of exposure to air pollution are well established. Fostering behavioral change concerning air quality may be challenging because the detrimental health effects of exposure to air pollution are delayed. Delay discounting, a measure of impulsive choice, encapsulates this process of choosing between the immediate conveniences of behaviors that increase pollution and the delayed consequences of prolonged exposure to poor air quality. In Experiment 1, participants completed a series of delay-discounting tasks for air quality and money. We found that participants discounted delayed air quality more than money. In Experiment 2, we investigated whether the common finding that large amounts of money are discounted less steeply than small amounts of money generalized to larger and smaller improvements in air quality. Participants discounted larger improvements in air quality less steeply than smaller improvements, indicating that the discounting of air quality shares a similar process as the discounting of money. Our results indicate that the discounting of delayed money is strongly related to the discounting of delayed air quality and that similar mechanisms may be involved in the discounting of these qualitatively different outcomes. These data are also the first to demonstrate the malleability of delay discounting of air quality, and provide important public health implications for decreasing delay discounting of air quality.


Wed, 31 May 2017, 5:00 pm


Feasibility of a Mobile Group Financial-Incentives Intervention Among Pairs of Smokers With a Prior Social Relationship

Abstract

Smoking is associated with a number of chronic health conditions, including cardiovascular disease and various types of cancer. The decision to smoke can be conceptualized as preference for small, immediate rewards (e.g., relief from withdrawal) over larger, delayed rewards (e.g., good health). Contingency management (CM) takes advantage of this preference for immediate outcomes by delivering incentives, usually financial, for making the healthier choice to abstain from smoking. The current study tested the feasibility of harnessing naturally occurring social contingencies associated with smoking cessation to increase the promise of CM in initiating and sustaining long-term abstinence. Pairs of smokers with an existing relationship (i.e., friends, roommates, family, significant others) were recruited to quit together in the context of a smartphone-delivered, group CM intervention. Approximately 50% of interested participants identified a partner who also met criteria to participate, and five pairs (N = 10) completed the study. Using a within-subject design, participants could earn individual financial incentives for submitting breath carbon monoxide (CO) samples twice daily that met targeted goals for abstinence, and they could earn bonus incentives when both members of the pair met their targets together. Nine participants (90%) successfully reduced their mean breath CO during the intervention relative to baseline conditions. Individuals within a pair performed similarly to one another, for better or worse (i.e., both participants abstained, smoked, or missed samples at the same time). The social contingencies of quitting with someone with whom the smoker has an existing relationship may be helpful, but may also introduce unique challenges, particularly with regard to recruitment and treatment retention.


Wed, 31 May 2017, 5:00 pm



Spider Fear and Avoidance: A Preliminary Study of the Impact of Two Verbal Rehearsal Tasks on a Behavior–Behavior Relation and Its Implications for an Experimental Analysis of Defusion

Abstract

The current study examined the impact of a brief verbal rehearsal task on performance on two Implicit Relational Assessment Procedures (IRAPs), actual approach behavior towards a live spider (a behavioral approach task; BAT), and the relationship between the IRAPs and the BAT. Participants first completed the Fear of Spiders Questionnaire (FSQ) followed by one of two verbal rehearsal tasks, one of which focused on fear acceptance and the other on fear reduction as ways of coping with fear. All participants then completed two IRAPs similar to those employed by Leech, Barnes-Holmes, and Madden (The Psychological Record, 66(3), doi:10.1007/s40732-016-0176-1, 2016). Finally, participants completed the BAT using a live common house spider. Broadly similar findings were obtained for performance on the IRAPs as were reported by Leech et al. No significant differences between the two verbal-rehearsal conditions emerged on the self-report measures, the IRAPs, or the BAT. However, correlations between performances on the IRAPs and the BAT were concentrated in the reduce-fear condition. When considered in the context of the results previously reported by Leech et al., the differential pattern of correlations observed in the current study suggest that the verbal rehearsal task impacted upon a behavior–behavior relation that may be directly relevant to the concept of defusion in the acceptance and commitment therapy literature.


Mon, 24 Apr 2017, 5:00 pm


Effects of Cultural Consequences on the Interlocking Behavioral Contingencies of Ethical Self-Control

Abstract

A particular type of self-control occurs when the conflict between immediate and delayed consequences is associated with consequences that are more favorable to either the individual or the group. In such cases, responding under the control of delayed consequences more favorable to the group can be considered an instance of ethical self-control. The literature shows that the selection of self-control and ethical self-control depends on contingencies arranged by group members, indicating that these phenomena are cultural products. This study proposes a procedure to investigate the selection, maintenance, and transmission of ethical self-control in an arrangement similar to a metacontingency. Two microcultures were exposed to a task in which each participant had to choose a row in a colored 10 × 10 matrix. There were individual contingencies in all conditions: choosing odd-numbered rows produced 3 tokens that could be exchanged for money, and choosing even-numbered rows produced only 1 token. In some conditions, there were also cultural contingencies that enabled the production of school items to be subsequently donated to public schools. This study aimed at assessing whether the interlocking behavioral contingencies (IBCs) associated with aggregate products could be selected by cultural consequences of a different nature from individual consequences in situations in which the production of cultural consequences competed with the production of individual consequences of a greater magnitude. The production of school items was contingent on the occurrence of IBCs + Aggregate Products (AP) that involved choosing 3 even rows of different colors. The results showed that cultural consequences had an effect on the selection of IBCs + AP that involved ethical self-controlled responses. The procedure here presented showed promising to study the phenomena of ethical self-control.


Sun, 23 Apr 2017, 5:00 pm