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TRI. science. addiction. A Behavioral Model for Maintenance of Drug Abstinence DA 017444. Kimberly C. Kirby, Ph.D. Lois A. Benishek , Ph.D. James R. McKay, Ph.D. MaryLouise Kerwin , Ph.D. A. Thomas McLellan , Ph.D. Tanya Christoffel, M.Ed. Douglas B. Marlowe , J.D., Ph.D

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a behavioral model for maintenance of drug abstinence da 017444

TRI

science

addiction

A Behavioral Model for Maintenance of Drug AbstinenceDA 017444

Kimberly C. Kirby, Ph.D. Lois A. Benishek , Ph.D.

James R. McKay, Ph.D. MaryLouise Kerwin , Ph.D.

A. Thomas McLellan , Ph.D. Tanya Christoffel, M.Ed.

Douglas B. Marlowe , J.D., Ph.D

Treatment Research Institute and the University of Pennsylvania

Population: Opiate-dependent, cocaine-using adults

Setting: Methadone Maintenance Clinic

slide2

TRI

science

addiction

Primary Research Questions

  • Do longer durations of contingency management (CM) result in a greater abstinence 2 yrs post-tx?
  • Does a longer duration of CM result in increases in non-drug using activities?
  • Do increases in the number of non-drug using activities predict better long-term drug abstinence?
  • Are better long-term outcomes associated with more natural contingencies of reinforcement for non-drug using activities?
slide3

TRI

science

addiction

Contingency Management

  • Escalating Schedule of Reinforcement
    • Base value = $ 2.50 3 row bonus = $10
    • Increments + $ 1.25 Pos. urine => reset $2.50
    • Max. value = $40.00 5 row neg => return
  • Patients Randomly Assigned to:
  • Usual CM (3 mo) Extended CM (9 mo)
  • Both Groups then Receive Aftercare for 3 mo
  • $1 lottery ticket/clean urine
slide4

TRI

science

addiction

Logic Model

Reinforce

drug-free urines

Longer-term

abstinence &

less relapse

Increased abstinence during treatment

Contact natural contingencies of reinforcement?

Type?

Type 1

Yes

More likely to relapse

Increase

non-drug

using activities

Type 2

No

slide5

TRI

science

addiction

Outcome Measures

  • ComQol=Comprehensive Quality of Life Scale
  • Q-LES-Q=Quality of Life Enjoyment/Satisfaction PES= Pleasant/Unpleasant Events
  • Life Changes=Lifestyle Changes Questionnaire
slide6

TRI

science

addiction

Cross-Cutting Activities

Investigator groups on common themes:

  • Similar populations
  • Mediators or moderators of change
  • Similar intervention elements

Advising/problem-solving methodological issues:

  • Maintaining follow-up
  • Monitoring treatment fidelity
  • Data analysis challenges (e.g., missing data, mediating variables)