Title: A Behavioral Model for Maintenance of Drug Abstinence DA 017444
1A 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
2Primary 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?
3Contingency Management
Escalating Schedule of Reinforcement Base value
2.50 3 row bonus 10 Increments 1.25
Pos. urine gt reset 2.50 Max. value 40.00 5
row neg gt 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
4 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
5Outcome Measures
ComQolComprehensive Quality of Life
Scale Q-LES-QQuality of Life Enjoyment/Satisfacti
on PES Pleasant/Unpleasant Events Life
ChangesLifestyle Changes Questionnaire
6Cross-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)