Contingency Management in Community Programs Treating Adolescent Substance Abuse: A Feasibility Study

Autor: Kathleen T. Brady, Angela E. Waldrop, Therese K. Killeen, Himanshu P. Upadhyaya, Aimee L. McRae-Clark
Rok vydání: 2012
Předmět:
Zdroj: Journal of Child and Adolescent Psychiatric Nursing. 25:33-41
ISSN: 1073-6077
DOI: 10.1111/j.1744-6171.2011.00313.x
Popis: Data from the 2009 National Survey on Drug Use and Health showed that current marijuana use in 12- to 17-year-olds increased from 6.7% in 2007 and 2008 to 7.3% in 2009 (Substance Abuse and Mental Health Services Administration, 2010). In the most recent Monitoring the Future report on adolescent drug use (Johnston, O’Malley, Bachman, & Schulenberg, 2011), there was a slight increase in past month marijuana use in 8th graders (8%), 10th graders (16.7%), and 12th graders (21.4%). Marijuana use prevalence is two to three times higher than any other drug category. Although evidence is growing to support behavioral interventions, there is still limited consensus on the best approaches for treating adolescents with substance use disorders. Effective treatments must retain adolescents in treatment long enough for them to benefit from cognitive and psychosocial strategies on which many treatments are based. Contingency management (CM), a procedure that uses tangible incentives to reinforce positive behavior change, has been shown to be efficacious in many difficult-to-treat substance-dependent populations. CM is rooted in behavioral modification operant conditioning. Behaviors that are reinforced are more likely to reoccur and behaviors that are punished are less likely to reoccur (Skinner, 1969). Drug use is a conditioned behavior with continued use being reinforced by the rewarding properties of the drug. This behavior is best altered by providing positive reinforcement for more adaptive behavior (i.e., abstinence) versus negative reinforcement of old (drug using) behaviors (Bigelow, Stitzer, Griffiths, & Liebson, 1981). Contingency management procedures, coupled with certain psychosocial interventions such as cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), and family therapy, have been shown to increase retention in treatment and reduce drug use in adolescents and young adults with marijuana use disorders (Budney, Moore, Rocha, & Higgins, 2006; Carroll et al., 2006; Kadden, Litt, Kabela-Cormier, & Petry, 2007; Stanger, Budney, Kamon, & Thostensen, 2009). Henggeler et al. (2006) found that CM increased retention and abstinence rates when added to multisystemic family therapy and standard community treatment in an adolescent drug court population. Despite a body of evidence supporting the efficacy of CM in the treatment of substance-abusing populations, clinicians in frontline treatment settings have been reluctant to adopt CM into their usual practice and integration of CM into standard treatment in community programs among adolescents has not been well studied. Kirby, Benishek, Dugosh, and Kerwin (2006) explored beliefs regarding CM in a large sample of community treatment providers. Although approximately half of those surveyed said they would be open to using CM, the most commonly reported objections were the cost of incentives, incentives not addressing the underlying issues and incentives not targeting multiple behaviors or treatment goals. Other less common concerns included incentives being considered a “bribe,” causing discord among patients, and undermining the treatment process and internal motivation. The present study was intended to explore the feasibility of integrating a cost-effective CM procedure similar to the one developed by Petry, Martin, Cooney, and Kranzler (2000) into standard community treatment for adolescents with primary marijuana use disorders. This study differs from previous studies in that CM was not coupled with another evidence-based psychosocial treatment and exclusion criteria were minimized so that participants were more representative of those typically seen in community programs. It was hypothesized that participants randomized to the incentive group plus standard community treatment would be retained in treatment longer, have a greater percentage of urine drug screens (UDS) negative for marijuana, and have longer periods of sustained marijuana abstinence than those participants randomized to a control group plus standard community treatment. In order to encourage submission of UDS, participants in the control group were given a set number of draws for each UDS submission. They received two draws for each UDS submitted (regardless of results) throughout the intervention period. This was necessary to increase the likelihood that the control group would submit sufficient UDS for comparison with the experimental group.
Databáze: OpenAIRE
Externí odkaz: