Kimberly C. Kirby

Nonmedical prescription stimulant use (NMPSU) is a rising trend among college-age adults (18-25 years old). Survey research has identified several reasons for use, including enhancing cognitive, athletic, and social performance. Less is known about how relative reinforcing value differs based on the self-reported reasons for use. The commodity purchase task (CPT) is used to assess demand for substances such as alcohol and cigarettes and has been extended for NMPSU among college student users. However, this work has not been replicated for NMPSU or expanded to determine how reason for use affects drug demand. The aim of this study was to develop a novel functional purchase task (FPT) to measure demand for preferred stimulant-like drug effects (e.g., focus, academic achievement, energy). Undergraduate students (n = 116) recruited from two universities who endorsed lifetime NMPSU completed five hypothetical stimulant purchase tasks, one for stimulant medication and four based on their ordinal ranking of eight possible reasons for stimulant use. Results support using a CPT to measure the reinforcing value of prescription stimulants and found demand predicts past year NMPSU, but not other variables associated with use. Furthermore, there are multiple reinforcing functions of NMPSU among college students, and more preferred reasons for use corresponded with higher demand intensity and inelasticity on the FPT at the aggregate level but less so at the individual participant level. These results suggest the need for further work exploring the utility of a functional approach to measure demand as reinforcing value. Public Health Significance Non-medical prescription stimulant use is a rising concern among college students. Quantitative means of assessing motivating reasons for use in this population could guide prevention and intervention approaches. This study found behavioral economic demand can measure reinforcer value for stimulants in a way that is sensitive to the self-reported reason for use.

Introduction: Contingency management interventions are among the most efficacious psychosocial interventions in promoting abstinence from smoking, alcohol and substance use. The aim of this study was to assess the beliefs and objections towards contingency management among patients in UK‐based drug and alcohol services to help understand barriers to uptake and support the development and implementation of these interventions.Methods: The Service User Survey of Incentives was developed and implemented among patients (N = 181) at three UK‐based drug and alcohol treatment services. Descriptive analyses were conducted to ascertain positive and negative beliefs about contingency management, acceptability of different target behaviours, incentives and delivery mechanisms including delivering incentives remotely using technology devices such as mobile telephones.Results: Overall, 81% of participants were in favour of incentive programs, with more than 70% of respondents agreeing with the majority of positive belief statements. With the exception of two survey items, less than a third of participants agreed with negative belief statements. The proportion of participants indicating a neutral response was higher for negative statements (27%) indicating greater levels of ambiguity towards objections and concerns regarding contingency management.Discussion and Conclusions: Positive beliefs towards contingency management interventions were found, including high levels of acceptability towards a range of target behaviours, incentives and the use of technology devices to remotely monitor behaviour and deliver incentives. These findings have implications for the development and implementation of remote contingency management interventions within the UK drug treatment services.

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final. What is the research about? Substance use disorder occurs when a person’s use of alcohol or drugs could lead to health problems, risky behavior, or problems at work, school, or home. Finding good treatment for substance use disorder can be hard because treatment programs are often costly, have a long waiting list, or may not be available in the area where a person lives.

Community Reinforcement and Family Training (CRAFT) assists family members with a treatment-resistant loved one. The most consistent outcome of CRAFT is increased treatment entry of the identified treatment-resistant person (IP). This led us to question whether all 6 components of CRAFT are necessary. In a randomized clinical trial, 115 concerned significant others (CSOs) of an IP received 12-14 sessions of the full CRAFT intervention, 4-6 sessions focused on Treatment Entry Training (TEnT), or 12-14 sessions of Al-Anon/Nar-Anon Facilitation (ANF). We monitored treatment entry, attendance, and substance use of the IP and the CSO's mood and functioning. Data were collected at baseline and 4, 6, and 9 months after the baseline. We found significant reductions in time to treatment entry (χ(2)2 = 8.89, p = .01) and greater treatment entry rates for CRAFT (62%; odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.1-6.9) and TEnT (63%; OR = 2.9, 95% CI = 1.2-7.5) compared with ANF (37%), but CRAFT and TEnT did not differ significantly from each other (OR = 1.1, 95% CI = 0.4-2.7). No between-group differences in IP drug use were reported by CSOs, but days of drug use decreased over time for all groups (F(3, 277) = 13.47, p < .0001). Similarly, CSO mood and functioning did not differ between the 3 conditions but improved over time (p < .0001 for all significant measures). We replicated the results of previous trials demonstrating that CRAFT produces greater treatment entry rates than ANF and found similar treatment entry rates for CRAFT and TEnT. This suggests that treatment entry training is sufficient for producing the best established outcome of CRAFT. (PsycINFO Database Record

Previous research showing that parents tend to underestimate adolescent substance use is consistent with concerns that adolescent substance use may develop because parents delay in reacting to it. However, little research has examined parental decisions regarding how and when to intervene on adolescent substance use. This study examines the actions that parents report they would take after (a) discovering substance use to intoxication and (b) when they believe their child has a substance use problem. Internet surveys were conducted asking parents (N = 975) how they would respond to (a) evidence of their child’s use to intoxication and (b) their child’s significant problem with either alcohol, cannabis, prescription opioids, or illicit drugs. While parental response to alcohol and cannabis intoxication focused on talking with their children (34% and 45%, respectively) and punishment (30% and 18%, respectively), parents were significantly more likely to report help-seeking behaviors when responding to prescription opioid or illicit drug use intoxication (37% and 30%, respectively). More effective public health initiatives are needed to provide parents with practical strategies to address adolescent substance use and to increase parental engagement in the services offered by addiction specialists.

BACKGROUND AND OBJECTIVE: Despite maternal and child health benefits, breastfeeding rates are relatively low among low-income Puerto Rican mothers. This study examined the hypothesis that monthly financial incentives would significantly increase the proportion of breastfeeding mothers at 6 months postpartum compared with Supplemental Nutrition Program for Women, Infants, and Children (WIC) services only among Puerto Rican mothers. METHODS: A randomized, 2-arm parallel-group design, from February 2015 through February 2016. Half of the randomized participants received monthly financial incentives contingent on observed breastfeeding for 6 months (Incentive), and the other half received usual WIC services only (Control). Thirty-six self-identified Puerto Rican women who initiated breastfeeding were enrolled. Monthly cash incentives were contingent on observed breastfeeding increasing the amount given at each month from $20 to $70 for a total possible of $270. RESULTS: The intent-to-treat analysis showed significantly higher percentages of breastfeeding mothers in the incentive group at each time point compared with those in the control group (89% vs 44%, P = .01 at 1 month; 89% vs 17%, P < .001 at 3 months; 72% vs 0%, P < .001 at 6 months). No significant differences were detected at any time point between study groups for self-reported exclusive breastfeeding rate and infant outcomes (ie, weight, emergency department visits). CONCLUSIONS: Contingent cash incentives significantly increased breastfeeding through 6-month postpartum among WIC-enrolled Puerto Rican mothers; however, no significant differences between the study groups were observed on exclusive breastfeeding rate and infant outcomes. Larger-scale studies are warranted to examine efficacy, implementation potential, and cost-effectiveness.

Brief interventions such as Screening, a single session of Brief Intervention, and Referral to Treatment (SBIRT) have shown mixed effectiveness in primary care. However, there are indications that multi-session brief interventions may demonstrate more consistently positive outcomes, and perhaps a more intensive approach would be of benefit in addressing substance use in primary care. This study compared the effectiveness of SBIRT with a single BI session (BI/RT) to a multi-session brief-treatment intervention (BI/RT+) in primary care. We also developed easy-to-use, evidence-based materials to assist clinicians in delivering these interventions. This study was conducted in three Federally Qualified Healthcare Centers (FQHCs). A total of 10,935 patients were screened, and 600 individuals were recruited. The sample was primarily Black/African American (82 %) with a mean age of 40. Patients who attended a healthcare appointment were screened for substance use via the AUDIT and DAST. Patients were eligible for the study if they scored 8 or higher on the AUDIT, were using only marijuana and scored 2 or higher on the DAST, or were using other illicit drugs and scored 1 or higher on the DAST. Participants were randomly assigned to receive one-session BI/RT, or two to six sessions of brief intervention that incorporated elements of motivational enhancement therapy and cognitive-behavioral therapy (BI/RT+). Both interventions were delivered by behavioral health consultants at the FQHCs. Participants completed follow-up assessments every 3 months for 1 year. Primary outcome variables included substance use treatment sessions attended and days of substance use. Secondary outcomes included measures of health, employment, legal, and psychiatric functioning and HIV risk behaviors. Additionally, we will conduct an economic evaluation examining cost-effectiveness and will analyze outcomes from a process evaluation examining patient and provider experiences. The ability of brief interventions to impact substance use has great potential, but research findings have been mixed. By conducting a large-scale randomized controlled trial in real-world health centers, this study will answer important questions about the effectiveness of expanded BIs for patients who screen positive for risky substance use in primary care. Trial registration NCT01751672

Contingency management (CM) programs that arrange reinforcement of biologically verified abstinence are among the most powerful treatments for a wide range of substance use disorders (1–3). Neverth...