Recent Applications of Contingency Management to Enhance Health Outcomes becomes clinically important the moment a team has to turn good intentions into reliable action inside home routines and caregiver-led implementation, adult services and community participation. In Recent Applications of Contingency Management to Enhance, for this course, the practical stakes show up in safe, humane intervention that respects health variables and daily-life feasibility, not in abstract discussion alone.
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Join Free →Contingency management (CM) interventions have been remarkably effective at promoting positive behavior change related to public health, such as enhancing adherence with prescribed medications and reducing problematic drug use. This symposium consists of three presentations of recent CM research. The presentations highlight (a) the use of CM to improve viral suppression among individuals with HIV, (b) the use of abstinence-contingent wage supplements (ACWS) to increase alcohol abstinence and employment and reduce poverty, and (c) the use of demand analyses to predict CM efficacy. These studies underscore the value of contingency management in handling widespread public health issues. Paper 1: Individualized Analyses of HIV Viral Suppression During A Contingency Management Intervention. Cory Toegel, Forrest Toegel, Kenneth Silverman The HIV/AIDS epidemic has continued to spread and negatively affect the health of millions of people in the United States and worldwide. A major component in preventing the spread of HIV/AIDS involves adherence to antiretroviral therapy (ART), which can suppress an individual's blood concentration of HIV-1 RNA (i.e., viral load) to the extent that the virus is "undetectable" and consequently untransmittable to others through unsafe sex. A recent randomized controlled trial demonstrated that an incentive-based contingency management intervention was effective at increasing adherence to ART and suppressing viral loads. This presentation will provide detailed descriptions of the individualized patterns of treatment effects for all individuals who completed the randomized controlled trial. We will also describe effects of the schedule-thinning procedure on viral suppression as the schedule of blood-sample collection was thinned progressively from once per week to once every 12 weeks. Overall, these results will provide information on the time course effects of incentivized viral suppression and can inform best practice guidelines of contingency management procedures aimed to bring treatment in line with standard HIV care. Paper 2: Post-intervention Outcomes of A Therapeutic Workplace for Adults with Alcohol Use Disorder Who are Experiencing Homelessness. Haillie McDonough, Forrest Toegel, Kenneth Silverman, Kay Hintze, Jeremy Andrzejewksi, Matthew Novak, August Holtyn Alcohol use disorder and unemployment are concentrated among people living in poverty. The present study evaluated the effects of abstinence-contingent wage supplements in promoting alcohol abstinence and employment and reducing poverty among homeless adults with alcohol use disorder. As part of a 6-month clinical trial, 119 participants were randomized into two groups and received either standard treatment for alcohol use disorder (Control; n=57) or standard treatment plus Abstinence-Contingent Wage Supplements (ACWS; n=62). All participants wore alcohol biosensors (SCRAM or BACtrack Skyn) that continuously monitored alcohol use. ACWS participants received abstinence-contingent stipends for working with employment services and abstinence-contingent wage supplements for working at a community job. The magnitude of these stipends depended on recent abstinence from alcohol. In the trial, ACWS participants reported significantly higher rates of alcohol abstinence and employment, and significantly less poverty compared to Control participants. The present study reports on the persistence of treatment effects in the year after the study period, when the ACWS intervention was removed. Results from this study will provide information on the lingering effects of the ACWS intervention on alcohol abstinence, employment, and poverty among homeless adults with alcohol use disorder. Paper 3: Using Demand Curves to Analyze What Works in Contingency Management Interventions. Rosemarie Davidson, Anthony DeFulio Contingency management (CM) is the most effective psychosocial treatment for substance use disorders. Some evidence suggests the effects of CM exceed the value of the monetary incentives used to reinforce drug abstinence in the intervention. However, the evidence in support of this possibility is limited and flawed. We examined CM studies targeting single-drug contingencies to more clearly assess the extent to which CM generates a larger-than-predicted effect. We found that interventions for cocaine abstinence overwhelmingly outperformed their predicted effect, whereas interventions for smoking cessation did not. Thus, the incentives alone may not fully account for the success of CM, at least when applied for stimulant use. This finding (1) opens the door to a rich palate of research questions designed to identify and optimize the sources of the beneficial effect of CM in substance abuse treatment and (2) serves as an example of using demand analyses as a starting point for investigations into the behavioral mechanisms that underlie behavior analytic interventions of any kind and for any population of interest. Future research is needed to isolate factors necessary for producing the greatest effect.
| Certification Body | Credits | Type |
|---|---|---|
| BACB® | 1.5 | General |
| COA | 1 | — |
Dig into the research behind this topic — plain-English summaries written for BCBAs.
252 research articles with practitioner takeaways
233 research articles with practitioner takeaways
231 research articles with practitioner takeaways
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