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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.06.022 Byline: Marc E. Mooney (b), Shelly L. Sayre (a)(c), Patricia S. Hokanson (a)(c), Angela L. Stotts (a)(c), Joy M. Schmitz (a)(c) Keywords: Bupropion; Medication compliance; MEMS Abstract: This study was conducted to replicate and extend initial positive findings on the usefulness of a Medication Event Monitoring System (MEMS) to assess pill-taking behavior and enhance compliance with bupropion for smoking cessation. Participants (N =55) received MEMS bottles containing bupropion-SR (150 mg) to be taken twice daily for 7 weeks. For participants randomly assigned to the Enhanced Therapy group (n =27), weekly individual smoking cessation therapy sessions included an additional 10 min of MEMS feedback and compliance enhancement counseling using CBT techniques. The Usual Care group (n =28) received weekly individual smoking cessation sessions only. Compliance outcomes included total doses taken and number of doses taken within the prescribed time interval. Results indicated significantly higher compliance over time for the Enhanced Therapy group. Smoking abstinence rates did not differ between the two groups, although results from the pooled sample analysis showed a significant association between level of medication compliance and abstinence status at treatment weeks 3 and 6. Incorporating MEMS-based compliance interventions into smoking pharmacotherapy trials is recommended. Author Affiliation: (a) University of Texas, Houston Substance Abuse Research Center, United States (b) Transdisciplinary Tobacco Use Research Center, University of Minnesota, Department of Psychiatry, Minneapolis, MN, United States (c) Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, United States

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.03.044 Byline: Ayesha Chawdhary (a)(b), Shelly L. Sayre (a)(b), Charles Green (a)(b), Joy M. Schmitz (a)(b), John Grabowski (a)(b), Marc E. Mooney (c) Keywords: Attrition; Cocaine; Impulsivity; Prognostic modeling Abstract: A substantial amount of attrition in cocaine dependence treatment studies occurs between the initial telephone contact and the first evaluative clinic visit. While decreasing the wait to first visit can significantly reduce pre-intake attrition (PIA), little is known about other factors that moderate delay tolerance for first clinic visit. The current report uses data from 833 subjects who completed a first-contact telephone interview prior to an intake evaluation visit for cocaine use treatment research. Hierarchical logistic regression was used to assess three successive models to predict PIA, with the most inclusive model testing interactions between delay interval and seven predictors: age, gender, treatment motivation, recency of cocaine, alcohol, and tobacco use, and self-reported depression. Consistent with previous reports, greater delay to first clinic visit predicted PIA. However, no evidence for the moderating role of the selected factors was found. Overall, the utility of the logistic models, built on basic demographic and psychiatric factors, was poor, as evaluated using receiver-operator characteristic curves. Alternative factors must be examined to identify predictors that will increase probability of initial enrolment in cocaine-dependence clinical trials. Author Affiliation: (a) University of Texas Health Science Center-Houston Substance Abuse Research Center, USA (b) Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, USA (c) Department of Psychiatry, University of Minnesota, Minneapolis, USA

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.02.004 Byline: Adam M. Leventhal (a)(b), Joy M. Schmitz (b) Keywords: Expectancies; Developmental psychopathology; Risk factor; Substance abuse Abstract: While a variety of risk factors for substance abuse have been identified, the psychological mechanisms underlying the transmission of risk is unclear based on studies using traditional risk-outcome research designs. The present paper identifies drug use outcome expectancies as a common etiological mechanism involved in substance abuse risk. Existing literature findings are reviewed and integrated according to an interactional-transformational (IT) model of developmental psychopathology. This model identifies the preliminary (mediating) and secondary (moderating) role of drug expectancies as important operations involved in the development of substance use patterns. Advantages of the IT model over traditional trait-based or environmental models are discussed, along with implications for intervention and future research. Author Affiliation: (a) Department of Psychology, University of Houston, Houston, TX 77204-5022, USA (b) Department of Psychiatry and Behavioral Sciences, The University of Texas-Houston, Houston, TX, USA

This study examines the effect of homework compliance on treatment outcome in 123 participants receiving cognitive-behavioral therapy (CBT) for cocaine dependence. Regression analyses revealed a significant relationship between homework compliance and cocaine use that was moderated by readiness to change. Homework compliance predicted less cocaine use during treatment but only for participants higher in readiness to change. For those lower in readiness to change, homework compliance was not associated with cocaine use during treatment. Homework compliance early in therapy was associated with better retention in treatment. Homework compliance was not predicted by participants' level of education or readiness to change. These findings support the use of homework during CBT for substance use disorders. Keywords: homework, relapse prevention, motivation, substance dependence, drug abuse

This study examined the role of a Medication Event Monitoring System (MEMS) to assess pill-taking behavior and enhance compliance within a randomized trial of bupropion-SR for smoking cessation. Female participants [...]

Determining pre-treatment variables that predict attrition in an outpatient cocaine abuse program is critically important in efforts to enhance retention and ultimately improve client outcome. Potential predictors have been identified, such as treatment history, deviant behaviors, and level of drug use; however there is not widespread agreement on their applicability across treatments and populations. This study examines the relationship of demographic, drug use severity, and psychosocial factors with treatment attrition and the time of dropout. One hundred and sixty-five individuals from the Houston area, seeking treatment for cocaine dependence, completed a pre-treatment assessment battery prior to starting 12 weeks of outpatient treatment. A series of regression analyses showed that treatment dropouts were more likely to be separated from their spouses, have poorer family/social functioning, have fewer years of education, and to be female. Those participants with higher education levels and those with poorer psychiatric functioning tended to remain in treatment longer. The implications of these findings are discussed., INTRODUCTION Patient attrition is a serious problem facing most drug treatment programs today. With dropout rates averaging 55% in such programs, efforts are now being made to further examine variables [...]

To determine whether impulsivity was related to severity of drug use and treatment outcome, 50 cocaine dependent subjects underwent baseline measures of severity of current cocaine use and the Barratt Impulsiveness Scale (BIS-11). The hypothesis of the study was that there would be a significant correlation between impulsivity and cocaine use severity. As predicted, there was a significant correlation between BIS-11 total scores and self-reported average daily cocaine use as well as cocaine withdrawal symptoms. A subset of 35 patients underwent a 12-week double-blind placebo controlled trial of buspirone and group therapy. Subjects with high baseline impulsivity remained in the study a significantly shorter period than did subjects with lower baseline impulsivity. This study shows that impulsivity is a significant predictor of cocaine use and treatment retention, and suggests the need for targeting impulsivity in cocaine dependence treatment. Keywords: Cocaine; Impulsivity; Treatment; Substance abuse

Monetary reinforcers have not been widely used as contingent reinforcers in the treatment of drug abuse, despite their demonstrated effectiveness. This is primarily due to concern that drug abusers will use monetary reinforcers to procure drugs. The present study addressed this concern by examining 48 cocaine-dependent outpatients' biweekly self-reports of how they used their earned reinforcers. For each subject, their reinforcement usage was classified into 12 higher-order categories and 34 subcategories. Usage proportions were calculated for each. Results indicated that monetary reinforcers were used very infrequently to acquire drugs or alcohol (2%). Reinforcers were used primarily for daily life activities (25%) (e.g., food and gas), money-related uses (18%) (e.g., savings and repaying debts), personal use (15%) (e.g., cosmetics and clothes), and household items (11%) (e.g., rent and bills). These findings challenge the concern that drug abusers use monetary reinforcers to purchase drugs and have important implications for the use of contingent monetary reinforcers in treatment settings.

A study was conducted to analyze the relationship between parental drug abuse and children's problems. Children of cocaine and opiate-dependent parents were evaluated against demographically matched referred and nonreferred children. A range of children's problems were examined using standardized instruments. Results indicated that children of drug abusers showed more internalizing and externalizing psychopathology than nonreferred children.

Relapse has gained prominence as theoretically sound approach for substance-abuse treatment. Several cocaine-dependent respondence were assessed to investigate the role of treatment modality in relapse prevention treatment and to compare the effectiveness of group versus individual therapy. The study reveals that although both individual and group treatments possess certain unique features that might enhance client's response to relapse prevention, group therapy proves to be less expensive than individual therapy.

Results of two preliminary studies examining the efficacy of the contingency management procedure (shaping) on decreasing cocaine use and increasing compliance with the prescribed medical regimen in two high-risk cocaine-dependent population, tuberculin-exposed patients and pregnant women, are described. Monetary reinforcers were effective in reducing cocaine consumption.

A within-subjects study of five cigarette smoking methadone maintenance patients revealed that monetary incentives had minimal effects in mitigating their carbon monoxide intake levels. This result has important implications in shaping contingency management procedures in smoking cessation programs.

A study of cocaine-dependent pregnant women reveals that those who received 'baseline' drug treatment were more successful in the cessation of cocaine when compared to those taking 'intensive' drug treatment. Pregnant women taking 'baseline' treatment enjoy a better success rate because of their decision to abstain from cocaine prior to starting treatment and due to their concern for the baby. Pregnant women taking 'intensive' treatment require more time to stop cocaine intake.

This study demonstrates the use of paired comparisons and interval scaling techniques for measuring the relative priority of program Privileges available at a methadone maintenance clinic. Fifteen methadone program privileges were combined in all possible pairs (N = 105) on a reinforcer menu and administered to a group of 12 methadone patients and a second group of counselors (N = 4). Data were converted to interval scales using the law of comparative judgment to form a quantitative continuum from least to most preferable. Free methadone, free dental service, and more take-homes were ranked highest in both groups; however, patients showed less differentiation in their preference for these privileges. Dose decreases were least preferred. Results are discussed in terms of their clinical applicability in identifying privileges for potential use in modifying the behavior of drug abusers. The method of paired comparisons has excellent psychometric properties and may offer some advantages over other response scale formats. Keywords -- methadone maintenance; reinforcer; contingency; paired comparisons; interval scaling; behavioral-pharmacological interventions.

Tuberculosis has increased dramatically in the United States. Noncompliance with treatment is high. The purpose of this investigation was to achieve compliance with prophylactic TB treatment and simultaneously decrease drug use in a high-risk group of intravenous drug users. Two studies were conducted. Study 1: Subjects were 9 chronic opiate users who tested positive for tuberculosis and were placed on isoniazid (INH) and methadone. Methadone was dispensed contingent upon INH ingestion throughout. A within-subject, A-B design with contingency management interventions on drug use was implemented. Results: Compliance with INH was 100% in 8 patients. Cocaine use remained high. Study 2: Two patients, meeting same criteria as Study 1, participated in a within-subject A-B multiple baseline design. Methadone was dispensed contingent upon INH ingestion throughout. Successive decreases in cocaine use were reinforced in the contingent phase. Results: Compliance with INH was high. During contingency, both patients had over 40% cocaine-free urine samples compared with 0% at baseline. This investigation serves as a model for achieving compliance with TB treatment in opiate users.

The study assessed the impact of motivational interviewing (MI) intervention on transtheoretical (TTM)-based mechanisms of change in low-income pregnant smokers. Repeated measures analyses indicate that relative to usual care (UC), pregnant smokers who received MI reported a greater increase in confidence to abstain from smoking, a decrease in temptation to smoke, and a decrease in level of depression.

A survey was conducted to evaluate the recruitment methods and the initial screening processes used in outpatient treatment clinical trails for cocaine and alcohol nicotine treatment. Some of the implications of these findings, and recommendations for developing program recruitment and screening methods are described.

A brief motivational interviewing (MI) intervention was evaluated within the context of an outpatient, cocaine-detoxification program. MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment. Participants (N = 105) were randomly assigned to MI or to detox-only conditions. Results indicated that although participants completed the detoxification program at equal rates, completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment. MI patients with lower initial motivation were more likely to complete detoxification.

Research into the joint action of naltrexone in combination with relapse prevention therapy for treating cocaine addiction is presented. It is suggested that naltrexone interacts with the form of therapy received.