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OBJECTIVE: Sexual delay discounting describes the decreased likelihood of condom-protected sex if a condom is not immediately available, which can be quantitatively summarised using the Sexual Delay Discounting Task (SDDT). The present studies determined the extent to which condom use likelihood as assessed by the SDDT is associated with self-reported sexual risk behaviours and demographics in two online samples of adults. DESIGN: Study 1 (n = 767) assessed demographics, sexual risk behaviour, and delay discounting, and examined relations between these variables using correlation and regression. Study 2 (n = 267) examined whether real-world instances of unprotected sex because a condom was not immediately available predicted greater sexual discounting. MAIN OUTCOME MEASURES: sexual delay discounting, condom use RESULTS: Both studies observed significant positive relations between sexual delay discounting and self-reported sexual risk behaviours, and found that males tended to show greater sexual discounting. In Study 2, 46% of the sample self-reported having unprotected sex because a condom was not immediately available, and these individuals showed significantly greater sexual delay discounting. CONCLUSION: These results extend prior findings by demonstrating that delay is a critical variable underlying real-life sexual risk behaviour among non-clinical samples. The SDDT is an ecologically-valid measure of these processes.

Nicotine is the primary addictive constituent of tobacco products. The purpose of the chapter is to review the findings of clinical smokeless tobacco (ST) laboratory studies of use characteristics, user preferences, and additive content. Assessment tools such as the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco (FTND-ST), the Hooked on Nicotine Checklist (HONC), and the Product Evaluation Scale (PES) are discussed and their strengths and limitations noted. The absorption of nicotine from ST products is contingent upon both user behaviors and product characteristics. Particular emphasis is placed on characteristics that affect nicotine bioavailability and thus addiction liability. Some other factors that affect use, such as format, are mentioned. Projections and suggestions are offered for the future of clinical laboratory studies.

People who inject drugs (PWID) are at increased risk of HIV infection. Although methadone maintenance therapy can help lower this risk, many methadone patients continue to engage in HIV risk behaviors, especially patients who use cocaine and alcohol. The purpose of the current study was to investigate relations between alcohol use disorders and HIV risk behavior in 239 cocaine-dependent methadone patients participating in a randomized controlled trial of a behavioral intervention to promote cocaine abstinence. Past 3-month HIV Risk-taking Behavior Scale (HRBS) scores were compared between cocaine-dependent methadone patients who met DSM-IV-TR diagnostic criteria for alcohol abuse or dependence and those who did not meet these criteria. No significant differences in HRBS drug subscale scores were observed between participants with and without alcohol use disorders, indicating risky drug use was similar between groups. However, alcohol use disorder was significantly associated with HRBS sex subscale scores (t=2.59, p=0.01), indicating participants with alcohol use disorders were more likely to engage in risky sexual behavior. Item-level analyses of the sex-related HRBS questions showed participants with alcohol use disorders were significantly more likely than participants without alcohol use disorders to have unprotected sex, engage in transactional (paid) sex, and have anal sex. Interventions are needed to reduce risky sexual behavior and attenuate the spread of HIV in this high-risk population.

Smoking is associated with a number of chronic health conditions, including cardiovascular disease and various types of cancer. The decision to smoke can be conceptualized as preference for small, immediate rewards (e.g., relief from withdrawal) over larger, delayed rewards (e.g., good health). Contingency management (CM) takes advantage of this preference for immediate outcomes by delivering incentives, usually financial, for making the healthier choice to abstain from smoking. The current study tested the feasibility of harnessing naturally occurring social contingencies associated with smoking cessation to increase the promise of CM in initiating and sustaining long-term abstinence. Pairs of smokers with an existing relationship (i.e., friends, roommates, family, significant others) were recruited to quit together in the context of a smartphone-delivered, group CM intervention. Approximately 50% of interested participants identified a partner who also met criteria to participate, and five pairs (N = 10) completed the study. Using a within-subject design, participants could earn individual financial incentives for submitting breath carbon monoxide (CO) samples twice daily that met targeted goals for abstinence, and they could earn bonus incentives when both members of the pair met their targets together. Nine participants (90%) successfully reduced their mean breath CO during the intervention relative to baseline conditions. Individuals within a pair performed similarly to one another, for better or worse (i.e., both participants abstained, smoked, or missed samples at the same time). The social contingencies of quitting with someone with whom the smoker has an existing relationship may be helpful, but may also introduce unique challenges, particularly with regard to recruitment and treatment retention.

Combining alcohol and caffeine is associated with increased alcohol consumption, but no prospective experimental studies have examined whether added caffeine increases alcohol consumption.This study examined how caffeine alters alcohol self-administration and subjective reinforcing effects in healthy adults.Thirty-one participants completed six double-blind alcohol self-administration sessions: three sessions with alcohol only (e.g., beverage A) and three sessions with alcohol and caffeine (e.g., beverage B). Participants chose which beverage to consume on a subsequent session (e.g., beverage A or B). The effects of caffeine on overall beverage choice, number of self-administered drinks, subjective ratings (e.g., Biphasic Alcohol Effects Scale), and psychomotor performance were examined.A majority of participants (65%) chose to drink the alcohol beverage containing caffeine on their final self-administration session. Caffeine did not increase the number of self-administered drinks. Caffeine significantly increased stimulant effects, decreased sedative effects, and attenuated decreases in psychomotor performance attributable to alcohol. Relative to nonchoosers, caffeine choosers reported overall lower stimulant ratings and reported greater drinking behavior prior to the study.Although caffeine did not increase the number of self-administered drinks, most participants chose the alcohol beverage containing caffeine. Given the differences in subjective ratings and pre-existing differences in self-reported alcohol consumption for caffeine choosers and nonchoosers, these data suggest that decreased stimulant effects of alcohol and heavier self-reported drinking may predict subsequent choice of combined caffeine and alcohol beverages. These predictors may identify individuals who would benefit from efforts to reduce risk behaviors associated with combining alcohol and caffeine.

Background: Energy drink use is associated with increased risk behavior among adolescents and college students. This study examined this relationship in a nationwide sample of young adults and also examined relations between energy drink use and delay discounting. Methods: Participants were 874 U.S. adults 18–28 years of age with past 30-day consumption of caffeine and alcohol. Participants completed an online survey of energy drink use, drug use, sexual activity, alcohol misuse (alcohol use disorders identification test [AUDIT]), sensation seeking (four-item Brief Sensation Seeking Scale [BSSS-4]), and delay discounting of monetary rewards and condom use. Results: Over one-third of participants (n = 303) reported consuming energy drinks at least once per week. Weekly energy drink users were more likely than less-than-weekly energy drink users to report a recent history of risk behaviors, including cigarette smoking (56% vs. 28%, p

Background Caffeine Use Disorder was added to DSM-5 as a diagnosis for further research, but few studies have been conducted to identify effective treatments. This randomized, controlled clinical trial examined the efficacy of a manual-only treatment program for caffeine cessation and reduction among individuals seeking treatment for problematic caffeine use. Methods Individuals meeting at least two proposed DSM-5 diagnostic criteria for Caffeine Use Disorder were randomly assigned to receive either immediate treatment or treatment delayed by 7 weeks. The treatment consisted of a manual containing information about caffeine and instructions for gradually reducing caffeine consumption over a period of 6 weeks, with no counseling or additional support. Caffeine consumption and caffeine-related distress were assessed before treatment, 7 weeks after receiving the treatment manual (end-of-treatment), and 20 weeks post-treatment. Results The manual-only treatment resulted in significant reductions in participants’ self-reported caffeine consumption and caffeine-related distress at end-of-treatment that were sustained at 20-weeks post-treatment. Salivary caffeine levels and community observers corroborated the self-reported reductions in caffeine consumption. Comparisons between the immediate and delayed treatment groups suggest the reductions in caffeine consumption were attributable to the manualized treatment rather than spontaneous with the passage of time. Conclusions The present study provides evidence that a gradual caffeine reduction and cessation program may be successfully implemented using a manual-only approach. This time- and cost-effective intervention may be easily adopted by practitioners with limited time or experience with behavioral interventions who want to encourage their patients to reduce caffeine consumption.

Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior.

Breath carbon monoxide (CO) is a biochemical marker of recent cigarette smoking (see Bittoun, 2008; Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification, 2002). Breath CO correlates well with other established assays of cigarette smoking, such as COHb concentration in blood samples (Hald, Overgaard, & Grau, 2003; Jarvis, Belcher, Vesey, & Hutchison, 1986), and urinary cotinine levels (Marrone, Paulpillai, Evans, Singleton, & Heishman, 2010; Marrone et al., 2011), and has high levels of sensitivity and specificity in distinguishing between cigarette smokers and non-smokers (Javors, Hatch, & Lamb, 2005; MacLaren et al., 2010; Perkins, Karelitz, & Jao, 2013; Raiff, Faix, Turturici, & Dallery, 2010). Further, as the collection of blood or urine samples is relatively invasive, breath CO provides a useful assay for researchers, clinicians, and physicians as a non-invasive, efficient method for assessing recent cigarette smoking. The clinical utility of breath CO has been established in a variety of contexts and across several populations of smokers. For example, adolescent (National Survey on Drug Use and Health, 2011) and pregnant (Cnattingius, 2004) smokers represent vital target populations for smoking prevention and cessation efforts. Given the often surreptitious nature of cigarette smoking in these populations, breath CO provides an accurate and reliable method for verifying self-report assessments, which may be unreliable under some conditions (Dolcini, Adler, Lee, & Bauman, 2003; Shipton et al., 2009). Breath CO has also been used as a sensitive measure for the verification of smoking abstinence in the context of behavioural interventions for smoking cessation (i.e., contingency man

The pharmacological effects of tobacco products are primarily mediated by nicotine; however, research suggests that several non-nicotine tobacco constituents may alter the reinforcing effects of nicotine. This study evaluated the reinforcing effects of aqueous solutions of smoke/aerosol condensate from cigarettes, little cigars, electronic cigarettes (e-cigarettes), and waterpipe tobacco in a self-administration procedure to determine if abuse liability of these tobacco products differed. Adult male Sprague-Dawley rats (n = 64 total) were trained to self-administer intravenous nicotine (30 μg/kg/infusion) on a fixed ratio 5 schedule of reinforcement. Following nicotine dose-effect assessment (1, 7.5, 15, and 30 μg/kg/infusion), rats were given access to smoke/aerosol condensate derived from their assigned tobacco product. Rats responded for smoke/aerosol condensate containing 1, 7.5, 15, and 30 μg/kg/infusion nicotine, with the ratio of nicotine:non-nicotine constituents held constant across doses for each tobacco product. Responding for nicotine or smoke/aerosol condensate was also assessed on a progressive ratio schedule of reinforcement. Cigarette, little cigar, and e-cigarette smoke/aerosol condensates shifted the nicotine dose-effect curve leftward, whereas waterpipe tobacco smoke condensate shifted the dose-effect curve rightward. Smoke/aerosol condensate from all tobacco products produced similar levels of responding compared to nicotine alone during the progressive ratio phase. Results suggest that non-nicotine constituents in cigarettes, little cigars, and e-cigarettes differentially enhance nicotine’s reinforcing potency. In contrast, waterpipe tobacco blunted nicotine’s reinforcing potency, suggesting that it may contain unique constituents that dampen nicotine’s reinforcing effects.

Caffeine is the most commonly used drug in the world. Although consumption of low to moderate doses of caffeine is generally safe, an increasing number of clinical studies are showing that some caffeine users become dependent on the drug and are unable to reduce consumption despite knowledge of recurrent health problems associated with continued use. Thus, the World Health Organization and some health care professionals recognize caffeine dependence as a clinical disorder. In this comprehensive literature review, we summarize published research on the biological evidence for caffeine dependence; we provide a systematic review of the prevalence of caffeine dependence and rates of endorsement of clinically meaningful indicators of distress and functional impairment among habitual caffeine users; we discuss the diagnostic criteria for Caffeine Use Disorder—a condition for further study included in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.); and we outline a research agenda to help guide future clinical, epidemiological, and genetic investigations of caffeine dependence. Numerous controlled laboratory investigations reviewed in this article show that caffeine produces behavioral and physiological effects similar to other drugs of dependence. Moreover, several recent clinical studies indicate that caffeine dependence is a clinically meaningful disorder that affects a nontrivial proportion of caffeine users. Nevertheless, more research is needed to determine the reliability, validity, and prevalence of this clinically important health problem.

Investigating Group Contingencies to Promote Brief Abstinence from Cigarette Smoking Contingency management (CM) has been shown to promote abstinence from a number of abused substances, including cocaine, opiates, alcohol, marijuana, and polydrug use (Lussier, Heil, Mongeon, Badger, & Higgins, 2006; Stitzer & Petry, 2006). Indeed, previous research and operant theory suggests that when incentives are available on a schedule incompatible with drug use, CM can be used to promote abstinence from any abused substance, including tobacco (see Higgins, Silverman, & Heil, 2008 for a review; Roll, Higgins, & Badger, 1996). Yet, despite robust evidence attesting to the efficacy of CM as a substance abuse treatment, the intervention is underutilized by community-based treatment providers (Benishek, Kirby, Dugosh, & Padovano, 2010; McGovern, Fox, Xie, & Drake, 2004). One possible barrier to dissemination is response effort. Frequent assessment of substance use is an important feature of CM programs that requires considerable effort from both patients and practitioners. In many CM interventions designed to promote abstinence from cigarette smoking, monetary incentives are delivered to smokers contingent on reductions in breath carbon monoxide (CO; Alessi, Badger, & Higgins, 2004; Dallery, Glenn, & Raiff, 2007; Dunn et al., 2008; Higgins et al., 2004; Roll & Higgins, 2000; Roll et al., 1996; Tidey, O'Neill, & Higgins, 2002). These samples must be collected at least twice daily to accurately assess smoking status. A frequent schedule of assessment is necessary due to the short half-life of breath CO (i.e., about 3–6 hours; Benowitz et al., 2002; Deller, Stenz, Forstner, & Konrad, 1992; Joumard, Chiron, Vidon, Maurin, & Rouzioux, 1981) and to minimize delays between alternative non-drug behavior and reinforcement (Bigelow & Silverman, 1999). However, routine clinic visits might not be possible for many patients due to distance, lack of transportation, clinic hours, or other practical constraints. To circumvent these barriers, Dallery and colleagues developed an Internet-based CM program to promote abstinence from cigarette smoking (Dallery & Glenn, 2005; Dallery et al., 2007; Dallery, Meredith, & Glenn, 2008; Meredith, Grabinski, & Dallery, 2011; Reynolds, Dallery, Shroff, Patak, & Leraas, 2008; Stoops et al., 2009). Participants submitted video recordings of breath CO measurements twice daily via the Internet, and abstinence was reinforced with vouchers exchangeable for various consumer goods. The Internet-based system allowed participants to overcome substantial distances to clinics (e.g., Meredith et al., 2011; Stoops et al.). However, the treatment model did not address another potential limitation of incentive-based interventions—incompatibility with standard care (Hartzler, Lash, & Roll, 2012; Roll, Madden, Rawson, & Petry, 2009). Although CM is typically evaluated under controlled conditions when it is delivered to individual substance users, many substance abuse treatment programs rely on group-oriented therapies, including the 12-step approach (Benishek, et al., 2010). Thus, integrating CM with group-centered treatment may help promote dissemination. Indeed, several researchers have recently begun investigating methods for integrating CM into group therapy (Petry, Weinstock, & Alessi, 2011; Petry, Weinstock, Alessi, Lewis, & Diekhuas, 2010). One strategy is to program monetary incentives contingent on group therapy attendance (Alessi, Hanson, Wieners, & Petry, 2007; Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008). Another promising strategy is to integrate monetary group contingencies into the incentive schedules used to promote drug abstinence (Kirby, Kerwin, Carpendo, Rosenwasser, & Gardner, 2008; Meredith et al., 2011). Several types of group contingencies have been described in the applied behavior analysis literature (Cooper, Heron, & Heward, 2007; Litow & Pumroy, 1975). Independent group contingencies are arranged when programmed consequences are contingent on individual performance, but the contingencies are applied simultaneously to all members of a group. In contrast, dependent and interdependent group contingencies are those in which “the behavior of one or more group member determines the consequences received by at least one other group member” (Speltz, Shimamura, & McReynolds, 1982, p. 533). One advantage of dependent and interdependent group contingency arrangements is that they may promote social support such as cooperation or abstinence-contingent praise (Gresham & Gresham, 1982; Williamson, Williamson, Watkins, & Hughes, 1992). Some evidence suggests that social incentives such as these may influence abstinence from cigarette smoking (Baha & Le Faou, 2010; Chen, White, & Pandina, 2001; Christakis & Fowler, 2008; Cohen & Lichtenstein, 1990; Hennrikus et al., 2010; Ji et al., 2005; Mermelstein, Cohen, Lichtenstein, Baer, & Kamarck, 1983; Moller, Pedersen, Villebro, & Norgaard, 2003; Westmaas, Wild, & Ferrence, 2002). Moreover, research suggests that practitioners are more willing to adopt treatments that use social incentives relative to those that use only tangible incentives (Kirby, Benishek, Dugosh, & Kerwin, 2006). In an initial investigation of group contingencies to promote drug abstinence, we developed and tested an Internet-based group CM program to promote smoking cessation by integrating independent and interdependent group contingencies and an online peer support forum into an existing Internet-based intervention (Meredith et al., 2011). This study demonstrated the feasibility, acceptability, and preliminary efficacy of Internet-based group CM. However, data from this experiment could not be used to assess the independent effects of social support and monetary group contingencies on smoking cessation. Therefore, the purpose of the current study was to isolate the effects of these variables on cigarette smoking by investigating the effects of various group CM treatment components on promoting only brief periods of abstinence.

Internet-based group contingencies have been shown to promote brief periods of abstinence from cigarette smoking. Under a group contingency, small teams of smokers must collectively meet abstinence goals to receive monetary consequences. The present study investigated two arrangements, one in which all team members had to meet group treatment goals to receive monetary consequences (Full Group), and one in which team members had to meet some group goals and some individual goals to receive these consequences (Mixed Group). Mōtiv8 Systems, an Internet-based remote monitoring platform, was used to collect video-recorded breath carbon monoxide (CO) samples. All team members could communicate with each other via an online discussion forum. During baseline conditions, only 3.3% of CO samples were negative for smoking, which suggests that self-monitoring and access to the online discussion forum were insufficient to initiate abstinence. When the group contingencies were instituted 41.3% of CO samples were negative. There were no statistically significant differences between the two arrangements in the percentage of negative CO samples or point prevalence at the end of treatment or at the 3-month follow-up. Participants posted an average of 25 comments on the discussion forum, most of which were rated as positive by independent observers. The mean cost of vouchers per participant was lower in the Full Group ($33) relative to the Mixed group ($190). The present results replicate and extend previous findings on group contingencies to promote abstinence and social support.

Contingency management (CM), in which positive consequences are delivered based on the evidence of drug abstinence, represents one of the most successful translations of behavior analytic principles and procedures to socially significant problem behavior. We discuss the history and contemporary applications of CM interventions to initiate and maintain abstinence across a range of drug classes. We also highlight innovations in CM that promise to increase access, sustainability, and cost effectiveness of this evidence-based behavioral intervention. We conclude with a brief discussion of considerations for implementation in clinical contexts and of methods to broaden the dissemination and implementation of CM.

i ntroduction: Mobile phones hold considerable promise for delivering evidence-based smoking cessation interventions that require frequent and objectiv e assessment of smoking status via breath carbon monoxide (Breath CO) measurement. However, there are currently no commercially available mobile-phone-based Breath CO meters. We developed a mobile-phone-based Breath CO meter prototype that attaches to and communicates with a smartphone through an audio port. The purpose of the current study was to evaluate the reliability and validity of Breath CO measures collected with the mobile meter prototype and assess the usability and acceptability of the meter. Methods: Participants included 20 regular smokers (≥10 cigarettes/day), 20 light smokers (

In contingency management (CM) interventions, monetary consequences are contingent on evidence of drug abstinence. Typically, these consequences are contingent on individual performance. Consequences contingent on group performance may promote social support (e.g., praise).Thus, to combine social support with the monetary incentives of CM, we integrated independent and interdependent group contingencies of reinforcement into an Internet-based intervention to promote smoking abstinence. Breath carbon monoxide (CO) measures were compared between treatment conditions and a baseline control condition. Thirteen participants were divided into 5 groups or "teams" (n=2-3 per team). Each participant submitted video recordings of CO measurement twice daily via the Internet. Teammates could monitor each other's progress and communicate with one another through an online peer support forum. During a 4-day tapering condition, vouchers exchangeable for goods were contingent on gradual reductions in breath CO. During a 10-day abstinence induction condition, vouchers were contingent on abstinence (CO≤4ppm). In both treatment conditions, concurrent independent and interdependent group contingencies were arranged (i.e., a mixed contingency arrangement).Less than 1% of CO samples submitted during baseline were≤4ppm, compared to 57% submitted during abstinence induction. Sixty-five percent of participants' comments on the online peer support forum were rated as positive by independent observers. Participants rated the intervention favorably on a treatment acceptability questionnaire.The results suggest that the intervention is feasible and acceptable for promoting abstinence from cigarette smoking.

Eight smokers were randomly assigned to a deposit contract ($50.00) or to a no-deposit group. Using a reversal design, participants could recoup their deposit (deposit group) or earn vouchers (no-deposit group) for smoking reductions and abstinence (breath carbon monoxide [CO]or =4 parts per million) during treatment phases. Treatment was delivered via a novel Internet-based method to monitor smoking status. Although equivalent decreases in breath CO and abstinence were observed during treatment in both groups, $178.50 in vouchers were distributed to participants in the no-deposit group, whereas a small surplus remained in the deposit group. A deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking.

Hazardous drinking and alcohol use disorder (AUD) are substantial contributors to USA and global morbidity and mortality. Patient self-management and continuing care are needed to combat these public health threats. However, services are rarely provided to patients outside of clinic settings or following brief intervention. Smartphone applications (“apps”) may help narrow the divide between traditional health care and patient needs. The purpose of this review is to identify and summarize smartphone apps to reduce alcohol consumption or treat AUD that have been evaluated for feasibility, acceptability, and/or efficacy. We searched two research databases for peer-reviewed journal articles published in English that evaluated smartphone apps to decrease alcohol consumption or treat AUD. We identified six apps. Two of these apps (A-CHESS and LBMI-A) promoted self-reported reductions in alcohol use, two (Promillekoll and PartyPlanner) failed to promote self-reported reductions in alcohol use, and two (HealthCall-S and Chimpshop) require further evaluation and testing before any conclusions regarding efficacy can be made. In summary, few evaluations of smartphone apps to reduce alcohol consumption or treat AUD have been reported in the scientific literature. Although advances in smartphone technology hold promise for disseminating interventions among hazardous drinkers and individuals with AUD, more systematic evaluations are necessary to ensure that smartphone apps are clinically useful.