Academic journal article The Psychological Record

A Comparison of Five Reinforcement Schedules for Use in Contingency Management-Based Treatment of Methamphetamine Abuse

Academic journal article The Psychological Record

A Comparison of Five Reinforcement Schedules for Use in Contingency Management-Based Treatment of Methamphetamine Abuse

Article excerpt

Methamphetamine abuse is a growing public health and criminal justice problem in much of the Western and Midwestern United States and its use appears to be increasing east of the Mississippi River (CEWG, 2002; DASIS 2003). Methamphetamine use occurs in all types of communities from large cities to rural settings, although often the most severe impact is observed in rural areas and moderately sized urban communities (Rawson, Gonzales, & Brethen, 2002). In 2001, an estimated 9.6 million people in the United States had tried methamphetamine at least once (SAMHSA, 2002). As more Americans abuse this drug, the demand for treatment grows. Research and past experience with other types of stimulant abuse suggest that contingency management represents a promising behavioral therapy for treating methamphetamine use disorders (e.g., Higgins & Silverman, 1999; Huber, Shoptaw, Roll, Ling, & Rawson, 2002; Rawson, Huber, et al., 2002; Roll & Shoptaw, in press).

Contingency management interventions are based on a robust basic-science literature supporting a position that drug use is a form of operant behavior (e.g., Bigelow & Silverman, 1999; Higgins, 1997). As such, the probability of using drugs should be influenced by the environmental context in which drug use occurs. More specifically, the availability of alternative non-drug reinforcers should decrease use if they are available in sufficient magnitude and according to a schedule that is incompatible with drug use (Carroll, Lac, & Nygaard, 1989; Higgins, Bickel, & Hughes, 1994; Nader & Woolverton, 1991). These observations form the conceptual basis for the contingency-management approaches to drug abuse treatment, which have proven effective at initiating clinically relevant periods of abstinence (Higgins, Alessi, & Dantona, 2002; Higgins & Silverman, 1999; Magura, Casriel, Goldsmith, Strug, & Lipton, 1988; Rawson, Huber, et al., 2002; Stitzer, Bigelow, Liebson, & Hawthorne, 1982).

A common type of contingency management intervention currently being used to treat substance abuse was popularized by Higgins and colleagues (e.g., Higgins, Budney, et al., 1994; Higgins et al., 1993; Higgins et al., 1991). In this procedure, patients receive "vouchers" for the provision of biological samples (urine or breath) that indicate no recent drug use. Hence, the procedure is often called Voucher Based Reinforcement Therapy (VBRT). These vouchers are withheld when the biological sample indicates recent drug use.

VBRT has proven to be successful at initiating periods of abstinence when compared to standard treatment regimens (e.g., Higgins & Silverman, 1999; Rawson, Huber, et al., 2002) and has been shown to produce relatively long periods of abstinence (Higgins, Badger, & Budney, 2000; Higgins, Wong, Badger, Ogden, & Dantona, 2000). Most individuals initiate some sobriety with this approach.

A number of important factors that may contribute to the success of contingency management have been examined, including: type of drug abuse (e.g., Stitzer & Higgins, 1995), type of reinforcer (e.g., Iguchi, Stitzer, Bigelow, & Liebson, 1988; Petry & Martin, 2002; Schmitz et al., 1998), type of response needed to earn reinforcement (e.g., Petry, 2000; Stitzer & Bigelow, 1985), type of procedure for distributing reinforcers (Petry, 2002), delay to the delivery of reinforcement (Schwartz, Lauderdale, Montgomery, Burch, & Gallant, 1987; Reilly, Roll, & Downey, 2000), magnitude of reinforcement (e.g., Dallery, Silverman, Chutuape, Bigelow, & Stitzer, 2001; Silverman, Chutuape, Bigelow, & Stitzer, 1999; Stitzer & Bigelow, 1985; Roll, Reilly, & Johanson, 2000), population (Corby, Roll, Ledgerwood, & Schuster, 2000; McNamara, Schumacher, Milby, Wallace & Usdan, 2001; Roll, Higgins, Steingard, & McGinley, 1998; Shanner et al., 1997), and schedule with which reinforcement is delivered (Kirby, Marlowe, Festinger, Lamb, & Platt, 1998; Roll, Higgins, & Badger, 1996; Roll & Higgins, 2000). …

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