Contingency Management Alcohol & Marijuana Term Paper

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" (1995)

The authors state: "The amphetamines occasioned dose-related increases in d- amphetamine-appropriate responding, whereas hydromorphone did not. Amphetamines also occasioned dose-related increases in reports of the drug being most like "speed," whereas hydromorphone did not. However, both amphetamines and hydromorphone occasioned dose-related increases in reports of drug liking and in three scales of the ARCI. Thus, some self-report measures were well correlated with responding on the drug-appropriate lever and some were not. Lamb and Henningfield (1994) suggest that self-reports are complexly controlled by both the private event and the subject's history of experience with the drug. Some of the self-reports they observed (e.g., feels like speed) are probably occasioned by a relatively narrow range of stimuli because in the subject's experience with drug administration, these reports have been more selectively reinforced by the verbal community relative to other reports (e.g., drug liking). They also suggest that these results imply that private events do not necessarily mediate drug-produced reinforcement, because some reports of private events (e.g., feels like speed) correlate better with the nonverbal operant studied than do those that are assumed to mediate reinforcement (e.g., drug liking). Although this is an interesting speculation, their subjects provided these self-reports in the context of a discrimination task rather than under conditions of a self-administration study that would allow examination of reinforcing functions of the drugs. However, whether stimulant identification mediates discriminative responding or whether both the identification and discriminative responding occur independently as a result of drug discrimination remains to be determined. Nonetheless, Lamb and Henningfield's inclusion of self-report measures and examination of their relation to nonverbal operants provide excellent examples of ways to examine and conceptualize relations among private events, verbal responding, and nonverbal responding." (Ibid)

The work of Drummond, Cooper & Glautier entitled: "Conditioned Learning in Alcohol Dependence: Implications for Cue Exposure Treatment" is a "review of the literature pertinent to cue exposure treatment in alcohol dependence." (1990) This work further evaluates the models of relapse, based on conditioning and social learning theories. He also suggested that these conditioned responses (CRs) remain unaltered by conventional addiction treatment. A later study by Ludwig, Wikler & Stark (1974) which explored the effects of exposure to alcohol related cues (ARCs) in alcoholics, went further by concluding: "Obviously any therapeutic approach, whether it be insight, behaviorally or pharmacologically orientated, that does not recognize the powerful, evocative effects of interoceptive and exteroceptive stimuli., and that neglects to provide techniques for modifying the strength of these effects will likely be destined for failure" (p, 547)" (Drummond, Cooper, & Glautier, 1990) According to Drummond, Cooper & Glautier (1990) While there have been those who have questioned CRs important in treatment and specifically in the relapse of individuals in treatment, "The technique of cue exposure, originally described in relation to the treatment of cat phobia (Freeman & Kendrick, 1960), has gained considerable popularity in the treatment of both phobic and obsessive-compulsive neurosis (Marks, Hodgson & Rachman, 1975), Drummond, Cooper & Glautier (1990) do state however, that "In comparison to the neuroses, however, we argue that no study has so far demonstrated that cue exposure has any influence on the clinical outcome in either alcohol or drug dependence." (Ibid) More recently cue exposure has been applied to the treatment of alcohol and drug dependence (Blakey & Baker, 1980; Rankin, Hodgson & Stockwell, 1983; Laberg & Euertsen, 1987; McLellan et al., 1986) and owes much to this and Wikler's early pioneering work." (1990) According to Wikler's model "the connection between a conditioned withdrawal response and relapse is that the drug is motivated by the relief or avoidance of withdrawal symptoms which are aversive in nature. In effect aversive CRs to ARCs act as discriminative stimuli (SDs) for operant drinking behavior." (Drummond, Cooper, & Glautier, 1990) Related as well is the Siegel (1988) proposed "an alternative explanation of the observed phenomenon of CRs to drug cues..." In which he states the argument that "environmental stimuli which precede drug administration, rather than follow drug withdrawal, come to elicit drug compensatory (or antagonistic) CRs which oppose the unconditional effects of the drug and thus account for the development of tolerance." (Ibid) According to this work what distinguishes the models of Siegel and Wikler "lies in the temporal relationship between the cues and the unconditioned effects of the drug." (Ibid) the authors state however that in actuality it is quite difficult to distinguish the difference "in that drug cues are often present both during withdrawal and for some time after the onset of drug agonist effects when an individual take s a drug whilst experiencing withdrawal." (Ibid)

Literature Review

The most commonly used "illicit drug in the United States (Anthony et al., 1994) is Marijuana according to the work of McRae, Budney & Brady (2002). Further reported is a "trend toward greater use, especially among adolescents (Monitoring the Future, 1999) Estimates have been given stating that: "10% of individuals who ever use marijuana become daily users (Johnson, O'Malley, & Bachman, 1995)." (McRae, Budney & Brady, 2002) it is stated that: "Anthony et al. (1994) report that marijuana has substantial rates of conditional dependence (9%)" as compared to others as follows: alcohol (15%) cocaine (17%), heroin (23%) tobacco (32%)

Budney, et al. (2006) in the work entitled: "Clinical Trial of Abstinence-Based Vouchers and Cognitive-Behavioral Therapy for Cannabis Dependence" state that the demand increased "twofold during the 1990s" for treatment related to marijuana (cannabis) problems in the United States. (Substance Abuse and Mental Health Services Administration, 2001) This work states that."..only five randomized, clinical trails examining the efficacy of treatment for adult cannabis dependence have been reported, these studies suggest that treatment efficacy appears comparable to that observed with other substances of abuse (Marijuana Treatment Project Research Group, 2004; McRae, Budney & Brady, 2003)." (Budney, et al., 2006) it is interesting to note that: "Cognitive-behavioral treatments such as relapse prevention, behavioral coping skills therapy, and motivational enhancement therapy appear efficacious." (Budney et al., 2006) the problem is that in relation to "abstinence and relapse rates observed across these studies suggest that the majority of participants do not have positive outcomes [in other words this is shown to be complete ineffective] indicating that continued development and testing of more potent and cost-effective treatments remain a priority" (Budney, et al., 2006) One study reported by Budney, et al. which added an "abstinence-based voucher incentive program to a standard cognitive-behavioral therapy significantly improved marijuana abstinence rates during a 14-week treatment episode (Budney, Higgins, Radanovich, & Novy, 2000). Documented analysis of urine testing marijuana clear resulted in the participants receiving vouchers which they could exchange for retail items. Budney, et al. states that: "These findings were concordant with a growing literature showing that incentive-based intervention developed from principles of positive reinforcement can enhance outcomes when combined with other effective psychological and pharmacological interventions for substance dependence (Higgins, Heil, & Lusier, 2004)." (Ibid) However, there is still the only one report "on the efficacy of abstinence-based vouchers for cannabis dependence, and that study was limited by use of a relatively small sample size and did not include posstreatment follow-up assessments." (Ibid) Budney et al. (2006) also relates that in three recent studies relating to treatment of cocaine dependent the examination of whether "combining abstinence-based vouchers with other behavioral therapies improves outcomes." The report states that the "Community Reinforcement Approach therapy, an intensive, outreach-oriented behavioral therapy, plus vouchers enhanced psychosocial and substance use outcomes compared with vouchers alone in a 24-week intervention for primary cocaine dependence (Higgins et al. 2003)" (Budney et al. 2006) However two studies that were with participants relating to methadone maintenance in connection to opiate dependence with the combination of cognitive/behavioral therapy did not improve outcomes with vouchers only. (Epstein, Hawkins, Covi, Umbicht, & Preston, 2003; Rawson et al., 2002)

According to the work of Petry et al. (2000) entitled "Contingency Management Interventions: From Research to Practice": "Behavioral Interventions have enjoyed widespread use in the treatment of variety of psychiatric conditions, including autism (1) conduct disorder (2) developmental disorders (3) eating disorders and (4) even schizophrenia. These techniques are based upon rearranging the environment to reinforce appropriate behavioral patterns while providing negative reinforcement for inappropriate behaviors. Similar procedures have been applied to substance-abusing populations, and these interventions have been termed contingency management." (2001) additionally stated is that: "In treatment of substance use disorders, contingency management techniques have demonstrated efficacy in retaining substance-abusing clients in treatment, promoting drug abstinence, and encouraging appropriate behaviors. These treatments are based on three general behavioral principles: (1) frequent monitoring of the target behavior; (2) Provision of tangible, positive reinforces when the target behavior occurs; and (3) removal of the reinforcer when the target behavior does not occur." (Petry, et…[continue]

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