Based on the
2003-2004 National Survey on Drug Use and Health, 1.5 million
youth aged 12-17 years (6.1% of youth in that age range) needed
treatment for alcohol abuse, and alcohol is the primary drug
reported by 19% of the adolescent treatment population. Recent
intervention research on adolescent alcohol abuse has focused
primarily on school-based, community, or ER populations.
Although new outpatient family-based and contingency-management
(CM) interventions for adolescent marijuana abuse have been
developed, not one of them specifically targets adolescent
primary alcohol users. We could find no published outpatient
randomized trial specifically targeting alcohol abuse in
adolescents. Thus, little is known about how to most effectively
intervene with primary adolescent alcohol abuse and dependence
in an outpatient setting. Our goal is to adapt our family-based
CM treatment to target primary adolescent alcohol abuse and
dependence. Specific Aim 1 is to provide a preliminary
demonstration of the efficacy of a family based CM intervention
to treat adolescent alcohol abuse and dependence. CM components
include 1) an incentive program to enhance the adolescent's
engagement in the treatment process and engender alcohol
abstinence by providing positive reinforcement for documented
abstinence via breathalyzers administered by parents regularly
at home, self and parent report, and clinic-based urine drug
testing; and 2) a parent management training program to enhance
and maintain the positive effects of the incentive program by
teaching parents how to effectively use contingency management
in the home environment to motivate their adolescent to achieve
abstinence and improve their behavior in other domains.
A randomized trial will determine whether the
CM intervention enhances outcomes when added to a standard
individual cognitive behavioral therapy. Specific Aim 2 is to
determine whether and how treatment interventions modify
parental and adolescent risk and protective factors using
observational and laboratory measures (parenting practices,
family functioning, risk taking, delay discounting, and child
and parent psychopathology) and to determine whether these
factors are associated with outcomes over time. Findings will
extend the scientific evidence for CM and support the ability of
parents to implement CM at home. Findings that support the CM
model's efficacy will make a significant contribution to
research on the treatment of adolescent alcohol abuse, which has
lagged behind research on adult substance abuse and on
adolescent illicit drug use. Future projects will include
isolation of active treatment components, dissemination to
community clinics, and cost-effectiveness studies.
More US
residents are dependent on marijuana than on any other illicit
drug, and the number enrolled in treatment for marijuana
continues to increase such that it is now comparable to that for
cocaine and heroin. This application seeks to advance our
overarching goal to develop and disseminate cost-effective
treatments for marijuana dependence that can address this
growing problem. Our previous research suggests that an
intervention comprising motivational enhancement,
cognitive-behavioral, and contingency-management components
(MET/CBT/CM) produces greater rates of successful and durable
outcomes than has been demonstrated previously. However, three
issues relevant to its efficacy and eventual dissemination must
be confronted. First, the outcomes achieved can only be
characterized as modest; many individuals do not respond to the
treatment and relapse rates remain problematic. Second, access
is limited by the availability of trained providers. Third, the
cost of delivering the treatment is higher than more traditional
outpatient interventions. To address these issues, Specific Aim
1 is to develop and test a computer-assisted version of
MET/CBT/CM. Computerized treatments have the potential to
increase overall effectiveness of treatment services by
increasing availability of and access to potent treatments, and
by applying innovative technology to enhance outcomes. During
Year 1, the intervention will be developed and pilot tested. An
interactive program that showed promise in our previous trial
for opioid dependence will be modified and enhanced to deliver
individualized MET/CBT/CM using effective computer learning
technologies. These technologies and access to the MET/CBT/CM
program made available via the Internet between treatment
sessions and after treatment ends have the potential to promote
better learning and more use of coping skills, which in turn can
improve outcomes. During Years 2-4 a randomized trial will
provide an initial efficacy test of cMET/CBT/CM by comparing it
with a brief treatment (MET) and with therapist-delivered
MET/CBT/CM. Specific Aim 2 is to learn more about how behavioral
treatments like MET/CBT/CM work by focusing on two putative
mechanisms of action examined in prior trials:
self-efficacy/coping skills and impulsivity/delay discounting.
The experimental design will provide a unique opportunity to
explore such mechanisms in a novel context where the therapist
is vs. is not a prominent part of the treatment. The proposed
project will address the objectives of NIDA's Behavioral and
Integrative Treatment Development Program by providing research
on technology-assisted treatment that attempts to make treatment
delivery less complex, easier to access, and less costly - while
retaining or improving its effectiveness. Findings will inform
future studies designed to refine the technology and how it is
applied; conduct more definitive effectiveness testing; test
generality to other populations including adolescents; and to
further advance translation to community settings.
In this research, we will continue our study of
computerized treatment. In a prior trial, computer-delivered
Community Reinforcement Approach (CRA) with contingency
management (CM) was as effective as therapist-delivered CRA with
CM. The design of that study, however, did not indicate whether
the computer-delivered CRA produced increases in therapeutic
outcomes over that produced by the CM procedures alone. Thus, we
will propose to isolate the contribution of the computerized
treatment to therapeutic outcomes. The aim of this project is to
address this serious public health concern by being one of only
three outpatient clinics providing pharmacotherapies for opioid
dependence in the State of Arkansas.
Understanding
drug dependence requires an understanding of the factors that
render drug taking preeminent among otherwise powerful
reinforcers (e.g., work, family, & health). Discussed in this
manner, drug dependence is a matter of understanding reinforcer
interactions. Behavioral economics provides a new conceptual
system to understand reinforcer interactions and choice. In this
MERIT Award continuation, we propose to use this behavioral
economic approach to drug choice to address three purposes. We
will stringently test a new behavioral economic theory of
relative reinforcing efficacy that we developed in the prior
grant period. We have proposed an empirically derived theory of
reinforcing efficacy that can account for data where the typical
measures of reinforcing efficacy are concordant and where they
are not. In this regard, our theory appears to be a more general
account. However, a more stringent test would be to discern
within subject whether the behavioral economic theory could
account for concordant and discordant data.
Relapse poses significant challenges to the
treatment of a broad array of behavioral disorders, especially
for addictions such as cigarette smoking. Although substantial
progress has been made in understanding how certain phenomena,
including self-efficacy, reinforcement, and craving, may
contribute to relapse, the behavioral phenomena that contribute
to or underlie relapse are generally not well understood.
However, given the paucity of our knowledge, the identification
of additional behavioral phenomena that predict or underlie
relapse is an important research agenda. Identifying such
behavioral phenomena may suggest new targets for molecular study
and perhaps lead to new therapeutic approaches.
Stimulant addicts have been shown to
exhibit executive dysfunction. Overall, this proposal will test
treatments to improve executive function among stimulant
addicts. This may enhance the efficacy of CBT treatment.
Moreover, this proposal will contribute to personalized medicine
approaches in the addictions, where the treatment delivered is
defined by the documented executive dysfunction in individual
addicts. Importantly, our work targets cocaine- and amphetamine-
(including methamphetamine) addicted individuals. These
addictions, particularly methamphetamine, represent a
significant public health crisis that this study could
positively impact.
Our research
on the marijuana withdrawal syndrome has primarily involved
human laboratory studies documenting the reliability, validity,
time course, and pharmacological specificity of the syndrome.
Most recently, this project has engaged in direct comparisons of
marijuana and tobacco withdrawal, as well as withdrawal that
follows simultaneous cessation of tobacco and marijuana among
those who use both substances regularly. Data from these studies
indicate great similarity between these two withdrawal syndromes
and an interesting, non-additive effect of withdrawal from both
substances simultaneously. This project has also used survey
methodology to document characteristics and rates of withdrawal
symptoms among clinical samples of adults and adolescents
seeking treatment for marijuana abuse or dependence. An
additional telephone survey study has been comparing tobacco and
marijuana withdrawal among adults who have made recent cessation
attempts. Planned studies in this area will involve more
clinically relevant experiments that involve adults and
adolescents seeking treatment for marijuana dependence.
Future projects will also follow-up on the multiple substance
withdrawal phenomenon and the development of behavioral or
pharmacological interventions that target marijuana withdrawal.
Marijuana
remains the most prevalent illicit substance used by adolescents
and the number of adolescents receiving treatment for marijuana
abuse more than tripled during the last decade. A small number
of clinical trials suggest that family-based and individual
interventions have efficacy for treating adolescent substance
abuse. However, even with these interventions most adolescents
fail to reduce their substance use substantially, thus, there
remains much room for improvement of treatment services. The
overarching goal of this project is to develop and test novel
behavioral treatments to enhance treatment outcome in this
important treatment population, and in so doing, learn more
about mechanisms of change that have broader implications for
addiction science. In our initial Stage IB project "Behavioral
Treatment for Adolescent Marijuana Abuse", we created,
manualized, and pilot tested a unique contingency-management
(CM) intervention that combined abstinence-based voucher
incentives with contingency management training for parents. A
small randomized, clinical trial provided encouraging results.
When added to a commonly used cognitive-behavior therapy, CM
improved rates of sustained abstinence during treatment.
Adolescents receiving this intervention were less likely to
relapse over the 9-month follow-up period, however this finding
was not as robust as the observed during treatment effects, most
likely due to the small sample size and associated low power to
detect effects. Despite strong indicators of the efficacy of
this CM intervention, there remained room for improvement in
increasing rates of treatment response and reducing rates of
relapse. Hypothesized mediators and moderators of change
indicated that changes in parenting had direct effects on
post-treatment marijuana abstinence outcomes, and that
abstinence early in treatment was a robust predictor of the CM
treatment effect. This proposal will systematically replicate
and extend these findings. A Stage II trial will compare three
treatment conditions: (1) cognitive behavior therapy (CBT only);
(2) CBT plus CM; and (3) CBT plus an enhanced CM model targeting
increased early abstinence rates, parenting skills, and
maintenance of effects. Replicating the initial demonstration of
the positive effects of CM will extend the scientific evidence
for use of CM to increase treatment efficacy for
substance-abusing adolescents. Testing an enhanced CM model will
determine if modifications that are consistent with the
underlying behavioral principles and empiricism supporting CM
interventions can result in improved outcomes. Last, assessment
of potential mechanisms of action, particularly parenting,
adolescent psychopathology and impulsivity, will provide
scientific information directly relevant to future development
of more effective intervention and prevention models of
adolescent substance abuse, and will inform us about fundamental
mechanisms operating in drug-dependence.
This is a
research study that examines the behavioral effects of common
medications, including sedatives and stimulants, in healthy
participants. Volunteers between the ages of 18 and 70 years
will participate for about 6-10 weeks, attending study sessions
up to five days (Monday through Friday) per week for about 4-1/2
hours per day. This study is conducted at the General Clinical
Research Center (GCRC) on the 6th floor of the Central Arkansas
Veterans Healthcare System (CAVHS). Subjects are paid for their
participation.
These series
of studies investigate the effects of common medications in
methadone-maintained individuals, examining their ability to
distinguish between two drugs as well as to compare the effects
of other drugs to these two drugs. This study is conducted at
the General Clinical Research Center (GCRC) on the 6th floor of
the Central Arkansas Veterans Healthcare System (CAVHS).
Volunteers will be recruited for this study from the UAMS
Substance Abuse Treatment Clinic and will participate on an
outpatient basis. Subjects are maintained on their stable dose
of methadone through the methadone clinic and will ingest their
medication prior to attending study sessions. Subjects are paid
for their participation.
This 14-wk,
placebo-controlled, double-blind, randomized clinical trial
examines the clinical efficacy of disulfiram in reducing cocaine
use in opioid-dependent cocaine abusers maintained on methadone
and receiving Cognitive Behavioral Therapy. Dually opioid- and
cocaine-dependent volunteers participate on an outpatient basis
and are stabilized on methadone and assigned to receive a dose
of disulfiram or placebo. Participants attend clinic six days
per week to receive medication and complete research tasks. At
the end of the trial, participants no longer receive disulfiram
(or placebo) and are either transferred to a local methadone
program, if eligible, or tapered off methadone over a 4- to
6-week period. Individuals participate at no cost to them.
This 12-wk,
randomized, placebo-controlled, double-blind clinical trial
examines the clinical efficacy of the antidepressant sertraline
alone or augmented with gabapentin, prescribed for nerve pain as
well as seizures in preventing relapse in depressed, recently
abstinent cocaine dependent individuals. Participants first
reside for 2 weeks at the Recovery Centers of Arkansas to
establish abstinence and be stabilized on the medications. Then
they transfer to an outpatient treatment research program for 10
weeks, during which they attend clinic at least 3 days per week
in order to receive medications, receive individual
psychotherapy and complete research tasks. At the end of 12
weeks, participants are tapered off their medications and
referred to an area program for further treatment. Individuals
participate at not cost to them. In addition, during the
outpatient portion of the study, individuals can earn up to $250
for attending scheduled appointments and returning medication
blister packs.
The primary
purpose of this research is to examine the discounting of
negative outcomes by cigarette smokers experiencing nicotine
withdrawal. Given that some theories posit negative outcomes of
withdrawal as a significant factor in the maintenance of
cigarette smoking, the discounting of negative outcomes during
withdrawal would appear to be important. Cigarette smokers
participate in temporal and probability discounting procedures
during both nicotine satiation (regular smoking) and acute
nicotine withdrawal (24-hour abstinence).
The primary purpose of the current study is
to gather preliminary data examining temporal discounting, and
impulsiveness in patients with Parkinson’s Disease who are
treated with dopamine agonists, in an effort to illuminate the
relationship between dopaminergic medications for Parkinson’s
Disease and associated impulsive behaviors.
This current study compares various types of discounting
procedures in Methamphetamine users and non-users, in order to
gain a greater insight into the initiation, maintenance, and
consequences of MA use and abuse which may lead to greater
knowledge of the variables that co-vary with drug dependence
status (the forms of discounting for the current proposal).
The primary
purpose of this research is to determine if discounting due to
interpersonal discounting results in the same profile of results
for discounting due to temporal distance. Participants are asked
to rate the subjective closeness (interpersonal distance) of
various persons in their lives. Participants then take part in
an interpersonal discounting procedure modeled on temporal
discounting studies; subjective closeness is equated to the
temporal distance dimension. Participants must choose between a
hypothetical outcome for the self and a hypothetical outcome for
the other. Interpersonal discounting that is hyperbolic in
shape, with Magnitude and Sign Effects, would replicate findings
from temporal discounting research, indicating a possible
commonality between the two. The
current pilot study’s primary purpose is to examine the
possibility that working memory can be improved in stimulant
users receiving treatment with a computerized training program,
Executive Functioning Therapy.
UAMS - Center for Addiction Research
4301 West Markham, #843 • Little Rock, Arkansas 72205
Telephone: (501) 526-7802 • Fax: (501) 526-7816
