background rationale & hypotheses findings conclusions
DESCRIPTION
CTN MIEDAR Studies Baseline Comparison: Methadone vs Psychosocial Participants Maxine Stitzer, Ph.D. AAAP December, 2003. Background Rationale & hypotheses Findings Conclusions. Drugs are Positive Reinforcers. They Make People Feel Good. - PowerPoint PPT PresentationTRANSCRIPT
CTN MIEDAR Studies Baseline Comparison:
Methadone vs Psychosocial Participants
Maxine Stitzer, Ph.D.AAAP December, 2003
• Background • Rationale & hypotheses • Findings• Conclusions
Drugs are Drugs are Positive Positive Reinforcers Reinforcers
They Make People They Make People Feel Good.Feel Good.
The Problem: Allure of Immediate Drug Reinforcement
Drug Abusers Straddle the FenceDrug Abusers Straddle the Fence
Continued Drug Use
DrugAbstinence
Methods are needed to:Methods are needed to:
- - counteract ambivalencecounteract ambivalence- increase motivation for change- increase motivation for change
Motivational IncentivesMotivational Incentives
Offer tangible incentivesOffer tangible incentivesfor drug abstinencefor drug abstinence
Make abstinence a more Make abstinence a more attractive option through attractive option through positive reinforcement of positive reinforcement of behavior changebehavior change
Incentive Therapies Promote AbstinenceCocaine (Higgins et al., 1994; Silverman et al., 1996; Petry & Martin, 2002) Alcohol (Petry et al., 2000)Opioids
(Bickel et al., 1997; Silverman et al., 1996)Marijuana
(Budney et al., 1991, Budney et al., 2000)Nicotine (Tobacco smoking)
(Stitzer & Bigelow, 1984; Roll et al., 1996)
Problem: Cost
• Society can’t afford this• Our program can’t afford this
Intermittent Reward Reduces CostNancy Petry’s “Fishbowl”
• Drug-free patient draws from the “fishbowl”• Only 50% of draws are “winners”• Three types of prizes:
- small (toiletries; food)- large (cordless phone; CD player)- jumbo (TV; video)
CTN MIEDAR Protocol: CTN MIEDAR Protocol: How Does It Work?How Does It Work?
Eligible PatientsEligible Patients
Stimulant AbusersStimulant Abuserseither cocaine or methamphetamineeither cocaine or methamphetamine
Random Assignment
• Usual care
• Enhanced care with incentives
Sample CollectionSample CollectionTwice WeeklyTwice Weekly
Abstinence BowlAbstinence Bowl
Good Job
Good Job
Good Job
Small Small
Small
Large
Large
Jumbo
Good Job
Good Job
Good Job
Good Job
Good Job
Small
Good Job
Small
Examples ofExamples ofIncentive PrizesIncentive Prizes
SMALLSMALL ($1-$5 items)($1-$5 items)
LARGELARGE($20 items)($20 items)
JUMBOJUMBO($80-$100 items)($80-$100 items)
Draws Escalate with Draws Escalate with Stimulant-Free Test ResultsStimulant-Free Test Results
Weeks Drug Free
# Draws
12
45
3
Bonus Draws for Marijuana Bonus Draws for Marijuana and/or Opiate Abstinenceand/or Opiate Abstinence
Weeks Drug Free
# Draws2 2 2 2 2
Total Earnings
• $400 in prizes could be earned on average – If participant tested negative for all targeted
drugs over 12 consecutive weeks
Two MIEDAR Study Samples
• Psychosocial (8 clinics; N = 415)– New admissions– Self-reported stimulant use within past 2 weeks
(74%) or within 2 weeks of entering a controlled environment (23%)
• Methadone (6 clinics; N = 388)– In treatment 1-36 months– Stimulant positive urine within past 2 weeks
Baseline Comparison: Why Do IT?
• Unique opportunity to characterize stimulant abusers entering different modalities
• Results may suggest differential service needs
Baseline Comparison: Methods
• Data derived from selected questions in study intake interview
• Areas of interest:– Demographics– Psychosocial characteristics (employment,
education, etc)– Health problems(medical & psychiatric)– Drug use (stimulants, opiates, alcohol, cannabis)
Hypotheses
• Some patient characteristics may differ due to differential referral patterns (e.g. criminal justice)
• Methadone patients will generally have more severe psychosocial and drug use problems due to their history of concurrent opiate and stimulant abuse
Basic Demographics
<.013642Age (mean years)
<.013626Race (% Caucasian)
<.014556Gender (% male)
P valuePSOC(N = 415)
METH (N = 388)
Subsequent analyses adjusted for gender, race & age
Psychosocial Characteristics
METH PSOC P value
Education (mean years)Marital Status (% married)
1214
1224
0.42<.01
Employed- past 3 years (%)Employed- past 30 days (%)
5032
6835
<.010.74
Legal Status
0.3
0.1
OR†
3516Parole/Probation (%)
336CJ referral (%)
PSOCMETH
† OR is methadone vs drug-free
Health ProblemsMETH PSOC OR
Chronic med probs (%) 59 38 1.8Lifetime hospital (%) 80 67 1.8
Psychiatric hospital (%) 29 29Psychiatric outpatient (%) 37 35
Lifetime psych meds(%) 42 40
Drug Use: Stimulants
METH PSOC
Dependence/Abuse (% with diagnosis) 82 84 ___
First Study Urine 76 26 7.8 (% positive)
OR
Drug Use: Opiates
Dependence/Abuse (% with diagnosis) 80 9 48
METH PSOC OR
First Study Urine (% positive) 47 3 30
Drug Use: Alcohol
METH PSOC OR
Dependence/Abuse (% with diagnosis) 17 42 0.3
First Study BAL (% positive) 1 1 __
Drug Use: Cannabis
METH PSOC OR
Dependence/Abuse (% with diagnosis) 8 21 0.5
First Study Urine (% positive) 12 11 __
Drug Use: Other
SEDATIVES
METH PSOC
25 6
ASI past 30 days; % with any use
NICOTINE
METH PSOC
91 79
Data Summary
• Stimulant abusers entering methadone are:– Older– Less likely to have work history – More likely to have medical problems
– More likely to be using opiates, stimulants & sedatives
– Less likely to be alcohol or cannabis dependent
Data Summary
• Both groups have:– Substantial unemployment– Substantial psychiatric co-morbidity– High rates of medical problems– High rates of nicotine use– Modest rates of cannabis use
Limitations
• Data apply only to stimulant abusers • Clinics may or may not be representative• Methadone have been in treatment longer• Methadone are pre-selected for opiate abuse
Conclusions: Service Needs
• Common service needs suggested:– Employment; co-occurring medical & psychiatric– Shift in emphasis from cannabis to nicotine
• Differential service needs suggested:– Effective interventions for on-going polydrug
(opiate, stimulant and sedative) use in methadone– Relapse prevention in outpatient psychosocial
Conclusions: CTN Potential
• CTN is a great place to collect data on large samples of community treatment patients
• Access to special patient subgroups of interest to service providers