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Nancy M. Petry - One of the best experts on this subject based on the ideXlab platform.
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the national implementation of Contingency Management cm in the department of veterans affairs attendance at cm sessions and substance use outcomes
Drug and Alcohol Dependence, 2018Co-Authors: Nancy M. Petry, Dominick Dephilippis, Marcel O Bonnmiller, Sarah B Rosenbach, James R MckayAbstract:Abstract Background In 2011, the Department of Veterans Affairs launched an initiative to expand patients’ access to Contingency Management (CM) for the treatment of substance use disorders, particularly stimulant use disorder. This study evaluates the uptake and effectiveness of the VA initiative by presenting data on participation in coaching, fidelity to key components of the CM protocol, and clinical outcomes (CM attendance and substance use). Methods Fifty-five months after the first VA stations began offering CM to patients in June 2011, 94 stations had made CM available to 2060 patients. As those 94 VA stations began delivering CM to Veterans, their staff participated in coaching calls to maintain fidelity to CM procedures. As a part of the CM coaching process, those 94 implementation sites provided data describing the setting and structure of their CM programs as well as their fidelity practices. Additional data on patients’ CM attendance and urine test results also were collected from the 94 implementation sites. Results The mean number of coaching calls the 94 programs participated in was 6.5. The majority of sites implemented CM according to recommended standard guidelines and reported high fidelity with most CM practices. On average, patients attended more than half their scheduled CM sessions, and the average percent of samples that tested negative for the target substance was 91.1%. Conclusion The VA’s CM implementation initiative has resulted in widespread uptake of CM and produced attendance and substance use outcomes comparable to those found in controlled clinical trials.
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Contingency Management treatment for substance use disorders how far has it come and where does it need to go
Psychology of Addictive Behaviors, 2017Co-Authors: Nancy M. Petry, Sheila M Alessi, Todd A Olmstead, Carla J Rash, Kristyn ZajacAbstract:Contingency Management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is rarely implemented in practice settings. This article briefly outlines the evidence base of CM and then describes 4 of the most often-cited concerns about it: philosophical, motivational, durability, and economic. Data supporting and refuting each of these issues are reviewed. The article concludes with suggestions to address these matters and other important areas for CM research and implementation, with the aims of improving uptake of this efficacious intervention in practice settings and outcomes of patients with substance use disorders. (PsycINFO Database Record
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patients undergoing substance abuse treatment and receiving financial assistance for a physical disability respond well to Contingency Management treatment
Journal of Substance Abuse Treatment, 2015Co-Authors: Ashley E Burch, Benjamin J Morasco, Nancy M. PetryAbstract:Physical illness and disability are common in individuals with substance use disorders, but little is known about the impact of physical disability status on substance use treatment outcomes. This study examined the main and interactive effects of physical disability payment status on substance use treatment. Participants (N = 1,013) were enrolled in one of six prior randomized clinical trials comparing Contingency Management (CM) to standard care; 79 (7.8%) participants reported receiving disability payments, CM improved all three primary substance use outcomes: treatment retention, percent negative samples and longest duration of abstinence. There was no significant main effect of physical disability payment status on treatment outcomes; however, a significant treatment condition by physical disability status interaction effect emerged in terms of retention in treatment and duration of abstinence achieved. Patients who were receiving physical disability payments responded particularly well to CM, and their time in treatment and durations of drug and alcohol abstinence increased even more markedly with CM than did that of their counterparts who were not receiving physical disability assistance. These findings suggest an objectively defined cohort of patients receiving substance use treatment who respond particularly well to CM.
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standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine dependent methadone patients
Journal of Consulting and Clinical Psychology, 2015Co-Authors: Nancy M. Petry, Sheila M Alessi, Danielle Barry, Kathleen M CarrollAbstract:Objective Contingency Management (CM) reduces cocaine use in methadone patients, but only about 50% of patients respond to CM interventions. This study evaluated whether increasing magnitudes of reinforcement will improve outcomes.
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a randomized trial of Contingency Management delivered in the context of group counseling
Journal of Consulting and Clinical Psychology, 2011Co-Authors: Nancy M. Petry, Jeremiah Weinstock, Sheila M AlessiAbstract:Contingency Management interventions provide tangible reinforcers for objective evidence of behavior change. Typically, researchers provide vouchers exchangeable for retail goods or services (Higgins et al., 1994) or the chance to win prizes of varying magnitudes (Petry, Martin, Cooney, & Kranzler, 2000) when patients submit urine samples that indicate drug abstinence. A recent meta-analysis (Dutra et al., 2008) of psychosocial treatments for substance use disorders found that CM is the intervention with the greatest effect size. Meta-analyses of CM studies (Lussier, Heil, Mongeon, Badger, & Higgins, 2006; Prendergast, Podus, Finney, Greenwell, & Roll, 2006) likewise reveal efficacy of CM in treating substance use disorders. However, the vast majority of studies evaluated CM when delivered entirely on an individual basis, yet most treatment is provided in a group context. An empirically established method for delivering CM in group settings would enhance the dissemination of CM. Given providers’ concerns about the practicality of individually administered CM (Kellogg et al., 2005; Kirby, Benishek, Dugosh, & Kerwin, 2006), a handful of studies have begun examining CM when delivered in a group context (Alessi, Hanson, Tardif, & Petry, 2007; Kirby, Kerwin, Carpendo, Rosenwasser, & Gardner, 2008; Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008; Petry, Martin, & Finocche, 2001; Sigmon & Stitzer, 2005). With the exception of the Alessi et al. (2007) and Kirby et al. (2008) studies, the researchers chose attendance alone, rather than drug abstinence, as the behavioral target of their intervention, primarily because of concerns about confidentiality related to urine testing; these studies did not monitor substance use, so effects of the group-based CM interventions on substance use outcomes could not be determined. Although these studies found benefits of CM on attendance, more research on group-based CM approaches is needed to evaluate its effects on substance use. If efficacious, a CM intervention delivered in a group context could have benefits for patients, providers, and society at large. Patients may remain in treatment longer and reduce drug use (Higgins et al., 1994; Higgins, Wong, Badger, Ogden, & Dantona, 2000; Petry, Alessi, Marx, Austin, & Tardif, 2005; Petry, Peirce et al., 2005). Providers could benefit because CM can increase attendance at treatment (Higgins et al., 1994; Higgins, Wong et al., 2000; Ledgerwood et al., 2008; Petry, Alessi et al., 2005; Petry et al., 2001; Petry, Peirce et al., 2005) so that groups should be fuller, and unexcused absences and attrition reduced. Job satisfaction may increase when therapists provide CM (Kellogg et al., 2005), which in turn may reduce therapist turnover rates. Potentially, CM could also enhance the therapeutic alliance and improve group cohesion, resulting in more satisfying groups for both patients and providers. Greater attendance can increase provider reimbursement rates in non-capitated reimbursement systems (Lott & Jencius, 2009). Society may also benefit from the introduction of CM clinically. Reductions in drug use that occur with CM may reduce drug-related criminal activity and medical consequences associated with substance abuse. In particular, recent analyses (DeFulio, Donlin, Wong, & Silverman, 2009; Ghitza, Epstein, & Preston, 2008; Hanson, Alessi, & Petry, 2008) find that CM reduces HIV risk behaviors in methadone-maintained patients, and it is associated with a reduction in viral loads when administered to HIV-positive substance abusers (Petry, Weinstock, Alessi, Lewis, & Dieckhaus, 2010). CM can be very beneficial, but a practical group-based CM approach for use in community settings must be applicable to all patients attending a group, as groups in community settings are usually heterogeneous with respect to substance use problems. To date, however, most CM studies have limited enrollment to individuals with a particular substance use disorder, and most reinforcement has been contingent on abstinence from just the primary substance of abuse (Higgins et al., 1994; Lussier et al., 2006). Meta-analyses reveal that effect sizes for CM are higher when abstinence from a single substance is reinforced versus when abstinence from multiple substances is reinforced (Griffith, Rowan-Szal, Roark, & Simpson, 2000; Lussier et al., 2006), but the vast majority of patients entering treatment programs have polysubstance use problems (Substance Abuse and Mental Health Services Administration Office of Applied Studies, 2009). The purpose of the present study was to evaluate the efficacy of CM when delivered in a group format and applicable to patients with a range of substance use disorders. The reinforcement procedure was a novel adaptation from previous group-based CM interventions (Alessi et al., 2007; Ledgerwood et al., 2008; Petry et al., 2001). Each day CM patients attended group counseling sessions, they earned at least one chance to have their name drawn from a hat, and chances increased with sustained attendance and abstinence from four substances (cocaine, methamphetamine, opioids and alcohol) as assessed by twice-weekly testing. Whenever their names were drawn from the hat, patients won a prize ranging from $1 to $100 in value. We evaluated the efficacy of this CM treatment delivered in a group format compared to standard care. Patients with a variety of substance use disorders were included to enhance generalization to those typically treated in outpatient treatment programs, and the study was conducted at two community clinics that had never participated in CM projects. We also assessed effects of CM on the therapeutic process and HIV risk behaviors. We expected patients assigned to the CM condition would evidence greater attendance, more abstinence, stronger group cohesion and therapeutic alliances, and reduced HIV risk behaviors than patients assigned to standard care.
John M Roll - One of the best experts on this subject based on the ideXlab platform.
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a review of Contingency Management for the treatment of substance use disorders adaptation for underserved populations use of experimental technologies and personalized optimization strategies
Substance Abuse and Rehabilitation, 2018Co-Authors: Sterling Mcpherson, Michael G Mcdonell, Katherine Hirchak, Oladunni Oluwoye, Ekaterina Burduli, Crystal Lederhos Smith, Jalene Herron, Michael F Orr, John M RollAbstract:This review of Contingency Management (CM; the behavior-modification method of providing reinforcement in exchange for objective evidence of a desired behavior) for the treatment of substance-use disorders (SUDs) begins by describing the origins of CM and how it has come to be most commonly used during the treatment of SUDs. Our core objective is to review, describe, and discuss three ongoing critical advancements in CM. We review key emerging areas wherein CM will likely have an impact. In total, we qualitatively reviewed 31 studies in a systematic fashion after searching PubMed and Google Scholar. We then describe and highlight CM investigations across three broad themes: adapting CM for underserved populations, CM with experimental technologies, and optimizing CM for personalized interventions. Technological innovations that allow for mobile delivery of reinforcers in exchange for objective evidence of a desired behavior will likely expand the possible applications of CM throughout the SUD-treatment domain and into therapeutically related areas (eg, serious mental illness). When this mobile technology is coupled with new, easy-to-utilize biomarkers, the adaptation for individual goal setting and delivery of CM-based SUD treatment in hard-to-reach places (eg, rural locations) can have a sustained impact on communities most affected by these disorders. In conclusion, there is still much to be done, not only technologically but also in convincing policy makers to adopt this well-established, cost-effective, and evidence-based method of behavior modification.
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pretreatment ethyl glucuronide levels predict response to a Contingency Management intervention for alcohol use disorders among adults with serious mental illness
American Journal on Addictions, 2017Co-Authors: Michael G Mcdonell, Sterling Mcpherson, Emily Leickly, Jordan Skalisky, Debra Srebnik, Katherine Hirchak, Oladunni Oluwoye, John M RollAbstract:Background and Objectives This study investigated if pretreatment ethyl glucuronide (EtG) levels corresponding to light (100 ng/mL), heavy (500 ng/mL), and very heavy (1,000 ng/mL) drinking predicted longest duration of alcohol abstinence (LDA) and proportion of EtG-negative urine tests in outpatients receiving a 12-week EtG-based Contingency Management (CM) intervention for alcohol dependence. Methods Participants were 40 adults diagnosed with alcohol use disorders and serious mental illness who submitted up to 12 urine samples for EtG analysis during a 4-week observation period and were then randomized to 12-weeks of CM for alcohol abstinence and addiction treatment attendance. Alcohol use outcomes during CM as assessed by EtG and self-report were compared across those who did and did not attain a pre-treatment average EtG level of 500 ng/mL—a level that equates to frequent heavy drinking. Results Only the 500 ng/mL cutoff was associated with significant differences in LDA and proportion of EtG-negative samples during CM. Those with a pre-treatment EtG < 500 ng/mL attained a LDA 2.3 (alcohol) to 2.9 (drugs) weeks longer than pre-treatment heavy drinkers. Discussion and Conclusions The EtG biomarker can be used to determine who will respond to a CM intervention for alcohol use disorders and could inform future trials that are designed to be tailored to individual patients. Scientific Significance Results suggest pre-treatment EtG cutoffs equivalent to heavy and very heavy drinking predict outcomes in CM. (Am J Addict 2017;26:673–675)
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pilot investigation of a phosphatidylethanol based Contingency Management intervention targeting alcohol use
Psychology of Addictive Behaviors, 2017Co-Authors: Michael G Mcdonell, John M Roll, Sterling Mcpherson, Nathalie S Hillkapturczak, Emily Leickly, Jordan Skalisky, Martin A JavorsAbstract:: Phosphatidylethanol (PEth) can be detected in blood from 14 to as many as 28 days after alcohol consumption, depending on the amount and frequency of alcohol consumed. PEth may have utility for verifying abstinence in a Contingency Management (CM) intervention for alcohol use, particularly in settings where frequent verification of abstinence is impossible or impractical. Five nontreatment-seeking heavy drinkers (40% men) participated in an 11-week, ABA-phased within-subject experiment for which they submitted blood spots for PEth measurement, urine samples for ethyl glucuronide (EtG) testing, and self-report drinking data weekly. Participants received reinforcers for submitting samples throughout the A phases. During the B phase (CM phase), they received additional reinforcers when their PEth level was reduced from the previous week and was verified by a negative EtG (<150 ng/ml) urine test and self-report. PEth, EtG, and self-report outcomes were compared between A phases (Weeks 1-3, 8-11) and B phases (Weeks 4-7). During the A phases, 23% of PEth results indicated alcohol abstinence, whereas 53% of PEth samples submitted during the CM (B phase) indicated alcohol abstinence. Participants were more likely to submit EtG-negative urine samples and report lower levels of drinking and heavy drinking during the B phase, relative to the A phases. We also explored the ability of PEth to detect self-reported drinking. The combined PEth homologs (16:0/18:1 and 16:0/18:2) predicted self-reported drinking with area under the curve from 0.81 (1 week) to 0.80 (3 weeks). Results support the initial feasibility of a Peth-based CM intervention. (PsycINFO Database Record
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a randomized controlled trial of ethyl glucuronide based Contingency Management for outpatients with co occurring alcohol use disorders and serious mental illness
American Journal of Psychiatry, 2017Co-Authors: Michael G Mcdonell, John M Roll, Sterling Mcpherson, Emily Leickly, Jordan Skalisky, Debra Srebnik, Frank Angelo, Roger Vilardaga, Jenny R Nepom, Richard K RiesAbstract:Objective:The authors examined whether a Contingency Management intervention using the ethyl glucuronide (EtG) alcohol biomarker resulted in increased alcohol abstinence in outpatients with co-occurring serious mental illnesses. Secondary objectives were to determine whether Contingency Management was associated with changes in heavy drinking, treatment attendance, drug use, cigarette smoking, psychiatric symptoms, and HIV-risk behavior.Method:Seventy-nine (37% female, 44% nonwhite) outpatients with serious mental illness and alcohol dependence receiving treatment as usual completed a 4-week observation period and were randomly assigned to 12 weeks of Contingency Management for EtG-negative urine samples and addiction treatment attendance, or reinforcement only for study participation. Contingency Management included the variable magnitude of reinforcement “prize draw” procedure contingent on EtG-negative samples (<150 ng/mL) three times a week and weekly gift cards for outpatient treatment attendance. Ur...
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biochemical marker of use is a better predictor of outcomes than self report metrics in a Contingency Management smoking cessation analog study
American Journal on Addictions, 2014Co-Authors: Sterling Mcpherson, Robert R Packer, Jennifer M Cameron, Donelle Howell, John M RollAbstract:Background and Objectives This investigation compared cotinine (primary metabolite of nicotine) at study intake to self-report metrics (eg, Fagerstrom Test of Nicotine Dependence [FTND]) and assessed their relative ability to predict smoking outcomes. Methods We used data from an analog model of Contingency Management for cigarette smoking. Non-treatment seeking participants (N = 103) could earn money in exchange for provision of a negative carbon monoxide (CO) sample indicating smoking abstinence, but were otherwise not motivated to quit. We used intake cotinine, FTND, percent of friends who smoke, and years smoked to predict longitudinal CO and attendance, time-to-first positive CO submission, and additional cross-sectional outcomes. Results Intake cotinine was consistently predictive (p < .05) of all outcomes (eg, longitudinal CO and attendance, 100% abstinence, time-to-first positive CO sample), while years smoked was the only self-report metric that demonstrated any predictive ability. Conclusions and Scientific Significance Cotinine could be more informative for tailoring behavioral treatments compared to self-report measures. (Am J Addict 2014;23:15–20)
Cathy J Reback - One of the best experts on this subject based on the ideXlab platform.
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A Novel Adaptation of Peer Health Navigation and Contingency Management for Advancement Along the HIV Care Continuum Among Transgender Women of Color
AIDS and Behavior, 2019Co-Authors: Cathy J Reback, Kimberly A. Kisler, Jesse B FletcherAbstract:Transgender women, particularly racial/ethnic minority transgender women, evidence disproportionately high rates of untreated HIV infection and disproportionately low rates of HIV viral suppression. The Alexis Project was a combined peer health navigation (PHN) and Contingency Management (CM) intervention that targeted HIV milestones associated with advancement along the HIV care continuum. From February 2014 through August 2016, 139 transgender women of color (TWOC) enrolled and received unlimited PHN sessions and an escalating CM rewards schedule for confirmed achievement of both behavioral (e.g., HIV care visits) and biomedical (e.g., viral load reductions and achieved/sustained viral suppression) HIV milestones. Results demonstrated that increased attendance to PHN sessions was associated with significant achievement of both behavioral (coef. range 0.12–0.38) and biomedical (coef. = 0.10) HIV milestones (all p ≤ 0.01); 85% were linked to HIV care, and 83% who enrolled detectable and achieved the minimum 1 log viral load reduction advanced to full viral suppression. The combined PHN and CM intervention successfully promoted advancement along the HIV Care Continuum, with particularly robust effects for behavioral HIV milestones.
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Abstract Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5–68....
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.
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a public health response to the methamphetamine epidemic the implementation of Contingency Management to treat methamphetamine dependence
BMC Public Health, 2006Co-Authors: Steven Shoptaw, Cathy J Reback, Jeffrey D Klausner, Stephen Tierney, John Stansell, Bradley C Hare, Steven Gibson, Michael Siever, William D King, Uyen KaoAbstract:In response to increases in methamphatemine-associated sexually transmitted diseases, the San Francisco Department of Public Health implemented a Contingency Management (CM) field program called the Positive Reinforcement Opportunity Project (PROP). Methamphetamine-using men who have sex with men (MSM) in San Francisco qualified for PROP following expressed interest in the program, provision of an observed urine sample that tested positive for methamphetamine metabolites and self-report of recent methamphetamine use. For 12 weeks, PROP participants provided observed urine samples on Mondays, Wednesdays and Fridays and received vouchers of increasing value for each consecutive sample that tested negative to metabolites of methamphetamine. Vouchers were exchanged for goods and services that promoted a healthy lifestyle. No cash was provided. Primary outcomes included acceptability (number of enrollments/time), impact (clinical response to treatment and cost-effectiveness as cost per patient treated). Enrollment in PROP was brisk indicating its acceptability. During the first 10 months of operation, 143 men sought treatment and of these 77.6% were HIV-infected. Of those screened, 111 began CM treatment and averaged 15 (42%) methamphetamine-free urine samples out of a possible 36 samples during the 12-week treatment period; 60% completed 4 weeks of treatment; 48% 8 weeks and 30% 12 weeks. Across all participants, an average of $159 (SD = $165) in vouchers or 35.1% of the maximum possible ($453) was provided for these participants. The average cost per participant of the 143 treated was $800. Clinical responses to CM in PROP were similar to CM delivered in drug treatment programs, supporting the adaptability and effectiveness of CM to non-traditional drug treatment settings. Costs were reasonable and less than or comparable to other methamphetamine outpatient treatment programs. Further expansion of programs like PROP could address the increasing need for acceptable, feasible and cost-effective methamphetamine treatment in this group with exceptionally high rates of HIV-infection.
Steven Shoptaw - One of the best experts on this subject based on the ideXlab platform.
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Abstract Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5–68....
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.
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randomized placebo controlled trial of sertraline and Contingency Management for the treatment of methamphetamine dependence
Drug and Alcohol Dependence, 2006Co-Authors: Steven Shoptaw, John M Roll, Erin Rotheramfuller, Alice Huber, James A Peck, Xiaowei Yang, Juanmei Liu, Jeff Dang, Benjamin Shapiro, Walter LingAbstract:Abstract Background Methamphetamine dependence and associated medical and psychiatric concerns are significant public health issues. This project evaluated the efficacy of sertraline (50 mg bid) and Contingency Management (CM) for the treatment of methamphetamine dependence. Method In this randomized, placebo-controlled, double-blind trial, participants completed a 2-week non-medication baseline and were randomized to one of four conditions for 12 weeks: sertraline plus CM (n = 61), sertraline-only (n = 59), matching placebo plus CM (n = 54), or matching placebo-only (n = 55). All participants attended clinic thrice-weekly for data collection, medication dispensing, and relapse prevention groups. Outcomes included methamphetamine use (urine drug screening and self-reported days of use), retention (length of stay), drug craving (visual analogue scale), and mood symptoms (Beck Depression Inventory). Results No statistically significant main or interaction effects for sertraline or CM in reducing methamphetamine use were observed using a generalized estimating equation (GEE), although post hoc analyses showed the sertraline-only condition had significantly poorer retention than other conditions (χ2 (3) = 8.40, p Conclusions These data do not demonstrate improved outcomes for sertraline versus placebo for treatment of methamphetamine dependence; indeed, they suggest sertraline is contraindicated for methamphetamine dependence. Findings provide support for the use of Contingency Management for treatment of methamphetamine dependence.
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a public health response to the methamphetamine epidemic the implementation of Contingency Management to treat methamphetamine dependence
BMC Public Health, 2006Co-Authors: Steven Shoptaw, Cathy J Reback, Jeffrey D Klausner, Stephen Tierney, John Stansell, Bradley C Hare, Steven Gibson, Michael Siever, William D King, Uyen KaoAbstract:In response to increases in methamphatemine-associated sexually transmitted diseases, the San Francisco Department of Public Health implemented a Contingency Management (CM) field program called the Positive Reinforcement Opportunity Project (PROP). Methamphetamine-using men who have sex with men (MSM) in San Francisco qualified for PROP following expressed interest in the program, provision of an observed urine sample that tested positive for methamphetamine metabolites and self-report of recent methamphetamine use. For 12 weeks, PROP participants provided observed urine samples on Mondays, Wednesdays and Fridays and received vouchers of increasing value for each consecutive sample that tested negative to metabolites of methamphetamine. Vouchers were exchanged for goods and services that promoted a healthy lifestyle. No cash was provided. Primary outcomes included acceptability (number of enrollments/time), impact (clinical response to treatment and cost-effectiveness as cost per patient treated). Enrollment in PROP was brisk indicating its acceptability. During the first 10 months of operation, 143 men sought treatment and of these 77.6% were HIV-infected. Of those screened, 111 began CM treatment and averaged 15 (42%) methamphetamine-free urine samples out of a possible 36 samples during the 12-week treatment period; 60% completed 4 weeks of treatment; 48% 8 weeks and 30% 12 weeks. Across all participants, an average of $159 (SD = $165) in vouchers or 35.1% of the maximum possible ($453) was provided for these participants. The average cost per participant of the 143 treated was $800. Clinical responses to CM in PROP were similar to CM delivered in drug treatment programs, supporting the adaptability and effectiveness of CM to non-traditional drug treatment settings. Costs were reasonable and less than or comparable to other methamphetamine outpatient treatment programs. Further expansion of programs like PROP could address the increasing need for acceptable, feasible and cost-effective methamphetamine treatment in this group with exceptionally high rates of HIV-infection.
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a comparison of Contingency Management and cognitive behavioral approaches for stimulant dependent individuals
Addiction, 2006Co-Authors: Richard A Rawson, Steven Shoptaw, Michael J Mccann, Frank Flammino, Karen Miotto, Chris Reiber, Walter LingAbstract:Aims Previous research has reported that both Contingency Management (CM) and cognitive-behavioral therapy (CBT) are efficacious interventions for the treatment of stimulant abusers. The present study sought to directly compare the effectiveness of (CM) and (CBT) alone and in combination in reducing stimulant use. Design Randomized clinical trial. Participants Stimulant-dependent individuals (n = 171). Intervention CM, CBT or combined CM and CBT, 16-week treatment conditions. CM condition participants received vouchers for stimulant-free urine samples. CBT condition participants attended three 90-minute group sessions each week. Measurements Participants were interviewed at baseline and weeks 17, 26 and 52. Measures included psychiatric disorders and alcohol and drug use and concomitant social problems. Findings CM procedures produced better retention and lower rates of stimulant use during the study period. Self-reported stimulant use was reduced from baseline levels at all follow-up points for all groups and urinalysis data did not differ between groups at follow-up. While CM produced robust evidence of efficacy during treatment application, CBT produced comparable longer-term outcomes. There was no evidence of an additive effect when the two treatments were combined. Conclusions This study suggests that CM is an efficacious treatment for reducing stimulant use and is superior during treatment to a CBT approach. CM is useful in engaging substance abusers, retaining them in treatment and helping them achieve abstinence from stimulant use. CBT also reduces drug use from baseline levels and produces comparable outcomes on all measures at follow-up.
Jesse B Fletcher - One of the best experts on this subject based on the ideXlab platform.
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A Novel Adaptation of Peer Health Navigation and Contingency Management for Advancement Along the HIV Care Continuum Among Transgender Women of Color
AIDS and Behavior, 2019Co-Authors: Cathy J Reback, Kimberly A. Kisler, Jesse B FletcherAbstract:Transgender women, particularly racial/ethnic minority transgender women, evidence disproportionately high rates of untreated HIV infection and disproportionately low rates of HIV viral suppression. The Alexis Project was a combined peer health navigation (PHN) and Contingency Management (CM) intervention that targeted HIV milestones associated with advancement along the HIV care continuum. From February 2014 through August 2016, 139 transgender women of color (TWOC) enrolled and received unlimited PHN sessions and an escalating CM rewards schedule for confirmed achievement of both behavioral (e.g., HIV care visits) and biomedical (e.g., viral load reductions and achieved/sustained viral suppression) HIV milestones. Results demonstrated that increased attendance to PHN sessions was associated with significant achievement of both behavioral (coef. range 0.12–0.38) and biomedical (coef. = 0.10) HIV milestones (all p ≤ 0.01); 85% were linked to HIV care, and 83% who enrolled detectable and achieved the minimum 1 log viral load reduction advanced to full viral suppression. The combined PHN and CM intervention successfully promoted advancement along the HIV Care Continuum, with particularly robust effects for behavioral HIV milestones.
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Abstract Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5–68....
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a novel combination hiv prevention strategy post exposure prophylaxis with Contingency Management for substance abuse treatment among methamphetamine using men who have sex with men
Aids Patient Care and Stds, 2012Co-Authors: Raphael J Landovitz, Steven Shoptaw, Jesse B Fletcher, Galina Inzhakova, Jordan E Lake, Cathy J RebackAbstract:Methamphetamine use has been associated with HIV transmission among men who have sex with men (MSM). However, providers have been hesitant to utilize post-exposure prophylaxis (PEP) in populations of stimulant users. This single-arm, open label pilot study sought to demonstrate the safety, feasibility, and acceptability of PEP combined with the drug abstinence intervention of Contingency Management (CM) in methamphetamine-using MSM. HIV-uninfected MSM reporting recent methamphetamine use were recruited to a CM intervention. Those who reported a recent high-risk sexual or injection drug exposure to an HIV-infected or serostatus unknown source were initiated on tenofovir/emtricitabine (Truvada)-based PEP. Participants were followed over 3 months for infectious/biologic, behavioral, and drug use outcomes. Fifty-three participants enrolled in the study; 35 participants (66%) initiated PEP after a high-risk exposure. The median time from exposure to medication administration was 37.8 h (range 12.5-68.0 h). Twenty-five (71.4%) PEP initiators successfully completed the treatment course. Median medication adherence was 96% (IQR 57-100%), and medication was generally well tolerated. Methamphetamine abstinence during CM treatment increased PEP adherence (2% [95% CI +1-+3%]) per clean urine toxicology sample provided), and increased the odds of PEP course completion (OR 1.17, 95% CI 1.04-1.31). One incident of HIV seroconversion was observed in a participant who did not complete PEP treatment, and reported multiple subsequent exposures. Findings demonstrate that PEP, when combined with CM, is safe, feasible, and acceptable as an HIV prevention strategy in methamphetamine-using MSM.