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Financial incentives promote smoking abstinence among patients with pulmonary disease
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Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
with low risk use identified by screening. These findings raise the possibility that low risk drug use in primary care may be uniquely amenable to brief intervention and warrant replication in a larger trial.Financial support: R01DA025068, UL1TR000157. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.407 Underage drinking diversion: Characterizing risk with latent class analysis Natasha Mendoza, Elizabeth Anthony, Dominique Row-Sepowitz Arizona State University, Phoenix, AZ, United States Aims: Alcohol and drug use of youths in late adolescence (YLA) is associated with serious safety and risk factors that can lead to numerous harmful consequences throughout the life cycle. Little is known about the heterogeneity among YLAs entering diversion programs and the impact of client characteristics on clinical decision making and program completion. This study utilized latent class analysis (LCA) and non-parametric tests to characterize program participants. Aims of the study were to: (1) identify subgroups of YLAs in the Southwest based on demographics and substance use characteristics and (2) examine the differences among groups based on clinical decision making, treatment type, and program completion. Methods: The current study is a secondary analysis of an Underage Drinking and Alcohol Possession Diversion Program in the Southwest. Available data included 1260 court-referred YLAs (2009–2011). Data related to alcohol and drug problems were collected via Substance Abuse Subtle Screening Inventory. Results: LCA demonstrated a three-class solution (AIC = 15729.37, BIC = 15909.23, entropy = .92). Bootstrapped likelihood ratio and LMR tests were significant. The high risk group (5%; n = 66) and the moderate risk group (35%; n = 446) were characterized by higher use of alcohol and marijuana, being over the legal limit at arrest, and being male (compared to the low risk group). The moderate risk group was more likely to be white and have less education than the higher risk group. The low risk group (59%; n = 748) was more likely to have attended college and be female. For the low risk group, Chi-square tests demonstrated lower instances of referral to treatment decisions and higher program completion compared to moderate and high risk groups. Conclusions: Findings highlight heterogeneity of YLAs based on demographics and these group differences may have implications for clinical decision making, treatment type, and completion. Results underscore the need to adapt diversion programs to meet the needs of substantially different YLAs. Financial support: City of Phoenix Prosecutors Office. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.408 Multidimensional assessment of cue-elicited increases in incentive salience for marijuana Jane Metrik 1 , Elizabeth Aston 1 , C.W. Kahler 1 , Damaris Rohsenow 1 , John McGeary 1 , Valerie Knopik 1 , James MacKillop 2 1 2
Brown University, Providence, RI, United States McMaster University, Hamilton, ON, Canada
Aims: Incentive salience is a multidimensional construct that includes craving, drug value, and implicit motivation such as attentional bias to drug cues. Laboratory-cue reactivity (CR) paradigms have been used to evaluate marijuana incentive salience with
measures of subjective craving or arousal, but not with behavioral economic measures of relative marijuana value or implicit attentional processing. This study used multidimensional assessment of acute increases in marijuana incentive salience during a CR procedure. Methods: Marijuana users (N = 93, 34% female) underwent exposure to neutral cues followed by exposure to actual marijuana cigarettes with repeated assessments of subjective craving and a state behavioral economic demand for marijuana, via a Marijuana Purchase Task (MPT), after each cue set. A modified Stroop task with cannabis and control words was completed after the marijuana cues. Results: GEE analyses indicated that marijuana vs. neutral cues significantly increased subjective craving, B = .48, 95% CI = .37, .59, p < .001, and MPT indices of demand, including consumption at zero cost (intensity), B = .02, p < .01, and maximum expenditure on marijuana (Omax), B = .03, p < .01. Craving was significantly correlated with MPT indices (r’s: 0.23–0.33). Marijuana users displayed significant attentional bias for cannabis by slower colornaming marijuana vs. neutral words, B = 31.01, p < .001. Cue-elicited changes in intensity predicted greater attentional bias for marijuana words, B = 415.41, p < .05, but subjective craving did not. Conclusions: These findings validate the CR paradigm with actual marijuana cigarettes, as greater incentive salience indexed by subjective, behavioral economic, and implicit measures was observed after marijuana vs. neutral cues. Findings support the utility of a behavioral economic approach in detecting cue-elicited changes in marijuana demand and attentional bias for marijuana stimuli.Financial support: R03DA027484 (Metrik, Knopik). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.409 Financial incentives promote smoking abstinence among patients with pulmonary disease Andrew C. Meyer, Joanna M. Streck, Taylor A. Ochalek, Bryce Hruska, Charlotte C. Teneback, Anne E. Dixon, Stacey C. Sigmon University of Vermont, Burlington, VT, United States Aims: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with an estimated 90% of all COPD deaths in the U.S. attributable to smoking. While smoking cessation is identified as the most effective intervention to reduce COPD-related consequences, patients with COPD show poorer outcomes across a range of smoking-cessation interventions. In this randomized pilot study, we are examining the efficacy of a behavioral economic intervention for promoting initial smoking abstinence in patients diagnosed with COPD. Methods: Daily smokers (N = 30) diagnosed with COPD (FEV1 /FVC < 70%) will be randomized to an Incentive or Control experimental group. Participants visit the clinic daily for 14 days and provide breath and urine samples for biochemical verification of smoking status. Incentive participants earn financial incentives delivered contingent upon smoking abstinence. Controls receive vouchers of the same value but independent of smoking status. Abstinence is defined as a breath CO level 6 ppm during Study Days 1–5 and a urinary cotinine level 80 ng/ml on Days 6–14. Results: Thus far, 23 participants have been randomly assigned to the Incentive (n = 11) or Control (n = 12) experimental groups. Participants are 57 years old, 48% male, and diagnosed with moderate COPD (FEV1 = 59% of normal). At intake, participants report smoking 24 cigs/day, have smoked regularly for 38 years, and present with moderate nicotine dependence (FTND = 6.1).
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
Preliminary analyses show significant group by visit interactions for breath CO (p = 0.006) and urinary cotinine (p = 0.03), with lower CO and cotinine levels in the Incentive vs. Control group. Final biochemical and abstinence data will be available for presentation at the June 2015 meeting, as will additional measures of nicotine withdrawal, craving, and respiratory symptomatology. Conclusions: These results suggest that an incentive-based intervention may be feasible and effective in producing initial smoking abstinence in this hard-to-treat sample of smokers.Financial support: T32 DA007242, P20 GM103644. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.410 Trauma exacerbates the effect of genetic variants in the dopamine system on cannabis use Jacquelyn L. Meyers 1 , Monica Uddin 2 , Sandro Galea 1 , Allison Aiello 3 , Derek Wildman 2 , Karestan C. Koenen 1 1 Epidemiology, Columbia University, New York, NY, United States 2 University of Champagne-Urbana, Urbana, IL, United States 3 University of North Carolina Chapel Hill, Chapel Hill, NC, United States
Aims: Although cannabis use is heritable, few studies have examined genetic risk for cannabis use alone, and of the studies that have been published, few genetic risk variants have been identified. In addition, the evidence for gene–environment interactions (GxE) in substance use behaviors is growing, with several GxE studies indicating that the effects of specific genetic variants are exacerbated by traumatic experiences. However, there have been no published GxE studies for cannabis involvement to date. Several biological systems that potentially incur risk for cannabis involvement have been identified via neurobiological studies, including variation in the dopaminergic system. For example, Volkow and colleagues investigated the effects of chronic cannabis use on the human brain using PET imaging, and found that cannabis abusers showed markedly blunted responses when challenged with methylphenidate, a drug that elevates dopamine. Methods: In this study, we provide evidence of association between sets of genetic variants in the dopamine system (96 single nucleotide polymorphisms across DRD1–DRD4) and frequency of cannabis use (days/month, within the past 30 days) in two independent majority African-American population based samples (Detroit Neighborhood Health Study, n = 788; Grady Trauma Project, n = 3752; p < 0.01). Results: Importantly, we also found that the experience of trauma (measured via the Traumatic Life Events checklist) in both samples exacerbated the influence of the dopaminergic system on frequency of cannabis use. However, the effect sizes are quite modest (® = 0.23–0.89, p < 0.01–0.03). Conclusions: These data provide additional evidence that variation in the dopaminergic system impacts risk for cannabis involvement, and that these effects are increased for individuals who have experienced trauma in their lifetime. These results also highlight the subtly of genetic and GxE effects for complex behavioral traits such as cannabis involvement.Financial support: R01DA022720; T32MH013043; F32AA022028. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.411
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Do private practitioners provide quality care to adolescents with substance abuse disorders? Kathleen Meyers 1 , John Cacciola 1,2 , Suzanne Ward 1 , Elena Bresani 1 , Kimberly C. Kirby 1,2 1
Treatment Research Institute, Philadelphia, PA, United States 2 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Of the 1.7 million adolescents with an SUD, only 10% actually receive treatment and less than 50% of them receive it in a specialty SUD treatment program. Instead, many receive treatment in PPs’ offices. While there is progress in understanding the quality of care in specialty programs, we know virtually nothing about the approaches PPs use. Methods: We surveyed a national sample of 433 psychologists, clinical social workers, and family therapists to assess under what conditions they treat adolescent SUD (e.g., substance type, problem severity) and what features of SUD Evidence Based Practices and Treatments (EBPs/EBTs) they offer. The Internet survey contained ∼70 questions and differed for PPs who did/did not treat adolescents with SUDs in the past year. Results: Eighty percent (n = 340) had treated adolescents with SUD in the past year. Sizable portions of these PPs treated SUD regardless of type of drug or SUD severity with ∼25% treating cocaine, prescription opiates, hallucinogens, inhalants, and designer drugs, >33% treating prescription stimulants and prescription depressants, and ∼50% treating alcohol and marijuana. Over 50% referred youth to specialty care if use included heroin or methamphetamine. The use of standardized assessments was rare and only ∼33% reported use of motivational interventions. Cognitive behavioral therapy was the predominate treatment delivered in individual youth sessions (85%); 75% provided family sessions but <20% were familiar with family-based EBTs. Less than 33% endorsed traumainformed care as a therapeutic approach. Only 33% monitored substance use progress through urine testing. Referral to recoveryoriented services was uncommon. Conclusions: These data suggest that many youth with SUDs are treated by PPs who do not use SUD-focused EBPs/EBTs and do not address the related problems of these youth. Given that SUD begins in adolescence in >90% of cases, it is critical that PPs be included in our effort to improve adolescent treatment quality.Financial support: P50-DA027841. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.412 Trends in use of and attitudes toward marijuana among youth before and after decriminalization: The case of California 2007–2013 Richard Miech, Lloyd A. Johnston, Patrick O’Malley, Jerald Bachman, John Schulenberg, Megan Patrick University of Michigan, Ann Arbor, MI, United States Aims: This analysis examines decriminalization as a risk factor for future increases in youth marijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana. Methods: Data come from the annual Monitoring the Future study, which since 1975 has used questionnaires administered in classrooms to survey nationally representative samples of
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
with low risk use identified by screening. These findings raise the possibility that low risk drug use in primary care may be uniquely amenable to brief intervention and warrant replication in a larger trial.Financial support: R01DA025068, UL1TR000157. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.407 Underage drinking diversion: Characterizing risk with latent class analysis Natasha Mendoza, Elizabeth Anthony, Dominique Row-Sepowitz Arizona State University, Phoenix, AZ, United States Aims: Alcohol and drug use of youths in late adolescence (YLA) is associated with serious safety and risk factors that can lead to numerous harmful consequences throughout the life cycle. Little is known about the heterogeneity among YLAs entering diversion programs and the impact of client characteristics on clinical decision making and program completion. This study utilized latent class analysis (LCA) and non-parametric tests to characterize program participants. Aims of the study were to: (1) identify subgroups of YLAs in the Southwest based on demographics and substance use characteristics and (2) examine the differences among groups based on clinical decision making, treatment type, and program completion. Methods: The current study is a secondary analysis of an Underage Drinking and Alcohol Possession Diversion Program in the Southwest. Available data included 1260 court-referred YLAs (2009–2011). Data related to alcohol and drug problems were collected via Substance Abuse Subtle Screening Inventory. Results: LCA demonstrated a three-class solution (AIC = 15729.37, BIC = 15909.23, entropy = .92). Bootstrapped likelihood ratio and LMR tests were significant. The high risk group (5%; n = 66) and the moderate risk group (35%; n = 446) were characterized by higher use of alcohol and marijuana, being over the legal limit at arrest, and being male (compared to the low risk group). The moderate risk group was more likely to be white and have less education than the higher risk group. The low risk group (59%; n = 748) was more likely to have attended college and be female. For the low risk group, Chi-square tests demonstrated lower instances of referral to treatment decisions and higher program completion compared to moderate and high risk groups. Conclusions: Findings highlight heterogeneity of YLAs based on demographics and these group differences may have implications for clinical decision making, treatment type, and completion. Results underscore the need to adapt diversion programs to meet the needs of substantially different YLAs. Financial support: City of Phoenix Prosecutors Office. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.408 Multidimensional assessment of cue-elicited increases in incentive salience for marijuana Jane Metrik 1 , Elizabeth Aston 1 , C.W. Kahler 1 , Damaris Rohsenow 1 , John McGeary 1 , Valerie Knopik 1 , James MacKillop 2 1 2
Brown University, Providence, RI, United States McMaster University, Hamilton, ON, Canada
Aims: Incentive salience is a multidimensional construct that includes craving, drug value, and implicit motivation such as attentional bias to drug cues. Laboratory-cue reactivity (CR) paradigms have been used to evaluate marijuana incentive salience with
measures of subjective craving or arousal, but not with behavioral economic measures of relative marijuana value or implicit attentional processing. This study used multidimensional assessment of acute increases in marijuana incentive salience during a CR procedure. Methods: Marijuana users (N = 93, 34% female) underwent exposure to neutral cues followed by exposure to actual marijuana cigarettes with repeated assessments of subjective craving and a state behavioral economic demand for marijuana, via a Marijuana Purchase Task (MPT), after each cue set. A modified Stroop task with cannabis and control words was completed after the marijuana cues. Results: GEE analyses indicated that marijuana vs. neutral cues significantly increased subjective craving, B = .48, 95% CI = .37, .59, p < .001, and MPT indices of demand, including consumption at zero cost (intensity), B = .02, p < .01, and maximum expenditure on marijuana (Omax), B = .03, p < .01. Craving was significantly correlated with MPT indices (r’s: 0.23–0.33). Marijuana users displayed significant attentional bias for cannabis by slower colornaming marijuana vs. neutral words, B = 31.01, p < .001. Cue-elicited changes in intensity predicted greater attentional bias for marijuana words, B = 415.41, p < .05, but subjective craving did not. Conclusions: These findings validate the CR paradigm with actual marijuana cigarettes, as greater incentive salience indexed by subjective, behavioral economic, and implicit measures was observed after marijuana vs. neutral cues. Findings support the utility of a behavioral economic approach in detecting cue-elicited changes in marijuana demand and attentional bias for marijuana stimuli.Financial support: R03DA027484 (Metrik, Knopik). http://dx.doi.org/10.1016/j.drugalcdep.2015.07.409 Financial incentives promote smoking abstinence among patients with pulmonary disease Andrew C. Meyer, Joanna M. Streck, Taylor A. Ochalek, Bryce Hruska, Charlotte C. Teneback, Anne E. Dixon, Stacey C. Sigmon University of Vermont, Burlington, VT, United States Aims: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with an estimated 90% of all COPD deaths in the U.S. attributable to smoking. While smoking cessation is identified as the most effective intervention to reduce COPD-related consequences, patients with COPD show poorer outcomes across a range of smoking-cessation interventions. In this randomized pilot study, we are examining the efficacy of a behavioral economic intervention for promoting initial smoking abstinence in patients diagnosed with COPD. Methods: Daily smokers (N = 30) diagnosed with COPD (FEV1 /FVC < 70%) will be randomized to an Incentive or Control experimental group. Participants visit the clinic daily for 14 days and provide breath and urine samples for biochemical verification of smoking status. Incentive participants earn financial incentives delivered contingent upon smoking abstinence. Controls receive vouchers of the same value but independent of smoking status. Abstinence is defined as a breath CO level 6 ppm during Study Days 1–5 and a urinary cotinine level 80 ng/ml on Days 6–14. Results: Thus far, 23 participants have been randomly assigned to the Incentive (n = 11) or Control (n = 12) experimental groups. Participants are 57 years old, 48% male, and diagnosed with moderate COPD (FEV1 = 59% of normal). At intake, participants report smoking 24 cigs/day, have smoked regularly for 38 years, and present with moderate nicotine dependence (FTND = 6.1).
Abstracts / Drug and Alcohol Dependence 156 (2015) e102–e182
Preliminary analyses show significant group by visit interactions for breath CO (p = 0.006) and urinary cotinine (p = 0.03), with lower CO and cotinine levels in the Incentive vs. Control group. Final biochemical and abstinence data will be available for presentation at the June 2015 meeting, as will additional measures of nicotine withdrawal, craving, and respiratory symptomatology. Conclusions: These results suggest that an incentive-based intervention may be feasible and effective in producing initial smoking abstinence in this hard-to-treat sample of smokers.Financial support: T32 DA007242, P20 GM103644. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.410 Trauma exacerbates the effect of genetic variants in the dopamine system on cannabis use Jacquelyn L. Meyers 1 , Monica Uddin 2 , Sandro Galea 1 , Allison Aiello 3 , Derek Wildman 2 , Karestan C. Koenen 1 1 Epidemiology, Columbia University, New York, NY, United States 2 University of Champagne-Urbana, Urbana, IL, United States 3 University of North Carolina Chapel Hill, Chapel Hill, NC, United States
Aims: Although cannabis use is heritable, few studies have examined genetic risk for cannabis use alone, and of the studies that have been published, few genetic risk variants have been identified. In addition, the evidence for gene–environment interactions (GxE) in substance use behaviors is growing, with several GxE studies indicating that the effects of specific genetic variants are exacerbated by traumatic experiences. However, there have been no published GxE studies for cannabis involvement to date. Several biological systems that potentially incur risk for cannabis involvement have been identified via neurobiological studies, including variation in the dopaminergic system. For example, Volkow and colleagues investigated the effects of chronic cannabis use on the human brain using PET imaging, and found that cannabis abusers showed markedly blunted responses when challenged with methylphenidate, a drug that elevates dopamine. Methods: In this study, we provide evidence of association between sets of genetic variants in the dopamine system (96 single nucleotide polymorphisms across DRD1–DRD4) and frequency of cannabis use (days/month, within the past 30 days) in two independent majority African-American population based samples (Detroit Neighborhood Health Study, n = 788; Grady Trauma Project, n = 3752; p < 0.01). Results: Importantly, we also found that the experience of trauma (measured via the Traumatic Life Events checklist) in both samples exacerbated the influence of the dopaminergic system on frequency of cannabis use. However, the effect sizes are quite modest (® = 0.23–0.89, p < 0.01–0.03). Conclusions: These data provide additional evidence that variation in the dopaminergic system impacts risk for cannabis involvement, and that these effects are increased for individuals who have experienced trauma in their lifetime. These results also highlight the subtly of genetic and GxE effects for complex behavioral traits such as cannabis involvement.Financial support: R01DA022720; T32MH013043; F32AA022028. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.411
e151
Do private practitioners provide quality care to adolescents with substance abuse disorders? Kathleen Meyers 1 , John Cacciola 1,2 , Suzanne Ward 1 , Elena Bresani 1 , Kimberly C. Kirby 1,2 1
Treatment Research Institute, Philadelphia, PA, United States 2 Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Of the 1.7 million adolescents with an SUD, only 10% actually receive treatment and less than 50% of them receive it in a specialty SUD treatment program. Instead, many receive treatment in PPs’ offices. While there is progress in understanding the quality of care in specialty programs, we know virtually nothing about the approaches PPs use. Methods: We surveyed a national sample of 433 psychologists, clinical social workers, and family therapists to assess under what conditions they treat adolescent SUD (e.g., substance type, problem severity) and what features of SUD Evidence Based Practices and Treatments (EBPs/EBTs) they offer. The Internet survey contained ∼70 questions and differed for PPs who did/did not treat adolescents with SUDs in the past year. Results: Eighty percent (n = 340) had treated adolescents with SUD in the past year. Sizable portions of these PPs treated SUD regardless of type of drug or SUD severity with ∼25% treating cocaine, prescription opiates, hallucinogens, inhalants, and designer drugs, >33% treating prescription stimulants and prescription depressants, and ∼50% treating alcohol and marijuana. Over 50% referred youth to specialty care if use included heroin or methamphetamine. The use of standardized assessments was rare and only ∼33% reported use of motivational interventions. Cognitive behavioral therapy was the predominate treatment delivered in individual youth sessions (85%); 75% provided family sessions but <20% were familiar with family-based EBTs. Less than 33% endorsed traumainformed care as a therapeutic approach. Only 33% monitored substance use progress through urine testing. Referral to recoveryoriented services was uncommon. Conclusions: These data suggest that many youth with SUDs are treated by PPs who do not use SUD-focused EBPs/EBTs and do not address the related problems of these youth. Given that SUD begins in adolescence in >90% of cases, it is critical that PPs be included in our effort to improve adolescent treatment quality.Financial support: P50-DA027841. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.412 Trends in use of and attitudes toward marijuana among youth before and after decriminalization: The case of California 2007–2013 Richard Miech, Lloyd A. Johnston, Patrick O’Malley, Jerald Bachman, John Schulenberg, Megan Patrick University of Michigan, Ann Arbor, MI, United States Aims: This analysis examines decriminalization as a risk factor for future increases in youth marijuana acceptance and use. Specifically, we examine marijuana-related behaviors and attitudes of 8th, 10th, and 12th graders in California as compared to other U.S. states during the years before and after California passed legislation in 2010 to decriminalize marijuana. Methods: Data come from the annual Monitoring the Future study, which since 1975 has used questionnaires administered in classrooms to survey nationally representative samples of