The Efficacy of Escalating and Fixed Contingency Management Reinforcement on Illicit Drug Use in Opioid-dependent Pregnant Women

Abstract

Objectives Contingency management (CM), long known to be efficacious in the treatment of substance-dependent men and women, has also been found to be efficacious for substance-dependent pregnant women. However, the specific CM reinforcement parameters in the special population of opioid-dependent pregnant women have been less fully and systematically studied. The Drug Abuse Incentive Systems (DAISY) study, a randomized controlled trial (RCT) of opioid-dependent pregnant patients, found that escalating reinforcement was not superior to a fixed reinforcement CM schedule after a 13-week intervention. To further examine CM’s reinforcement parameters in this population, this study aims to test the hypothesis that there is an early treatment response showing an escalating reinforcement schedule to be significantly more efficacious than a fixed schedule after 5 weeks of intervention in opioid-dependent pregnant patients. Methods Nine measures of opioid and cocaine abstinence among fixed and escalating CM schedule participants in the DAISY RCT (N=90) were compared over the initial 5 weeks of the intervention. Results No statistically significant difference in the opioid and cocaine abstinence measures was found between escalating and fixed conditions after 5 weeks (14 opportunities for each participant to leave a urine sample). The mean (SD) number of drug negative urine samples was 8.1 (4.5) and 7.4 (4.3), for escalating and fixed groups, respectively (p=0.46). Conclusions These results further the scientific knowledge regarding CM treatment in opioid-dependent pregnant women by supporting the finding that the escalating and fixed CM schedules produce similar amounts of drug negatives urine samples early in treatment.

The effects of fixed versus escalating reinforcement schedules on smoking abstinence

“…The current results are in contrast to a more recent study that compared escalating and fixed reinforcement schedules for opioid-dependent pregnant women (Hutchinson et al, 2012;Tuten et al, 2012). There may be at least two reasons why our results differed.…”

“…As shown in Figure 1, all but two escalating schedule participants provided at least one criterion breath CO sample during the 60-visit reinforcement period. This likely increased our expected effect size and thus our power to detect a difference between the two schedules compared to the earlier studies in opioid-dependent pregnant women (Hutchinson et al, 2012;Tuten et al, 2012).…”

“…A recent study directly compared escalating and fixed reinforcement schedules during CM treatments with opioid-dependent participants. In this study, pregnant, opioid-dependent women could receive vouchers contingent on drug-free urine samples (Hutchinson, Chisolm, Tuten, Leoutsakos, & Jones, 2012;Tuten, Svikis, Keyser-Marcus, O'Grady, & Jones, 2012). Patients were randomized into groups that received vouchers on either an escalating or fixed reinforcement schedule or to an attendance-only control group.…”

“…Thus, unlike previous analogue studies with escalating reinforcement schedules, the current study required escalating reinforcement participants to abstain initially for lower value reinforcers and maintain a longer period of smoking abstinence before reinforcement value was equal to or greater than that for fixed reinforcement participants. Due to these more extreme reinforcement-value and time-scale parameters, we hypothesized that there would be no difference in abstinence maintenance between escalating and fixed reinforcement participants, as was seen in another recent clinical trial (Hutchinson et al, 2012;Tuten et al, 2012).…”

Optimizing Pregnancy Treatment Interventions for Moms (OPTI-Mom): A Pilot Study

“…Clinicians and researchers have developed and examined a number of complementary psychological and behavioral interventions for pregnant women with opioid dependence, which have helped facilitate comprehensive care for this population. Yet, results from previous studies have not been clear regarding which behavioral interventions are most effectively paired with agonist therapy (Bickel et al, 1997; Jones et al, 2000; Brigham et al, 2010; Jones et al, 2011; Hutchinson, et al, 2012; Tuten et al, 2012; Ordean et al, 2013).…”