A Behavioral Model for Maintenance of Drug Abstinence

Kimberly C. Kirby, Ph.D.

Treatment Research Institute

Abstract:

Methods for initiating health behavior change have been studied extensively, but little empirical attention has been given to understanding factors that sustain long-term behavior changes. This application proposes to develop a model for long-term maintenance of behavior change by beginning to examine the basic parameters and processes of a behavioral treatment that has been extremely successful in initiating and sustaining periods of drug abstinence among drug dependent individuals. Contingency management (CM) procedures have been consistently effective in initiating drug abstinence in the majority of drug users and have sustained continuous abstinence for periods of up to 6 months. Despite the documented effectiveness of these interventions, the vast majority of CM interventions are kept in place for only 3 months. We propose to examine the effects of extending the duration of CM for drug abuse on long-term abstinence outcomes. We are not necessarily suggesting that the particular CM procedures we are proposing represent an immediately practical method of promoting long-term behavior change. We are suggesting that they provide a practical framework for beginning to investigate a behavioral model of maintaining drug abstinence. Following the tenets of basic behavioral research, we have outlined a model for long-term behavior maintenance that suggests that successful long-term behavior change does not focus on undoing old behaviors, but concentrates on developing new behaviors in a wide variety of new contexts, and provides enduring reinforcement for the new behaviors. This model predicts that interventions that promote long-term behavior change must provide a sufficient duration of treatment-contrived contingencies to develop new behaviors that are incompatible with drug use, and the new behaviors must have naturally-occurring sustaining contingencies. Research questions address issues of CM duration, the development of new behaviors incompatible with drug use, and the availability of natural maintaining contingencies of reinforcement.

Specific Aims:

Following the tenets of basic behavioral research, we have outlined a model for long-term behavior maintenance that suggests that successful long-term behavior change does not focus on undoing old behaviors, but concentrates on developing new behaviors in a wide variety of new contexts, and provides enduring reinforcement for the new behaviors. This model would predict that treatments that are effective in producing long-term behavior change must:

· provide a sufficient duration of treatment-contrived contingencies to

· develop new behaviors that are incompatible with drug use, and

· the new behaviors must have naturally-occurring sustaining contingencies

The implication of this model is that in order to develop strategies for supporting long-term behavior change we need to determine the optimal duration of continuing treatment-arranged contingencies, better specify incompatible behaviors that emerge for patients who are successful in sustaining periods of continuous drug abstinence, and determine which incompatible behaviors are most likely to have naturally-occurring sustaining contingencies of reinforcement. This research will begin to examine these issues by randomly assigning cocaine-abusing methadone maintenance program participants to either a Standard (3 mo. escalating contingency + 3mo. or Extended period of contrived contingencies. The research questions are as follows:

Primary Research Question

Does providing a longer duration of a CM result in a greater proportion of abstinent individuals during the two years after treatment entry?

Secondary Research Questions

CM duration

(1) Does providing a longer duration of CM result in longer durations of continuous drug abstinence during the first year after treatment entry?

(2) Do longer durations of drug abstinence during the first year after treatment entry predict better longer-term abstinence outcomes?

Incompatible behaviors

(3) Does providing a longer duration of CM result in greater increases in non-drug using activities?

(4) Do increases in the number of non-drug using activities predict better long-term drug abstinence?

Availability of natural reinforcers

(5) Are better long-term outcomes associated with more natural contingencies of reinforcement for non-drug using activities?