Anne C. Black

A Money Management-Based Substance Use Treatment Increases Valuation of Future Rewards

OBJECTIVE A positive association between delay discounting and substance use has been documented; substance users tend to discount future rewards more than non-users. However, studies detailing the responsiveness of delay discounting to interventions are lacking, and few have examined how any behavioral intervention affects delay discounting and whether these effects moderate changes in substance abuse. This study assesses the effectiveness of a money management intervention, Advisor-Teller Money Manager (ATM), in reducing delay discounting over time and the relationship of these effects to changes in cocaine use. METHOD Ninety psychiatric patients with histories of cocaine and/or alcohol use were randomly assigned to 36-weeks of ATM treatment or to a minimal-attention control condition. Delay discounting and cocaine use were measured throughout the intervention with a 52-week follow up measure of cocaine use. Analyses were conducted of (a) the effect of ATM on slopes of delay discounting and cocaine abstinence and (b) the relationship between change in delay discounting and change in cocaine abstinence. RESULTS The ATM intervention was associated with significantly less delay discounting and less cocaine use over time relative to controls. Increases in delay discounting were associated with decreased abstinence from cocaine. CONCLUSIONS ATM treatment decreased delay discounting rates and these effects extended to cocaine use. Concrete conceptualizations of future events, as occur in financial planning, with higher perceived probability may account for higher valuation of future rewards in counseled patients.

An investigation of the generalizability and dependability of direct behavior rating single item scales (DBR-SIS) to measure academic engagement and disruptive behavior of middle school students.

A total of 4 raters, including 2 teachers and 2 research assistants, used Direct Behavior Rating Single Item Scales (DBR-SIS) to measure the academic engagement and disruptive behavior of 7 middle school students across multiple occasions. Generalizability study results for the full model revealed modest to large magnitudes of variance associated with persons (students), occasions of measurement (day), and associated interactions. However, an unexpectedly low proportion of the variance in DBR data was attributable to the facet of rater, as well as a negligible variance component for the facet of rating occasion nested within day (10-min interval within a class period). Results of a reduced model and subsequent decision studies specific to individual rater and rater type (research assistant and teacher) suggested degree of reliability-like estimates differed substantially depending on rater. Overall, findings supported previous recommendations that in the absence of estimates of rater reliability and firm recommendations regarding rater training, ratings obtained from DBR-SIS, and subsequent analyses, be conducted within rater. Additionally, results suggested that when selecting a teacher rater, the person most likely to substantially interact with target students during the specified observation period may be the best choice.

Examining the Unexpected: Outlier Analyses of Factors Affecting Student Achievement.

In this study, we predicted achievement based on a variety of school demographic and background variables and identified schools that had achievement profiles that exceeded or fell short of their expected achievement levels. We identified schools that were over-or underper-forming and surveyed parents, teachers, and administrators in an effort to isolate factors that differ across the two types of schools. Across the three sets of surveys, perceptions of parents and perceptions about parents emerged as an interesting area of difference. Although parents in the positive and negative outlier schools reported similar perceptions about parent/teacher communication, teachers and administrators in the positive outlier schools appeared to have more positive perceptions of parents. Specifically, these teachers perceived the parents in their school as being more involved in their childrens education, and they encouraged high levels of parent involvement. Certainly, these more positive attitudes may help educators work more effectively with parents, building a more effective partnership to increase student achievement. Perhaps consequently, parents in the positive outlier schools reported greater satisfaction with their schools than parents in the negative outlier schools did. This study found that parental involvement and parental perceptions were key variables that helped to explain differences of the over-and underachieving schools. Thus, communication and collaboration among parents, teachers, and staff appear to be critical factors predicting the success of low-SES schools.

Advancement Via Individual Determination: Method Selection in Conclusions About Program Effectiveness

The authors present results of a 2-year mixedmethods evaluation study of Advancement Via Individual Determination (AVID; 2006), an academic intervention initiative supported by the Advanced Placement (AP) Incentive Program that targets middle-achieving students who have been underrepresented in advanced classes and 4-year colleges and that aims to increase their AP course and college enrollment. Results of the evaluation provide a mixed review of program effectiveness by year of implementation and method of inquiry, with highlights including universal stakeholder support and statistically significant differences between AVID and comparison students on a number of academic variables. The authors discuss implications of findings and suggestions for data triangulation.

Advisor-Teller Money Manager (ATM) Therapy for Substance Use Disorders

OBJECTIVE Patients with concomitant psychiatric and substance use disorders are commonly assigned representative payees or case managers to help manage their funds, but money management has not been conceptualized as a theory-based treatment. This randomized clinical trial was conducted to determine the effect of a money management-based therapy, advisor-teller money manager (ATM), on substance abuse or dependence. METHODS Ninety patients at a community mental health center who had a history of cocaine or alcohol abuse or dependence were assessed after random assignment to 36 weeks of ATM (N=47) or a control condition in which use of a financial workbook was reviewed (N=43). Patients assigned to ATM were encouraged to deposit their funds into a third-party account, plan weekly expenditures, and negotiate monthly budgets. Substance use calendars and urine toxicology tests were collected every other week for 36 weeks and again 52 weeks after randomization. RESULTS Patients assigned to ATM had significantly more negative toxicologies for cocaine metabolite over time than patients in the control group, and treating clinicians rated ATM patients as significantly more likely to be abstinent from illicit drugs. Self-reported abstinence from alcohol did not significantly differ between groups. Unexpectedly, patients assigned to ATM were more likely to be assigned a representative payee or a conservator than control participants during the follow-up period (ten of 47 versus two of 43). One patient in ATM assaulted the therapist when his check had not arrived. CONCLUSIONS ATM is an efficacious therapy for the treatment of cocaine abuse or dependence among people with concomitant psychiatric illness but requires protection of patient autonomy and staff safety.

Decreased Occipital Cortical Glutamate Levels in Response to Successful Cognitive-Behavioral Therapy and Pharmacotherapy for Major Depressive Disorder

Background: Previous studies have demonstrated that antidepressant medication and electroconvulsive therapy increase occipital cortical γ-aminobutyric acid (GABA) in major depressive disorder (MDD), but a small pilot study failed to show a similar effect of cognitive-behavioral therapy (CBT) on occipital GABA. In light of these findings we sought to determine if baseline GABA levels predict treatment response and to broaden the analysis to other metabolites and neurotransmitters in this larger study. Methods: A total of 40 MDD outpatients received baseline proton magnetic resonance spectroscopy (1H-MRS), and 30 subjects completed both pre- and post-CBT 1H-MRS; 9 CBT nonresponders completed an open-label medication phase followed by an additional/3rd 1H-MRS. The magnitude of treatment response was correlated with occipital amino acid neurotransmitter levels. Results: Baseline GABA did not predict treatment outcome. Furthermore, there was no significant effect of CBT on GABA levels. However, we found a significant group × time interaction (F1, 28 = 6.30, p = 0.02), demonstrating reduced glutamate in CBT responders, with no significant glutamate change in CBT nonresponders. Conclusions: These findings corroborate the lack of effect of successful CBT on occipital cortical GABA levels in a larger sample. A reduction in glutamate levels following treatment, on the other hand, correlated with successful CBT and antidepressant medication response. Based on this finding and other reports, decreased occipital glutamate may be an antidepressant response biomarker. Healthy control comparator and nonintervention groups may shed light on the sensitivity and specificity of these results.

Missing data techniques for multilevel data: implications of model misspecification

When modeling multilevel data, it is important to accurately represent the interdependence of observations within clusters. Ignoring data clustering may result in parameter misestimation. However, it is not well established to what degree parameter estimates are affected by model misspecification when applying missing data techniques (MDTs) to incomplete multilevel data. We compare the performance of three MDTs with incomplete hierarchical data. We consider the impact of imputation model misspecification on the quality of parameter estimates by employing multiple imputation under assumptions of a normal model (MI/NM) with two-level cross-sectional data when values are missing at random on the dependent variable at rates of 10%, 30%, and 50%. Five criteria are used to compare estimates from MI/NM to estimates from MI assuming a linear mixed model (MI/LMM) and maximum likelihood estimation to the same incomplete data sets. With 10% missing data (MD), techniques performed similarly for fixed-effects estimates, but variance components were biased with MI/NM. Effects of model misspecification worsened at higher rates of MD, with the hierarchical structure of the data markedly underrepresented by biased variance component estimates. MI/LMM and maximum likelihood provided generally accurate and unbiased parameter estimates but performance was negatively affected by increased rates of MD.

Financial Victimization of Adults With Severe Mental Illness

OBJECTIVE People with severe mental illness are vulnerable to having other people directly take or misappropriate their disability payments. This study investigated the prevalence of different types of financial victimization and the client characteristics associated with being financially victimized. METHODS Adults (N=122) receiving inpatient or intensive outpatient psychiatric treatment who received Social Security disability payments completed assessments about money management and victimization. A path model was used to estimate the association of victimization with participant characteristics. RESULTS Seventy percent of participants experienced at least one type of financial victimization in the preceding 28 days; 35% ran out of money because of victimization. Victimization was significantly associated with being younger, having had more psychiatric hospitalizations, having more recent alcohol use, and, most robustly, having problems managing money (β=.52, p<.01). CONCLUSIONS Financial victimization of disability recipients in acute care settings is common and more likely among people with recent substance use and difficulty managing their funds.

Build a better mouse: directly-observed issues in computer use for adults with SMI.

Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.

Acute Effects of Competitive Exercise on Risk-Taking in a Sample of Adolescent Male Athletes.

Exercise acutely reduces cravings for tobacco and alcohol, but the mechanism accounting for this relationship is not fully understood. To explore exercises effects on general risk-taking, we compared the performances of 20 adolescent male athletes on the balloon analog risk task (BART) immediately after periods of exercise (playing tennis) and rest. Statistically significant risk-taking effects were observed post-exercise. The established attenuating effect of exercise on desire for substance use did not extend to impulses for other risk behaviors in this study. In future studies, the moderating effects of participant characteristics and type of risk behavior should be considered.