Lois A. Benishek

Prize-based Contingency Management for the Treatment of Substance Abusers: A Meta-analysis

AIM To review randomized controlled trials to assess efficacy of a prize-based contingency management procedure in reducing substance use (where a drug-free breath or urine sample provides a chance of winning a prize). METHODS A meta-analysis was conducted on papers published from January 2000 to February 2013 to determine the effect size of studies comparing prize-based contingency management to a treatment-as-usual control condition (k = 19 studies). Parallel analyses evaluated the efficacy of both short- (k = nine studies) and long-term outcomes (k = six studies) of prize-based contingency management. RESULTS The average end-of-treatment effect size (Cohens d) was 0.46 [95% confidence interval (CI) = 0.37, 0.54]. This effect size decreased at the short-term (≤3-month) post-intervention follow-up to 0.33 (95% CI = 0.12, 0.54) and at the 6-month follow-up time-point there was no detectable effect [d = -0.09 (95% CI = -0.28, 0.10)]. CONCLUSION Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence, but the effect does not appear to persist to 6 months.

Prevalence and Frequency of Problems of Concerned Family Members with a Substance Using Loved One

Background: Limited research has examined the prevalence and frequency of specific problems of concerned family members and significant others (CSOs) of alcohol- or substance-using individuals (SUIs). Objectives: We surveyed CSOs of SUIs to determine the prevalence and frequency of their problems and explored whether relationship to the SUI, gender of the CSO, or living arrangements altered problem prevalence and frequency. Methods: Non-substance-using CSOs (n = 110) completed the Significant Other Survey, which asks about problems in seven domains (emotional; family; relationship; financial; health; violence; legal). Problem outcomes were compared based on the CSOs relationship to the SUI (partner or spouse vs. parent), gender of the CSO (male vs. female), and living arrangements of the CSO and the SUI (residing together vs. residing apart). Results: Problems were prevalent with at least two-thirds of the participants endorsing one or more problems in all but the legal domain. They also occurred frequently, with CSOs reporting problems on one-third to one-half of the past 30 days, in all but the violence and legal domains. Problems tended to be greater for CSOs who were partners, females, or living with the SUI. Conclusion: CSOs experience frequent problems in a wide range of life domains and the types of difficulties they experience appear to differ based on type of relationship, gender, and their living arrangement relative to the SUI. Scientific Significance: This investigation expands our understanding of the specific problems that CSOs face. The findings have important implications for treatment and health policy regarding these individuals.

Development of the Significant Other Survey: An Interview for Family Members of Substance Users

The Significant Other Survey (SOS) is a semi-structured interview designed to measure the multidimensional problems experienced by family members with a substance abusing loved one. This article describes the development of the SOS and its psychometric properties based on data obtained from significant others of 110 substance abusing adults. Interrater and test-retest reliability estimates were within acceptable ranges, adequate internal consistency was demonstrated for six of seven problem domains, and the problem domains were low to moderately correlated with each other. Issues related to future instrument development and the utility of the SOS for both family practitioners and researchers are described.

Randomized clinical trial examining duration of voucher-based reinforcement therapy for cocaine abstinence

BACKGROUND This is the first study to systematically manipulate duration of voucher-based reinforcement therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT. METHODS We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n=62) or Extended (36 weeks; n=68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every 2 weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week). RESULTS Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1-24 (5.7 vs 2.7 weeks; p=0.003) and proportionally more abstinence during weeks 24-36 (X(2)=4.57, p=.03, OR=2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p=0.001) and during the last 12 weeks of the study (p<0.001). Extended VBRT averaged higher monthly voucher costs compared to Standard VBRT (

Developing Community Reinforcement and Family Training (CRAFT) for Parents of Treatment-Resistant Adolescents

96 vs

Matching Consequences to Behavior: Implications of Failing to Distinguish between Noncompliance and Nonresponsivity

43, p<.001); however, the average cost per week of abstinence attained was higher in the Standard group (

Analyzing components of Community Reinforcement and Family Training (CRAFT): Is treatment entry training sufficient?

8.06 vs

Social adjustment of women with and without a substance-abusing partner.

5.88, p<.001). Participants in the Extended group with voucher costs exceeding

Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction

25 monthly averaged 20 weeks of continuous abstinence. CONCLUSIONS Greater abstinence occurred during Extended VBRT, but providing a longer duration was not by itself sufficient to maintain abstinence after VBRT. However, if abstinence can be captured and sustained during VBRT, then providing longer durations may help increase the continuous abstinence that predicts better long-term outcomes.

Contingency management works, clients like it, and it is cost-effective

We describe a project focused on training parents to facilitate their treatment-resistant adolescent’s treatment entry and to manage their child after entry into community-based treatment. Controlled studies show that Community Reinforcement and Family Training (CRAFT) is a unilateral treatment that fosters treatment entry of adults; however, there are no controlled trials for parents with a substance-abusing child. We examined the behavioral parent training literature to guide us in tailoring CRAFT for parents of adolescents. We discuss adaptations to CRAFT, outcomes and experiences gained from a brief pilot of the revised CRAFT program, and the future directions of this work.