Mark A. Belding

Reinforcing operants other than abstinence in drug abuse treatment: an effective alternative for reducing drug use.

This study examines the effectiveness of using vouchers to reinforce either the provision of urine samples testing negative for illicit drugs (UA group) or the completion of objective, individually defined, treatment-plan-related tasks (TP group). A third group was assigned to the clinics standard treatment (STD group). Participants were randomly assigned to groups after a 6-week baseline-stabilization period. Urine specimens were collected thrice weekly throughout the study. In the UA condition, participants earned

Natural classes of treatment response.

5 (U.S. dollars) in vouchers for each drug-free urine submitted. In the TP condition, participants earned up to

Identifying methadone maintenance clients at risk for poor treatment response: pretreatment and early progress indicators

15 in vouchers per week for demonstrating completion of treatment plan tasks assigned by their counselors. Contingencies were in effect for 12 weeks, after which all participants received the clinics standard treatment. Urinalysis results indicate that the TP intervention was significantly more effective in reducing illicit drug use than either the UA or STD interventions. These effects were maintained with a trend toward continuing improvement for the TP groups even after contingencies were discontinued.

Stages and processes of change among polydrug users in methadone maintenance treatment

This study examines an approach to identifying patterns of treatment response over time. Treatment response profiles are identified by cluster analyzing a repeated measure of patient performance collected at intervals during treatment. The procedure is demonstrated in Study 1 using monthly urinalysis results of 103 patients entering methadone maintenance treatment. The internal, external, and face validities of derived treatment response profiles are evaluated. A logistic regression model predicting treatment response is then constructed from intake variables found to correspond with the treatment response profiles. Study 2 replicates the procedures on an independent sample. Treatment response profiles facilitate the analysis of treatment response offering advantages over common measures of treatment outcome, such as performance at follow-up, change in performance from treatment entry to follow-up, or performance summed across treatment.

Stages and processes of change as predictors of drug use among methadone maintenance patients.

Exhaustive searches have uncovered few demographic or other pretreatment factors that reliably predict performance in substance abuse treatments. In this study we evaluate whether early treatment response offers improved prediction of treatment response 6 and 9 months later. New admissions to methadone maintenance treatment (n = 59) were dichotomized into outcome groups based on treatment retention and ongoing drug use as revealed by urinalysis results 6 and 9 months after admission. Regression analyses revealed two early (week 2) performance measures, counseling attendance and opiate abstinence, could be used to correctly classify, the outcomes of more than 80% of the sample. Strikingly, of the 20 participants who neither submitted an opiate-negative urine sample in week 2 nor attended at least two scheduled counseling sessions by that time, not one achieved a superior 6-month outcome. The odds of having a superior outcome increased considerably for those who submitted two opiate negative urine samples and attended two counseling sessions by week 2. Thus, 6-month outcomes were well predicted by treatment performance in week 2. Similar results are reported for month 9 outcomes.

Coping strategies and continued drug use among methadone maintenance patients

We applied the stages-of-change model of Prochaska and DiClemente to the problem of drug use among methadone maintenance patients to examine correlates of different stages of treatment readiness. The 276 subjects were divided into stage categories based on self-reported drug use and questionnaire responses regarding plans to discontinue unauthorized drug use in the future. Confirmatory factor analytic procedures validated four process scales derived from a 60-item questionnaire. Each stage was characterized by a profile of change-process scores largely consistent with predictions, though these scores did not distinguish stages as clearly as has been reported in previous research. Analysis of subject characteristics revealed that those in the Precontemplation stage reported significantly longer treatment tenures than subjects in any other stage besides Maintenance.

Stages of change in methadone maintenance: Assessing the convergent validity of two measures

In this study the authors evaluated the predictive validity of stages-of-change and processes-of- change measures among methadone maintenance patients. One month after treatment entry, participants completed questionnaires providing stage and process scale scores regarding readiness to discontinue polydrug use. Participants also completed an algorithm assigning them to a stage category on the basis of their stated intentions regarding quitting. The algorithm predicted urinalysis results during a 12-week posttest period; however, only 1 stage scale (contemplation) and no process scales correlated significantly with outcome. In a hierarchical regression, stage and process scale scores significantly improved prediction of posttest abstinence beyond that afforded by baseline drug-free urine rates, but this effect was attributable to the contemplation scale alone. Despite their widespread use, stage and process scales have yet to demonstrate clearly predictive validity.

Assessing the helping alliance and its impact in the treatment of opiate dependence

Drug addiction has been conceived as a maladaptive means of coping utilized by individuals unable or unwilling to deal with stresses in more adaptive ways. Although a growing body of evidence supports the link between alcohol abuse and maladaptive coping styles, there is relatively little empirical support for the connection between maladaptive coping and other kinds of drug use. The present study employed a cross-sectional design to assess coping and drug use in a sample of 276 methadone maintenance patients. Structural equation modeling was used to assess the factor structure of the coping measure and the relationship between coping and unauthorized drug use. The results suggest that coping and drug use are related in this population and that this relationship is different for Black patients than for White patients.