Physical education (PE) classes provide another context in which physical activity is expected to occur, even though research suggests that activity levels during PE classes are lower than they could or should be. The first four intervention sessions focused on encouraging Karen to eat solid foods, encouraging family support, and encouraging her to eat foods of increasing viscosity during the intervention sessions. Cocaine is a potent stimulant of the central nervous system, potentiating the action of central catecholamine neurotransmitters, norepinephrine, and dopamine. Finally, the paper draws attention to the special characteristics of this technique which distinguish its applications from other types of contingency management procedures. Contigency contracting. It is important to emphasize that biomarkers do not provide the final answer to the question of whether an individual has consumed a given drug during some time period. Operant Conditioning . All participants lost weight, though the weight loss was relatively small. Concerns, if any, are addressed, and results of the Youth Satisfaction with Parent Scale are disclosed. If the guardian is interviewed first, the counselor provides the youth with self-report questionnaires to complete in the waiting room. Therapists then implement, in a matter-of-fact manner, the consequences that have been established during contingency contracting procedures for positive urine assays (see Contingency Contracting section below). 550–559), Self-management strategies (Cooper et al., 2007, pp. This is done to give the conflicting parties practice at the contracting process and to experience success in problem-solving. Contingency contracting is an intervention that involves identifying a behavior, the conditions under which the behavior is supposed to occur, and the consequences for both achieving the goal and failing to perform to a criterion. In a set of two studies using a pre/post design, Iverson and colleagues (Iverson, Jurs, Johnson, & Rohen, 1978; Iverson & Roberts, 1980) conducted a community education-based program for parents and adolescents and found significant reductions in drug use at post-treatment and six-month follow-up. Contigency contracting. We believe it is important to disseminate assessment findings, and assess patient expectations, for several reasons. For example, biomarkers provide a complement to self-report/interview methods of obtaining consumption data in situations in which there may be an incentive for the client/patient, or the research participant, to underreport his or her consumption. These cases used, Iverson, Jurs, Johnson, & Rohen, 1978; Iverson & Roberts, 1980, Catalano, Hawkins, Wells, Miller, & Brewer (1990–91), Innovations in Adolescent Substance Abuse Interventions, Hodges, Kline, Stem, Cytryn & McKnew, 1982, Sobell, Sobell, Klajner, Pavan & Basian, 1986, Watches for the occurrence of the target behavior for the identified interval, Delivers reinforcement when target behavior does not occur during each interval, Resets the interval when target behavior occurs, Identifies an alternative behavior to reinforce (ideally a communicative response), Provides the functional reinforcer when the alternative behavior occurs, Implements an extinction procedure when target behaviors occur, Prompts the alternative behavior when establishing operation is in place prior to the occurrence of target behaviors, Identifies a response that is incompatible with the target behavior, Delivers the functional reinforcer contingent on the occurrence of the incompatible response, Uses an extinction procedure when target behaviors occur, Prompts the occurrence of the incompatible response when the establishing operation is in place and prior to the occurrence of the target behavior, Identifies the initial time based schedule based on the inter-response times during baseline, Delivers the functional reinforcer at the appropriate times, Increases the amount of time between reinforcer delivery once response suppression is achieved, Identifies appropriate target behaviors to reinforce, Identifies specific target behaviors for response cost, Contract contains the target behaviors stated in positive terms, Contract includes the criteria necessary to access reinforcement, Contract includes information regarding the reinforcement to access, Target behavior identified and operationally defined, Program includes a plan for training the client on self-recording, Program includes a self-reinforcement component, Program includes a plan for initial oversight to ensure fidelity of implementation, Antecedent interventions appropriate based on function, Alternative behavior is appropriate based on function, Procedures to teach alternative behavior are appropriate based on the response selected, Reinforcement procedures are appropriate based on function, Extinction procedures are appropriate based on function and are safe given the target behaviors addressed. One way to enhance the reliability and validity of accelerations is to require one type of activity, such as walking. A clinical trial comparing placebo to 400 mg modafinil in 62 cocaine-dependent subjects, also receiving twice-weekly CBT, found significant decreases in cocaine use (Dackis et al., 2003). In addition, when confronted with objective biomarker data, patients/clients often admit to substance use that they had denied previously. What makes you think that?….”). She was reported to be 106 pounds at that time (i.e., the 50th percentile in weight for a girl her age). LO1 Define operant conditioning and at least five of its basic principles. At least during the initial stages of interventions, we believe it is very important to test the youth’s urine for illicit drugs during each session to provide an objective measure of substance use. For operant conditioning to work, the rewards and punishments should be reliable. Contingency Management (CM) Contingency Management is often called motivational incentives, the prize method, or the carrot and stick method.. So far, there are no FDA-approved medications for the adjunctive treatment of cocaine dependence. A clinical trial in 121 cocaine-dependent patients randomized to placebo or disulfiram, also receiving one of two types of behavioral therapy, showed a significant reduction in cocaine use in the disulfiram group (Carroll, 1994). All six participants increased their activity according to experimenter-arranged criteria. In such contexts, which occur often in the alcohol and drug treatment field, biomarkers and self-report methods may be viewed from a methodological perspective as two different ways to estimate the same variable (actual consumption over a specified time), a point elaborated upon later in this chapter. Implementing Time Based Schedule of Reinforcement, Table 6.15. For example, a teenager may agree to attend school, adhere to curfew, and complete homework in exchange for visits with friends, money, and special privileges. Developing a Group Contingency, Table 6.17. That is, many people appear to simply enjoy exergaming and the associated improvements in balance, muscle tone, and coordination (Harvard Heart Letter, 2012). 489–492), Extinction (Cooper et al., 2007, pp. In fact it is far more often the case that testing will indicate no use, when in fact drug use has occurred, since illicit drugs other than marijuana (“hard drugs”) are excreted rapidly, making it difficult to detect these drugs. Example in everyday context: Your cell phone lights up and you see a text from an acquaintance. In these cases, we instruct therapists to simply tell the youth that the report indicates drug use, and that the youth will need to avoid similar situations in the future, particularly since a goal of treatment is to avoid drug associated stimuli. A pedometer is a mechanical device typically worn at the waist to record the number of steps taken by the wearer, with many models being relatively inexpensive and accurate enough for research purposes (e.g., Schneider, Crouter, & Bassett, 2004; Tudor-Locke, 2002). An Introduction to Operant Conditioning (Instrumental Conditioning) Operant conditioning, also known as Instrumental Conditioning, informs us of the interaction between environmental stimuli and our behaviours. Thus, Wysocki et al. Presentation of the biomarker results could provide the basis of discussion and of obtaining a more accurate and clinically useful self-report of consumption for that occasion as well as in future assessments. These studies were limited by small sample sizes, lack of control or comparison conditions and, in many cases, only anecdotal reporting of substance use behavior. One of the simplest operant conditioning techniques to stop smoking is the contingency contract. This operant conditioning intervention is based on a mutually agreed contract between clinician and client, stating that the client agrees to perform certain behaviors. De Luca and Holborn examined the effects of fixed-interval (De Luca & Holborn, 1985) and fixed-ratio (De Luca & Holborn, 1990) schedules of reinforcement on the rate obese and nonobese boys pedaled a stationary exercise bicycle. Broad screen assays (testing a variety of drugs; e.g., amphetamines, barbiturates, marijuana, cocaine, PCP, heroin) may be analyzed by professional companies for about $10.00 each. Stephen A. Maisto, Marketa Krenek, in Evidence-Based Addiction Treatment, 2009. Table 6.11. since contingency contracting was implemented. Recent research by the BFRU has expanded the established Food Dudes program to address physical activity. After a specific behavior (e.g., curfew) is defined as the presenting problem, each party (e.g., parent and adolescent) develops parameters to indicate how they would like the behavior defined and what consequences may follow its presence or absence. Chronic users experience dysphoria, depression, and drug craving with abstinence. Operant conditioning is implemented in brain-machine interfaces (BMI) to induce rapid volitional modulation of single neuron activity to control arbitrary mappings with an external actuator. Contingency management (CM), the systematic reinforcement of desired behaviors and the withholding of reinforcement or punishment of undesired behaviors, is an effective strategy in the treatment of alcohol and other drug (AOD) use disorders. The treatment’s central feature is an abstinence reinforcement contingency in which patients earn monetary reinforcement for providing cocainefree urine samples. negative urine drug screen tests), the number of chips they are allowed to draw from the bowl increases. She was provided a bonus opportunity that included a plane ticket to visit her out-of-state brother if she gained 5 lbs. This article describes a research program to develop an operant treatment for cocaine addiction in low-income, treatment-resistant methadone patients. The target client collaborates with the practitioner to develop the contract and then signs the contract to indicate agreement with the contingencies outlined. This paper resolves the above problems by presenting a set of definitive requirements of contingency contracting from an operant point of view. In other behavioral investigations, Duehn (1978) evaluated the effectiveness of aversive conditioning for adolescents with severe drug-use histories. What do you think will happen to your school attendance during the next few months?…. Definition: Consequences that result in an increase or decrease the frequency in the same type of behavior under similar conditions. A major question for this chapter is what biomarkers offer clinicians and clinical researchers in their need to estimate drug consumption. In their review of nonfamily-based treatments, Catalano, Hawkins, Wells, Miller, & Brewer (1990–91) addressed the limitations of these studies and could only conclude that some treatment is better than no treatment. Many of these demonstrations may need to be completed in a roleplay format as opposed to working directly with clients, due to the sensitive nature of recording clients exhibiting problem behavior. If the youth denies use, therapists report that the tests are highly valid and the most objective indicator of drug use. In the case of Marijuana, which although rarely may be detected for up to two or three weeks (particularly when youth are obese, inactive, and have recently consumed a large quantity of marijuana), most drug testing companies will report the level of THC found in the urine. However, although this section has been necessarily brief, it is apparent from its contents that a number of factors (i.e., the chemical composition of the drug in question, its pharmacokinetics, the biological sample used, and the laboratory procedures followed in handling and analyzing a sample) may affect the validity or accuracy of a drug test. Christopher A. Kearney, Jennifer Vecchio, in Encyclopedia of Psychotherapy, 2002. Holly B. Waldron, in Comprehensive Clinical Psychology, 1998. per week, and continued to attempt foods with greater viscosity, she maintained “green status.” Green status meant that she would receive one therapy session per week instead of two sessions, eat home meals in a room of her choice instead of being restricted to the dining room, be able to make long distance phone calls to her brother to report treatment gains, be able to leave the dinner table as soon as her meal was consumed instead of being restricted to the table for about 40 min, and be able to go to the grocery store with her mother to choose her favorite foods. You’re also skipping half your classes at school. Accordingly, it focuses attention on the importance of both the discovery and control of relevant consequences of adult behaviors in their natural settings and the reliable measurement of those behaviors. Finally, provide information regarding the use of punishment and the conditions under which these interventions should be used. This includes a focus on utilizing differential reinforcement procedures and extinction procedures based on the function of the behavior. This week we discussed and reviewed what respondent and operant conditioning were and the differences between the two. Provide instruction regarding focusing on function based interventions for individualized interventions. They reported that one-third of the total sample remained drug free. Failure to perform these behaviors may result in aversive consequences, whereas successful performance leads to rewards. per week, she was put on “red status,” which meant that Karen did not have an opportunity to earn the preceding rewards. Relapses are common. Interestingly, a pilot trial testing topiramate in cocaine dependence showed that topiramate-treated subjects were more likely to be abstinent from cocaine compared to placebo-treated subjects (Kampman et al., 2004). The therapist initiates the first treatment session with verbal reinforcement, telling the youth and parent something positive about their participation in the assessment sessions (e.g., being candid, cooperative, pleasant). Youth often argue that positive test results for marijuana are due to breathing marijuana smoke of someone else. Its effects include increased arousal, euphoria, a sense of creativity, expansiveness, excitement, and motor activation. While the Fit “n” Fun Dudes program has not yet been refined to the same degree as the Food Dudes program, BFRU researchers have specified long-term maintenance of effects as a goal for future research, and the early research looks promising. However, the symptoms have no identifiable organic etiology. Karen, a 12-year-old, Hispanic female, presented to an outpatient psychology clinic with a 5-month history of eating only stage II baby food and frozen yogurt. After the parent interview is concluded, the therapist collects the questionnaires from the youth and carefully checks to make sure the youth has completed all items correctly. Operant conditioning was first described by behaviorist B.F. Skinner, which is why you may occasionally hear it referred to as Skinnerian conditioning. It is important that clinicians recognize these factors and how they may affect the interpretation of biomarker findings, as well as the need to follow up initial positive drug tests with a confirmatory test. Brad Donohue, Nate Azrin, in Innovations in Adolescent Substance Abuse Interventions, 2001.
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