Journal article
Examining Longitudinal Stimulant Use and Treatment Attendance as Parallel Outcomes in Two Contingency Management Randomized Clinical Trials
Journal of substance abuse treatment, Vol.61, pp.18-25
02/2016
Handle:
https://hdl.handle.net/2376/115968
PMCID: PMC4695378
PMID: 26456717
Abstract
The primary aim of this study was to examine stimulant use and longitudinal treatment attendance in one ‘parallel outcomes’ model in order to determine how these two outcomes are related to one another during treatment, and to quantify how the intervention impacts these two on- and off-target outcomes differently. Data came from two multi-site randomized clinical trials (RCTs) of contingency management (CM) that targeted stimulant use. We used parallel multilevel modeling to examine the impact of multiple pre-specified covariates, including selected Addiction Severity Index (ASI) scores, age and sex, in addition to CM on concurrent attendance and stimulant use in two separate analyses, i.e., one per trial. In one trial, CM was positively associated with attending treatment throughout the trial (β=0.060, p<0.05). In the second trial, CM predicted negative urinalysis (−UA) over the 12-week treatment period (β=0.069, p<0.05). In both trials, there was a significant, positive relationship between attendance and −UA submission, but in the first trial a −UA at both baseline and over time was related to attendance over time (r=0.117; r=0.013, respectively) and in the second trial, a −UA submission at baseline was associated with increased attendance over time (r=0.055).
These findings indicate that stimulant use and treatment attendance over time are related but distinct outcomes that, when analyzed simultaneously, portray a more informative picture of their predictors and the separate trajectories of each. This ‘indirect reinforcement’ between two clinically meaningful on-target (directly reinforced behavior) and off-target (indirectly reinforced behavior) outcomes is in need of further examination in order to fully exploit the potential clinical benefits that could be realized in substance use disorder treatment trials.
•The primary aim of this study was to examine treatment attendance and stimulant use in one ‘parallel outcomes’ model in order to determine how these two related outcomes impact one another during stimulant use disorder treatment.•In one trial, contingency management (CM) was positively associated with attending treatment throughout the trial (β=0.060, p<0.05), but it was not related to urinalysis (UA) status during the trial.•In the second trial, CM positively predicted −UA over the 12-week treatment period (β=0.069, p<0.05), and CM was not associated with attendance during the treatment period.•In both trials, there was a significant, positive relationship between attendance and −UA submission. In the first trial a −UA at both baseline and over time was related to attendance over time (r=0.117; r=0.013, respectively, p<0.05), but in the second trial only baseline −UA submission was related to attendance over time (r=0.055, p<0.05).•These findings indicate that stimulant use and treatment attendance over time are related but distinct outcomes that, when analyzed simultaneously, portray a more informative picture of their predictors and the separate trajectories of each.
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Details
- Title
- Examining Longitudinal Stimulant Use and Treatment Attendance as Parallel Outcomes in Two Contingency Management Randomized Clinical Trials
- Creators
- Sterling McPherson - Washington State University, College of NursingOlivia Brooks - Washington State University, College of NursingCelestina Barbosa-Leiker - Washington State University, College of NursingCrystal Lederhos - Washington State University, College of NursingAmanda Lamp - Washington State University, Program of Excellence in Addictions ResearchSean Murphy - Washington State University, College of NursingMatthew Layton - Washington State University, Program of Excellence in Addictions ResearchJohn Roll - Washington State University, College of Nursing
- Publication Details
- Journal of substance abuse treatment, Vol.61, pp.18-25
- Academic Unit
- Nursing, College of; Elson S. Floyd College of Medicine; Medical Education and Clinical Science, Department of; Health Policy and Administration, Department of
- Publisher
- Elsevier Inc
- Identifiers
- 99900548016701842
- Language
- English
- Resource Type
- Journal article