Cost and cost-effectiveness of abstinence-contingent wage supplements for adults experiencing homelessness and alcohol use disorder.

Background: Alcohol use disorder, unemployment, and risk of homelessness are linked and often co-occurring, but most interventions do not address both alcohol use disorder and unemployment. The Abstinence-Contingent Wage Supplement (ACWS) model of the Therapeutic Workplace offers participants stipends or wage supplements contingent on both their abstaining from alcohol and engaging with an employment specialist or working in a community job. Wearable biosensors continuously tracked alcohol use.

Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial.

Achieving viral suppression in people living with HIV improves their quality of life and can help end the HIV/AIDS epidemic. However, few interventions have successfully promoted HIV viral suppression. The purpose of this study was to evaluate the long-term effectiveness of financial incentives for viral suppression in people living with HIV.

Rich-lean transitions produced by stimuli associated with accurate and inaccurate responding by pigeons.

Discriminable transitions from relatively favorable schedules of reinforcement to unfavorable schedules (rich-lean transitions) can produce disruptions in operant behavior. A prior evaluation in our laboratory (Toegel et al., 2021) found that placing a border around a key displayed on a resistive touchscreen increased pigeons' response accuracy relative to conditions without the border.

Latent factor structure of behavioral economic heroin and cocaine demand curves.

Research has shown that behavioral economic demand curve indices can be characterized by a two-factor latent structure and that these factors can predict dimensions of substance use. No study to date has examined the latent factor structure of heroin and cocaine demand curves. The objective of this study was to use exploratory factor analysis to examine the underlying factor structure of the facets of heroin and cocaine reinforcement derived from heroin and cocaine demand curves.

Being at work improves stress, craving, and mood for people with opioid use disorder: Ecological momentary assessment during a randomized trial of experimental employment in a contingency-management-based therapeutic workplace.

Employment problems are common among people with substance use disorders (SUDs), and improving vocational functioning is an important aspect of SUD treatment. More detailed understanding of the psychosocial benefits of employment may help refine vocational interventions for people with SUDs. Here, we used ecological momentary assessment to measure possible affective improvements associated with work.

The aversiveness of timeout from response-dependent and response-independent food deliveries as a function of delivery rate.

Seven experiments with rats assessed the aversiveness of timeout using punishment and avoidance procedures. Experiments 1 and 2 considered the contributions of stimulus change, suspending the response-reinforcer contingency, response prevention, the general disruption in the reinforcement schedule during time-in, and overall decreases in reinforcement. Results support the conclusion that response-contingent timeouts punish behavior because they are signaled periods during which an ongoing schedule of positive reinforcement is suspended.

Quality of life during a randomized trial of a therapeutic-workplace intervention for opioid use disorder: Web-based mobile assessments reveal effects of drug abstinence and access to paid work.

Background: Employment and improved quality of life (QOL) are, separately, valued outcomes of substance use disorder (SUD) treatment. It is also important to understand QOL changes caused by employment itself; therefore, we assessed QOL during a randomized trial of a contingency-management-based Therapeutic Workplace for people with opioid use disorder.

Methods: For 12 weeks, participants ( = 61) responded to QOL questionnaires in a mobile web app accessed with study-issued smartphones.

Effects of advance notice on transition-related pausing in pigeons.

Transitions between tasks can produce behavioral disruptions that are characterized as problematic. Advance notice, a procedure designed to reduce disruptions, involves presenting a stimulus to warn of the end of the ongoing activity and the nature of the upcoming activity. Clinical evaluations of advance notice have produced mixed results.

Psychosocial Interventions to Promote Undetectable HIV Viral Loads: A Systematic Review of Randomized Clinical Trials.

Suppressing HIV viral loads to undetectable levels is essential for ending the HIV/AIDS epidemic. We evaluated randomized controlled trials aimed to increase antiretroviral medication adherence and promote undetectable viral loads among people living with HIV through November 22, 2019. We extracted data from 51 eligible interventions and analyzed the results using random effects models to compare intervention effects between groups within each intervention and across interventions.

Technology-assisted opioid education for out-of-treatment adults with opioid use disorder.

Objective: To evaluate the feasibility and potential efficacy of a technology-assisted education program in teaching adults at a high risk of opioid overdose about opioids; opioid overdose; and opioid use disorder medications.

Method: A within-subject, repeated-measures design was used to evaluate effects of the novel technology-assisted education program. Participants ( = 40) were out-of-treatment adults with opioid use disorder, recruited in Baltimore, Maryland from May 2019 to January 2020.

Factors associated with obtaining employment among opioid use disorder patients enrolled in a therapeutic workplace intervention.

Background: Unemployment is a common problem among adults who have substance use disorder that often persists during treatment and recovery. We identified patient characteristics that were associated with obtaining employment among unemployed adults in opioid use disorder treatment.

Methods: This analysis used data from participants (N = 91) who were enrolled in a randomized controlled trial evaluating the effectiveness of a therapeutic workplace in promoting drug abstinence and employment.

Design and evaluation of a touchscreen apparatus for operant research with pigeons.

We developed a touchscreen apparatus for pigeons and conducted a series of experiments that assessed its utility for free-operant procedures. The apparatus incorporated an on-board Windows computer, an electromechanical interface, an amplified speaker, and the touchscreen. We found that merely projecting a virtual key on the screen was insufficient; too many pecks missed the key.

Remotely delivered incentives to promote buprenorphine treatment engagement in out-of-treatment adults with opioid use disorder.

Background: Opioid overdose remains a leading cause of death. Office-based buprenorphine could expand access to treatment to the many opioid users who are not in treatment and who are at risk for opioid overdose. However, many people in need of buprenorphine treatment do not enroll in treatment.

Employment outcomes of substance use disorder patients enrolled in a therapeutic workplace intervention for drug abstinence and employment.

Poverty is common among people who have substance use disorder. The therapeutic workplace addresses some of the interrelated and chronic problems of poverty, such as unemployment, lack of education and job skills, and drug use. A prior controlled trial showed that the therapeutic workplace was effective in promoting drug abstinence and self-reported community employment in unemployed adults in medication-assisted treatment for opioid use disorder.

Financial incentives promote engagement in employment services for unemployed adults in treatment for opioid use disorder.

Background: Promoting employment among unemployed adults with substance use disorder is a difficult challenge for which existing interventions have had limited effects. This study examined whether financial incentives could increase engagement in employment services for unemployed adults in treatment for opioid use disorder.

Methods: The study was conducted from 2014 to 2019 in Baltimore, MD.

Effects of incentives on viral suppression in people living with HIV who use cocaine or opiates.

Background: Antiretroviral therapy (ART) adherence is essential to maintenance of undetectable viral loads among people living with HIV, which improves health and reduces HIV transmission. Despite these benefits, some people living with HIV do not maintain the level of adherence required to sustain an undetectable viral load. This problem is particularly common among people who use drugs.

Effects of time-based administration of abstinence reinforcement targeting opiate and cocaine use.

Polydrug use is a common problem among patients in opioid-substitution treatment. Polydrug use has been reduced by administering abstinence-reinforcement contingencies in a sequence, such that a single drug is targeted until abstinence is achieved, and then an additional drug is targeted. The present study examined effects of administering abstinence-reinforcement contingencies sequentially based on time rather than on achieved abstinence.

Effects of incentivizing viral suppression in previously incarcerated adults living with HIV.

The amount of HIV in a person's blood can be suppressed to an undetectable level through antiretroviral therapy medications (ART). Adhering to an ART regimen can improve a person's health and reduce HIV transmission. Despite these benefits, many people with HIV do not maintain the level of adherence required to achieve an undetectable viral load.

Increased Reinforcer Immediacy can Promote Employment-Seeking in Unemployed Homeless Adults with Alcohol Use Disorder.

Unemployment, homelessness, and substance use are interrelated. The present study took place as part of a clinical trial aimed to promote employment and abstinence from alcohol in unemployed, homeless adults with alcohol use disorders. Participants earned abstinence-contingent financial incentives for completing employment-seeking activities and hourly stipends for working with an employment specialist.