SECTION ON BEHAVIORAL TREATMENTS AND APPLICATIONS
(Formerly the Sections on Behavioral Interventions and Treatment System Research)
Director: Kimberly Kirby, Ph.D.
Selected Past Projects
Family Training for Concerned Significant Others of Drug and Alcohol Users; Kimberly Kirby, Ph.D., Principal Investigator. In this NIDA-funded study, adults who were concerned about a treatment-resistant adult loved one with a drug or alcohol problem (concerned significant others/CSOs) were randomly assigned to one of three family-oriented treatments. Counselors completed weekly individual sessions with CSOs to help them learn healthier ways of interacting with their substance using loved one and to assist with the treatment referral process when it was requested by the loved one. Data analyses for this study are presently underway and will determine if the treatments varied in their ability to engage the substance user in treatment and to improve the CSO’s psychological well-being. The Significant Other Survey-SA, a measure of problems experienced by CSOs, was used in this study and may be of interest to researchers and clinicians who work with this population. A similar NIDA-funded study is presently being conducted by Dr. Kirby and her research team. This study, the Family Training Program for Parents of Adolescents, focuses on helping parents and guardians concerned about their adolescent child who is using marijuana, alcohol, or other drugs.
Survey of Counselors’ Attitudes toward Incentive Programs; Kimberly Kirby, Ph.D. The Provider Survey of Incentives (PSI), a 44-item survey, was developed and validated with 383 treatment providers to assess positive and negative beliefs regarding incentive interventions. Twenty-eight of the 44 items assess beliefs about both tangible and social incentives and 22 of the items are used to calculate two summary scores for tangible and social incentives. Both subscales demonstrated good internal consistency. The coefficient alpha estimate for the tangible subscale was .92, and the average item-total correlation was .56 (range = .39 - .75). The coefficient alpha for the social subscale was .90, and the average item-total correlation was .52 (range = .39 – .70).
Treatment Administrators’ Views of Empirically-Supported Drug Abuse Treatments: Lois Benishek, Ph.D. Financial concerns and limited resources for staff training are barriers to introduction of empirically supported drug abuse treatments (ESTs), according to this survey of clinical administrators conducted with funding from the Pennsylvania Department of Health and the National Institute on Drug Abuse. The survey was designed to 1) assess administrators’ knowledge of and attitudes toward ESTs versus treatments with little empirical support (ie, 12-step programs), 2) assess change in attitudes and willingness to implement ESTs after introduction of educational material, 3) investigate the extent to which administrators’ characteristics are associated with changes in their attitudes and willingness to implement ESTs, and (d) understand perceived barriers to and methods for integrating ESTs into existing outpatient treatment programs. Administrator subjects were surveyed prior to and after reading information about five treatments with varying levels of empirical support: contingency management (CM); relapse prevention, motivational interviewing, 12-step, and verbal confrontation. Results indicate that 1) knowledge of ESTs increased following the readings, 2) changes in the knowledge of ESTs did not translate into changes in beliefs about whether or not the intervention should be routinely used, and 3) financial concerns and limited resources for staff training are frequently reported barriers to implementing ESTs (CM).
Motivational Incentives to Enhance Drug Abuse Recovery; Kimberly Kirby, Ph.D.
Research shows that tangible rewards for drug-free urine samples reliably increase treatment retention and drug abstinence, but that applying incentives in practice is often prohibitively expensive for clinics. This study, part of a multisite trial under NIDA’s Clinical Trials Network, tested a less expensive reward system with cocaine-using patients in drug-free and methadone maintenance clinics. Through lottery drawing patients were given a 1:2 chance to earn low-cost items each time they submitted a cocaine-free urine, with substantially lower chance of earning a larger or a grand prize. In the drug-free outpatient settings, the incentive procedure cost an average of $68/month/participant and was efficacious in improving retention and abstinence outcomes. In the methadone clinics, at an average cost of $40/month/participant, similar improvements in abstinence rates were noted. Attendance rates were unchanged in the methadone group where rates of treatment attendance are typically high. View Publications.
Community Reinforcement through Religious Communities; Kimberly Kirby, Ph.D. Research has shown that individuals with influence over drug users can be trained to provide and withdraw rewards for abstinence, with corresponding improvement in patient rates of treatment entry and reduction in drug use. The usefulness of this Community Reinforcement Approach (CRA) is limited because many patients are not willing to involve family members in treatment or are socially isolated from their families, and because it requires considerable training and behavioral change on the part of counselors. This NIDA-funded project evaluated an adaptation of CRA, “CREST” or “Community Reinforcement Employing Spiritual Teams” where members of religious communities act as surrogates when it is not feasible for family members or significant others to assume this role. The initial study involved 18 African-American, cocaine-abusing women in residential treatment randomly assigned to 1) standard, drug-free treatment-as-usual; or 2) standard treatment-as-usual enhanced by pairing with volunteer mentors from the Bridges to the Community (BTC) program. At six months post-assignment, women in the BTC-enhanced group had significantly better treatment retention and less cocaine use than women receiving treatment-as-usual. A subsequent Behavior Therapy Development Grant from NIDA is specifying and enhancing the new CREST intervention using the principles of CRA. View Publication.
Credentialing Requirements of Substance Abuse and Mental Health Counselors; MaryLouise Kerwin, Ph.D. States are more likely to require mental health counselors to obtain training through formal education than substance abuse counselors according to this survey of 50 state governments and the District of Columbia. Compared to training and credentialing requirements for mental health counselors, states were more likely to allow substance abuse counselors learn on-the-job through “apprentice” programs and less likely to require certification or licensure. States also required fewer hours of formal coursework and practicum courses for substance abuse counselors, more hours of supervised work experience, and lower educational requirements. View Publication.
