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| Verbal Behavior Approaches to Treatment |
| Tuesday, November 20, 2018 |
| 8:00 AM–10:30 AM |
| Independence Hall A |
| Domain: Service Delivery |
| Instruction Level: Basic |
| CE Instructor: Mark Galizio, Ph.D. |
| Chair: Mark Galizio (University of North Carolina Wilmington) |
| Discussant: Jonathan Bricker (University of Washington) |
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| Acceptance and Commitment Therapy: Understanding and Treating Addiction |
| KELLY WILSON (University of Mississippi) |
 Kelly G. Wilson, Ph.D., is a Professor of Psychology at the University at Mississippi. He is Past President of the Association for Contextual Behavioral Science, Representative-at-Large of the Society for a Science of Clinical Psychology, and is one of the co-founders of Acceptance and Commitment Therapy. Dr. Wilson received his B.A. Summa Cum Laude from Gonzaga University and his Ph.D. at the University of Nevada, Reno. After running a National Institutes on Drug Abuse clinical trial in Reno, he joined the faculty at the University of Mississippi in 2000 where he established the Mississippi Contextual Psychology Lab. Dr. Wilson is a devoted mentor a university-wide Elsie M. Hood Award for undergraduate teaching and also the University of Mississippi Award for Excellence in Graduate Teaching and Mentoring. Dr. Wilson has devoted himself to the development and dissemination of Acceptance and Commitment Therapy, Relational Frame Theory, and their underlying theory and philosophy for the past 28 years, publishing 53 articles, 37 chapters, and 10 books. He has central interests in the application of behavioral principles to understanding topics such as purpose, meaning, values, therapeutic relationship, and present moment focused work. Dr. Wilson has presented his research in 32 countries, and has participated as co-investigator in a wide range of research projects in the U.S. and internationally. |
| Abstract: Substance use disorders remain among the most difficult to treat psychological problems. Psychologists often avoid this area. They frequently have minimal training in the treatment of substance use disorders and relapse rates remain high even using our best-developed treatments. In this presentation, we will examine recovery from addiction and barriers to recovery through the lens of the psychological flexibility model. A broadly contextual model will be contrasted with narrow disease-oriented perspective. The application of behavioral principles to a verbally established sense of self and life-purpose will be examined. |
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| Cognitive Behavioral Therapy for Substance Use Disorders: Development and Evaluation of a Computerized CBT Program |
| BRIAN KILUK (Yale School of Medicine
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 I received my Ph.D. in clinical psychology in 2009 from the University of Maryland, Baltimore County, completed postdoctoral training at Yale through a National Institute on Drug Abuse T32 Fellowship, and ultimately joined the faculty ranks in the Department of Psychiatry in 2012. My area of research includes an emphasis on three major topics: (1) the evaluation and enhancement of a web-based version of cognitive behavioral therapy for alcohol and drug use disorders (CBT4CBT); (2) exploration of the mechanisms of cognitive behavioral therapy (CBT) for substance use disorders, and (3) the identification of clinically meaningful outcome indicators of clinical trials for illicit drug use disorders. I have received research grants from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, and my work has been featured at national scientific meetings. As an expert in CBT for substance use disorders, I have consulted with treatment facilities across the U.S. to provide workshop training in manual-guided CBT, as well as ongoing fidelity monitoring and coaching. |
| Abstract: Cognitive behavioral therapy (CBT) has strong empirical support for the treatment of various substance use disorders, yet it has been difficult to successfully implement in community treatment centers despite considerable effort toward dissemination. Technology-based interventions offer the potential to close the gap between research and clinical practice by providing a broadly accessible, standardized, cost-effective, and engaging method of delivering evidence-based treatments directly to clients, while also freeing up clinician time to address clients’ various psychosocial and case management needs. Moreover, from a research standpoint, the standardized delivery of treatment ingredients offers the potential for more precise evaluation of the interventions’ mechanisms of behavior change, compared to prior investigations that have been hindered by therapist variability with respect to fidelity, dose and quality of delivery. This session will focus on the development, evaluation, and implementation of one such technology-based intervention for substance use disorders, “Computer Based Training for Cognitive Behavioral Therapy” (CBT4CBT). Data will be presented from two completed randomized controlled trials supporting the efficacy of CBT4CBT as an adjunct to standard substance abuse treatment (Carroll et al., 2008; Carroll et al., 2014), as well as two recently completed trials supporting the safety and efficacy of CBT4CBT as a stand-alone treatment (Kiluk et al., 2016; Kiluk et al., under review). Factors considered during the design/development phase of the intervention, as well as the characteristics of ongoing trials that are intended to advance the understanding of mechanisms will be discussed. Finally, the session will conclude with a discussion of the future directions of CBT4CBT, which include attempts to improve treatment outcomes and dissemination strategies. |
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| Target Audience: Board certified behavior analysts; licensed psychologists; graduate students. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe how operant conditioning can be used to promote drug abstinence and adherence to medications; (2) describe parameters of operant conditioning that are critical to promoting drug abstinence in refractory patients and maintaining drug abstinence over time; (3) describe the main features of the therapeutic workplace; (4) describe how the therapeutic workplace uses contingent access to employment (i.e., employment-based reinforcement) to promote drug abstinence, medication adherence, work, and productivity; (5) describe three models for arranging long-term exposure to employment-based reinforcement in the treatment of drug addiction; (6) describe the theoretical link between mindfulness and acceptance processes and behavioral principles; (7) describe the theoretical link between values and behavioral activation processes and behavioral principles; (8) describe methods of directly linking valued action to mindfulness practices in the treatment of addiction. |
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| Behavioral Analysis, Drug Use, and Society |
| Tuesday, November 20, 2018 |
| 12:00 PM–2:30 PM |
| Independence Hall A |
| Domain: Service Delivery |
| Instruction Level: Intermediate |
| CE Instructor: Mark Galizio, Ph.D. |
| Chair: Mark Galizio (University of North Carolina Wilmington) |
| Discussant: Kevin Volpp (University of Pennsylvania) |
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| Changing Drug Use and Other Health-Related Behavior in Vulnerable Populations |
| STEPHEN T. HIGGINS (University of Vermont) |
 Stephen T. Higgins, Ph.D., is Director of the University of Vermont’s (UVM) Center on Behavior and Health, and Principle Investigator on five NIH grants on the general topic of behavior and health, including two center grants, two research grants, and an institutional training award. He is the Virginia H. Donaldson Endowed Professor of Translational Science in the Departments of Psychiatry and Psychology and serves as Vice Chair of Psychiatry. He has held many national scientific leadership positions, including terms as President of the College on Problems of Drug Dependence and the American Psychological Association’s Division on Psychopharmacology and Substance Abuse. He is the author of more than 300 journal articles and invited book chapters and editor of a dozen volumes and therapist manuals in the area of behavior and health. |
| Abstract: The U.S. lags far behind other industrial countries on major markers of population health. When population health experts assess this situation, they identify unhealthy behavior patterns (e.g., cigarette smoking, other substance use disorders, physical inactivity and poor food choices, non-adherence with recommended medical regimens) as the largest contributor to the status quo. These behavior patterns increase risk for chronic disease (e.g., cardiovascular disease, site-specific cancers, type-2 diabetes) and associated premature death. Hence, identifying strategies to promote and sustain behavior change is critical to resolving this national problem. Because these risk behaviors are overrepresented in socioeconomically disadvantaged and other vulnerable populations, they also drive health disparities. In this report, we review research that focuses on identifying effective behavior change strategies for reducing drug use and other risk behaviors in vulnerable populations. An extensive body of experimental preclinical and clinical research demonstrates that the reinforcement process plays a fundamental role in the acquisition and maintenance of drug use and other unhealthy behavior patterns. The research discussed here illustrates how that same reinforcement process can be leveraged in the form of incentives and other strategies to promote and sustain behavior change. The overarching focus is on drug use, but we also review research with other types of health problems, illustrating the trans-disease influence of reinforcement and the broad generality of behavior-change strategies that leverage that process. |
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Application of Operant Conditioning to Address the Interrelated Problems of Poverty, Drug Addiction, and HIV |
| KENNETH SILVERMAN (Johns Hopkins University) |
 Kenneth Silverman has been in the Department of Psychiatry and Behavioral Sciences in the Johns Hopkins University School of Medicine since 1989 and is currently a Professor in the department. His research has focused on developing operant treatments to address the interrelated problems of poverty, drug addiction, and HIV. His primary research has focused on the development and evaluation of abstinence reinforcement interventions for the treatment of heroin and cocaine addiction in low-income, inner city adults; financial incentives to promote adherence to antiretroviral medications and viral suppression in people living with HIV; the development of the therapeutic workplace intervention and the use of employment-based reinforcement in the long-term maintenance of drug abstinence, adherence to addiction treatment medications, and employment; and the development of computer-based training to establish critical academic and job skills that unemployed adults need to gain and maintain employment and escape poverty. |
| Abstract: Poverty is a pervasive risk factor underlying poor health, including drug addiction and HIV. This presentation will review research on the utility of operant conditioning to address the interrelated problems of poverty, drug addiction, and HIV. Our research has shown that operant reinforcement using financial incentives can promote abstinence from cocaine and heroin in low-income adults with long histories of drug addiction and adherence to antiretroviral medications in low-income adults living with HIV. Our research has also shown that financial incentives are most effective when high-magnitude incentives are used, and that long-duration abstinence reinforcement can serve as an effective maintenance intervention. The utility of operant conditioning to promote behaviors needed to escape poverty is less clear, but research on an operant employment-based intervention called the therapeutic workplace shows some promise. In the therapeutic workplace, low-income or unemployed adults are hired and paid to work. To promote drug abstinence and/or medication adherence, employment-based reinforcement is arranged in which participants are required to provide drug-free urine samples and/or take prescribed medication to maintain access to the workplace and maximum pay. Because many low-income adults lack skills needed for gainful employment, the therapeutic workplace offers job-skills training and employment phases through which participants progress sequentially. Our research has shown that employment-based reinforcement within the therapeutic workplace can promote and maintain drug abstinence, medication adherence, work, and other adaptive behaviors that people need to move out of poverty. The therapeutic workplace could serve as a model anti-poverty program, particularly for people with histories of drug addiction or other health problems, although more research on the therapeutic workplace is needed that targets poverty directly. |
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| Target Audience: Board certified behavior analysts; licensed psychologists; graduate students. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe how operant conditioning can be used to promote drug abstinence and adherence to medications; (2) describe parameters of operant conditioning that are critical to promoting drug abstinence in refractory patients and maintaining drug abstinence over time; (3) describe the main features of the therapeutic workplace; (4) describe how the therapeutic workplace uses contingent access to employment (i.e., employment-based reinforcement) to promote drug abstinence, medication adherence, work, and productivity; (5) describe three models for arranging long-term exposure to employment-based reinforcement in the treatment of drug addiction; (6) the central role that lifestyle and the reinforcement process more specifically contributes to risk for chronic disease and premature death; (7) discuss how the reinforcement process can be leveraged to promote behavior change and improved health; (8) the reinforcement process can be leveraged to promote behavior change at the level of clinical interventions directed at individuals and policies directed at populations. |
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| Closing Remarks: Reducing the Nation's Drug Abuse Problems Through Effective Public Policy |
| Tuesday, November 20, 2018 |
| 2:30 PM–3:00 PM |
| Independence Hall A |
| Domain: Theory |
| Chair: Mark Galizio (University of North Carolina Wilmington) |
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Closing Remarks: Reducing the Nation's Drug Abuse Problems Through Effective Public Policy |
| ANTHONY BIGLAN (Oregon Research Institute) |
 Anthony Biglan, Ph.D., is a Senior Scientist at Oregon Research Institute. He is the author of The Nurture Effect: How the Science of Human Behavior Can Improve our Lives and Our World.
Dr. Biglan has been conducting research on the development and prevention of child and adolescent problem behavior for the past 30 years. His work has included studies of the risk and protective factors associated with tobacco, alcohol, and other drug use; high-risk sexual behavior; and antisocial behavior. He has conducted numerous experimental evaluations of interventions to prevent tobacco use both through school-based programs and community-wide interventions. And, he has evaluated interventions to prevent high-risk sexual behavior, antisocial behavior, and reading failure.
In recent years, his work has shifted to more comprehensive interventions that have the potential to prevent the entire range of child and adolescent problems. He and colleagues at the Center for Advanced Study in the Behavioral Sciences published a book summarizing the epidemiology, cost, etiology, prevention, and treatment of youth with multiple problems (Biglan et al., 2004). He is a former president of the Society for Prevention Research. He was a member of the Institute of Medicine Committee on Prevention, which released its report in 2009 documenting numerous evidence-based preventive interventions that can prevent multiple problems. As a member of Oregon’s Alcohol and Drug Policy Commission, he is helping to develop a strategic plan for implementing comprehensive evidence-based interventions throughout Oregon.
Information about Dr. Biglan’s publications can be found at http://www.ori.org/scientists/anthony_biglan. |
| Abstract: These closing remarks will attempt to draw out the implications of the evidence presented in this conference for public policy. The evidence to be presented at the conference points to numerous ways in which we can reduce drug abuse. However, the widespread and effective implementation of these evidence-based strategies will require us to articulate and advocate for public policies that will make effective strategies available and that will prevent the development of drug abuse in the first place. I will briefly present a number of specific policies that could be advocated and will then discuss the steps that individual behavioral scientists and behavioral science organizations could take to advance these policies. |
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