Including Contingency Management Research Articles

Tobacco use behaviors and views on engaging in clinical trials for tobacco cessation among individuals who experience homelessness

BackgroundClinical trials that include contingency management for smoking cessation have shown promising results for short-term quitting, but none have explored this approach for long-term abstinence in people experiencing homelessness. We designed a clinical trial of an extended contingency management intervention for smoking cessation for people experiencing homelessness. This study has two aims: (1) to explore tobacco use behaviors, and views toward smoking cessation, and (2) to explore factors influencing acceptability of engaging in such a trial in a sample of adult smokers experiencing homelessness. MethodsWe administered a questionnaire to obtain information on tobacco use behaviors and conducted in-depth, semi-structured interviews with 26 patients who had experienced homelessness and were patients at a safety net health clinic in San Francisco, California, where we planned to pilot the intervention. We obtained information on triggers for tobacco use, prior cessation experiences, attitudes toward cessation, attitudes toward engaging in a clinical trial for cessation, and factors that might influence participation in our proposed contingency management clinical trial. We analyzed transcripts using content analysis. ResultsParticipants described the normative experiences of smoking, co-occurring substance use, and the use of tobacco to relieve stress as barriers to quitting. Despite these barriers, most participants had attempted to quit smoking and most were interested in engaging in a clinical trial as a method to quit smoking. Participants noted that desirable features of the trial include: receiving financial incentives to quit smoking, having a flexible visit schedule, having the study site be easily accessible, and having navigators with lived experiences of homelessness. ConclusionA patient-centric clinical trial design that includes incentives, flexible visits and navigators from the community may increase feasibility of engaging in clinical trials among individuals experiencing homelessness.

Reducing problematic social media use via a package intervention.

Problematic social media use can be characterized as that which interferes with relationships, work, school, or sleep. Currently, there are no empirically supported treatments for reducing problematic social media use. We tested a package intervention to reduce the daily duration of social media use measured by a smartphone application with nine undergraduate students who scored as "addicted" to social media via a version of the Internet Addiction Test. The package intervention included contingency management, automated notifications of application use, and the selection of alternative activities. The package intervention was effective at reducing the daily duration of social media use to goal levels, or below, for all participants. Eight out of nine participants showed a decrease in their Internet Addiction Test scores from pre- to postintervention, and overall, participants did not show an increase in the time spent engaged in their selected alternative activities. These findings demonstrate that social media use is amenable to behavioral treatment.

A Behavior-Analytic Approach to Antivaccination Practices.

In recent years, there has been an increase in outbreaks of diseases that are preventable by vaccination. As vaccination involves behavior, behavior analysts are uniquely positioned to contribute solutions to this socially significant problem. The present article explores a behavior-analytic approach to understanding the function of the behavior of both people who have their children vaccinated and those who do not have their children vaccinated, and potential interventions to increase vaccination rates. An introduction to the problem is followed by a brief history of the antivaccination movement. In our analysis, a failure to vaccinate is conceptualized as a noncompliance response (i.e., medical nonadherence), and conditions giving rise to that noncompliance are evaluated. In this process, the roles of avoidance, the functional-altering impact of rule-governed behavior, relational frames, and countercontrol are considered. Potential solutions informed by applied behavior-analytic literature, including contingency management and behavioral safety, are discussed.

Efficacy and cost-effectiveness of an adjunctive personalised psychosocial intervention in treatment-resistant maintenance opioid agonist therapy: a pragmatic, open-label, randomised controlled trial

Opioid use disorder is a chronic, debilitating, and costly disorder that has increased in prevalence in many countries, with an associated sharp rise in mortality. Maintenance opioid agonist therapy is the first-line treatment, but many patients do not stop using illicit or non-prescribed drugs concomitantly. We aimed to test the efficacy and cost-effectiveness of a personalised psychosocial intervention implemented with a toolkit of behaviour-change techniques as an adjunct to opioid agonist therapy. We did a pragmatic, open-label, randomised controlled trial at a specialist UK National Health Service community addictions clinic in London, UK. Eligible patients were aged 18 years or older, met criteria for opioid or cocaine dependence, or both, in the past 12 months, and voluntarily sought continued oral maintenance opioid agonist therapy, which they had been prescribed for at least 6 weeks. All participants were treatment resistant (ie, had used illicit or non-prescribed opioids or cocaine on one or more days in the past 28 days at study screening, which was verified by positive urine drug screen). Participants were allocated (1:1) by a web-accessed randomisation sequence (stratified by opioid agonist medication, current cocaine use, and current rug use) to receive a personalised psychosocial intervention (comprising a flexible toolkit of psychological-change methods, including contingency management to reinforce abstinence, recovery activities, and clinic attendance) in addition to treatment as usual, or treatment as usual only (control group). The primary outcome was treatment response at 18 weeks, which was defined as abstinence from illicit and non-prescribed opioids and cocaine in the past 28 days, as measured with treatment outcomes profiles and urine drug screening. Taking a societal cost perspective, we did an evaluation of cost-effectiveness with a wide range of willingness-to-pay values for a unit improvement in the probability of treatment response. We also calculated quality-adjusted life-years (QALYs). Efficacy was analysed in a modified-intention-to-treat population, including all participants who were randomly allocated but excluding those who had previously completed the intervention. This trial is registered with ISRCTN, number ISRCTN69313751. The trial is completed. Between June 7, 2013, and Dec 21, 2015, we randomly allocated 136 participants to the psychosocial intervention group and 137 to the control group. The trial database was locked on April 19, 2017. Three patients (one in the psychosocial intervention group and two in the control group) who were re-randomised in error were excluded from the analysis. 22 (16%) of 135 patients in the psychosocial intervention group had a treatment response, compared with nine (7%) of 135 in the control group (adjusted log odds 1·20 [95% CI 0·01-2·37]; p=0·048). The psychosocial intervention had a higher probability of being cost-effective than treatment as usual. There was a probability range of 47-87% for willingness-to-pay thresholds of £0-1000 for a unit improvement in the probability of treatment response. QALYs were higher in the psychosocial intervention group than in the control group (mean difference 0·048 [95% CI 0·016-0·080]; p=0·004) in adjusted analyses, with 60% and 67% probabilities of cost-effectiveness at the UK National Institute for Health and Care Excellence's willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The number of adverse events was similar between groups, and no severe adverse events in either group were judged to be treatment related. One participant in the control group was hospitalised with drug-injection-related sepsis and died. In maintenance opioid agonist therapy, an adjunctive personalised psychosocial intervention in addition to standard therapy was efficacious and cost-effective compared with standard therapy alone at helping treatment-resistant patients abstain from using illicit and non-prescribed opioids and cocaine. Indivior.

Medication Treatment With Methadone or Buprenorphine: Differential Reasons for Premature Discharge.

Medication treatment with methadone or buprenorphine has shown demonstrated effectiveness for opioid dependence; while premature discharge is associated with adverse outcomes. Specific reasons for premature discharge generally fall into 2 broad categories (ie, patient- and program-initiated). Previous studies have typically failed to distinguish between different types of discharge reasons among patients who leave treatment early. This study sought to determine whether type of medication was associated with differential discharge reasons among medication treatment patients who were prematurely discharged. Data were derived from electronic health records for 5486 patients prematurely discharged from 41 for-profit licensed opioid treatment programs in the United States from 2012 to 2013. All patients were treated with methadone or buprenorphine. Patients were studied through retrospective chart review until premature discharge. Buprenorphine patients who left treatment prematurely were 2.18 times (95% confidence interval [CI] 1.89-2.53) more likely to be discharged against medical advice relative to methadone patients after controlling for intake differences. Methadone patients were 1.76 times (95% CI 1.47-2.10) more likely to be administratively discharged after adjustment for covariates. Further research is warranted to determine whether individually-tailored strategies may improve retention for certain patients based on medication. Ongoing review of program rules and policies may benefit methadone patients, who are nearly twice as likely to be discharged for an administrative, program-initiated reason. Strategies including contingency management, motivational incentives, and psychoeducation regarding the advantages of retention may benefit buprenorphine patients who are over 2 times more likely to leave treatment early due to a patient-initiated reason.

Neuropsychological Interventions for Decision-Making in Addiction: a Systematic Review.

Decision-making deficits are strong predictors of poor clinical outcomes in addiction treatment. However, research on interventions that address decision-making deficits among people with addiction is scarce and has not been analyzed. We aimed to systematically review evidence on neuropsychological interventions for decision-making deficits in addiction to identify promising therapies. Eligibility criteria were (1) participants with a diagnosis of substance use or behavioral addictive disorders, (2) interventions consisting of (neuro) psychological treatments that address decision-making, (3) comparators comprising control (sham) interventions, treatment as usual or no-treatment, (4) outcomes including a decision-making task, and (5) studies including RCTs and non-randomized trials. Search terms included addiction (or alcohol/drug/substance use/gambling) AND treatment (or specific interventions) AND decision-making (or specific tasks). The search yielded 728 hits, and two independent assessors agreed on the final selection of 12 articles. Interventions included Contingency Management (3 studies), Working Memory Training (2 studies) Goal Management Training (2 studies), Cognitive Behavioral Therapy (2 studies), Reality Therapy, Motivational Interview and Monetary Management. The main outcome measures were tasks of delay discounting, risk-taking and reward-based decision-making. Results showed that Goal Management Training improves reward-based decision-making, while Contingency Management combined with Cognitive Behavioral Therapy has beneficial effects on delay discounting. The evidence on Working Memory Training and Cognitive Behavioral Therapy as stand-alone treatments was mixed. Motivational Interview and Monetary Management had no significant effects on decision-making. Bias control across studies was moderate. We conclude that Goal Management Training and Contingency Management combined with Cognitive Behavioral Therapy have potential to modify decision-making in people with addiction. RCTs are needed to establish the efficacy of these interventions.

What Teachers Should Know About Selective Mutism in Early Childhood

Selective mutism is a relatively uncommon, yet significantly impairing anxiety disorder that causes difficulties in young children when communicating in social situations (such as school) even though they speak normally when they are comfortable (such as at home). Early childhood educators play a unique role in helping to identify selective mutism, given that symptoms often do not occur in the home environment. Parents are incumbent upon educators to bring non-communicative behavior to the parent’s attention, and recognition of selective mutism by early childhood professionals can lead to a referral for appropriate intervention services. Unfortunately, research has indicated a problematic, lengthy lag-time to treatment for children with selective mutism (i.e., symptoms occurring on average 3 years before beginning treatment). Early recognition and treatment of selective mutism can have a profound effect on prognosis; therefore, it is important for educators to understand the difference between shy behavior and symptoms of selective mutism, where to find information regarding selective mutism, and aspects surrounding referral for intervention. This article includes brief descriptions of components of evidence-based treatment for selective mutism including contingency management, stimulus fading techniques, exposure-based practice, and audio/video self-modeling are provided to guide educators of early childhood. Finally, specific classroom strategies for the teacher to use, such as providing a warm classroom environment, using a hierarchy of communication and fixed-choice questions, increasing wait-time for questions, and using video recordings for communication, are reviewed. Use of these strategies will aid in supporting the child’s treatment in the classroom environment, thus reducing the child’s anxiety and increasing verbalizations.

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons

This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.

Biological correlates of self-reported new and continued abstinence in cannabis cessation treatment clinical trials

BackgroundThe agreement between self-reported cannabis abstinence with urine cannabinoid concentrations in a clinical trials setting is not well characterized. We assessed the agreement between various cannabinoid cutoffs and self-reported abstinence across three clinical trials, one including contingency management for abstinence. MethodsThree cannabis cessation clinical trials where participants reported use and provided weekly urine samples for cannabis and creatinine concentration measurements were included. Bootstrapped data were assessed for agreement between self-reported 7+ day abstinence and urine cannabinoid tests using generalized linear mixed effects models for clustered binary outcomes. One study implemented contingency management for cannabis abstinence. Four hundred and seventy-three participants with 3787 valid urine specimens were included. Urine was analyzed for 11-nor-9-carboxy-Δ9-tetrahydrocannabinol and creatinine using immunoassay methods Biological cutoffs of 50, 100, and 200 ng/ml, as well as changes in CN normalized THCCOOH (25%/50% decrease), were assessed for agreement with self-reported abstinence during the three clinical trials. ResultsAgreement between measured THCCOOH and self-reported abstinence increases with increasing cutoff concentrations, while the agreement with self-reported non-abstinence decreases with increasing cutoff concentrations. Combining THCCOOH cutoffs with recent changes in CN-THCCOOH provides a better agreement in those self-reporting abstinence. Participants in the studies that received CM for abstinence had a lower agreement between self-reported abstinence and returned to use than those in studies that did not have a contingency management component. ConclusionUsing combinations of biological measurements and self-reported abstinence, confirmation of study related abstinence may be verifiable earlier and with greater accuracy than relying on a single measurement.

Psychosocial interventions in stimulant use disorders: a systematic review and qualitative synthesis of randomized controlled trials.

Stimulant use disorders are highly prevalent with a large burden of disease. Most clinical guidelines recommend psychosocial interventions, but there are no clear hierarchies or indications. Moreover, these interventions have been reported unevenly in the literature. Identifying the most suitable treatment for each patient therefore represents a major challenge. In this review, we describe all psychosocial interventions for stimulant use disorders investigated in randomized controlled trials - including contingency management, cognitive behavioral interventions, community reinforcement approach, 12-step program, meditation-based interventions and physical exercise, supportive expressive psychodynamic therapy, interpersonal psychotherapy, family therapy, motivational interviewing, drug counseling -, and we synthesize the main findings of these studies. Similarities and differences between treatments are highlighted, suggesting that distinct psychosocial interventions can be relevant for certain patients' groups but not for others. Conversely, several interventions can be equally effective in similar clinical contexts, suggesting that a shared element such as therapeutic alliance is key. Finally, combined approaches emerge as a viable option for people with complex needs. Future studies will need to benchmark psychosocial interventions in stimulant use disorders and ascertain markers of response with a view to individualized treatment.

Psychosocial interventions in stimulant use disorders: a focus on women.

Stimulant use disorders are significant contributors to the global burden of disease, with a growing impact on women. Psychosocial interventions are the gold standard for treating this condition, but several barriers may prevent women from accessing appropriate treatment. Therefore, we systematically reviewed the most recent findings about psychosocial interventions for stimulant use disorders, focussing on results relevant to women. Twenty-two eligible studies were identified. Psychosocial interventions in stimulant use disorders were examined in 17 recent studies, but no analyses for sex-related differences were performed. These aspects were investigated in further five studies, either through secondary analyses on the female subgroup or specifically examining a female-only sample. Contingency management, either alone or in combination with other interventions, provided the most positive results on several outcome measures. Only one pilot study showed good potential for an alternative approach of systemic family therapy, warranting further research in this direction. Research in stimulant use disorders shows an increasing interest in exploring interventions capable of addressing sex-specific issues. Combined therapy including contingency management and other treatments appears the most promising option, but larger secondary studies are needed to rank the efficacy of different psychosocial interventions while considering their feasibility and acceptability in specific subpopulations, including women.

Effectiveness of secondary prevention and treatment interventions for crack-cocaine abuse: A comprehensive narrative overview of English-language studies

There are an estimated several million crack-cocaine users globally; use is highest in the Americas. Most crack users are socio-economically marginalized (e.g., homeless), and feature elevated risks for morbidity (e.g., blood-borne viruses), mortality and crime/violence involvement, resulting in extensive burdens. No comprehensive reviews of evidence-based prevention and/or treatment interventions specifically for crack use exist. We conducted a comprehensive narrative overview of English-language studies on the efficacy of secondary prevention and treatment interventions for crack (cocaine) abuse/dependence. Literature searches (1990–2014) using pertinent keywords were conducted in main scientific databases. Titles/abstracts were reviewed for relevance, and full studies were included in the review if involving a primary prevention/treatment intervention study comprising a substantive crack user sample. Intervention outcomes considered included drug use, health risks/status (e.g., HIV or sexual risks) and select social outcome indicators. Targeted (e.g., behavioral/community-based) prevention measures show mixed and short-term effects on crack use/HIV risk outcomes. Material (e.g., safer crack use kit distribution) interventions also document modest efficacy in risk reduction; empirical assessments of environmental (e.g., drug consumption facilities) for crack smokers are not available. Diverse psycho-social treatment (including contingency management) interventions for crack abuse/dependence show some positive but also limited/short-term efficacy, yet likely constitute best currently available treatment options. Ancillary treatments show little effects but are understudied. Despite ample studies, pharmaco-therapeutic/immunotherapy treatment agents have not produced convincing evidence; select agents may hold potential combined with personalized approaches and/or psycho-social strategies. No comprehensively effective ‘gold-standard’ prevention/treatment interventions for crack abuse exist; concerted research towards improved interventions is urgently needed.

Treating Nonsuicidal Self-Injury

Nonsuicidal self-injury (NSSI) evaluation and treatment are critical for comprehensive patient care. A thorough assessment of nonsuicidal self-injury(NSSI) following DSM-5-proposed criteria is critical in understanding and treating NSSI and should be informed based upon past and current self-harm behaviors, including self-injury methods, frequency, severity, and intent, along with a comprehensive suicide risk assessment. After NSSI is diagnosed, patients should be offered proper management of co-occurring psychiatric illnesses, if applicable, enhanced by an 8 – 12 week trial of cognitive behavior therapy (CBT) focusing on NSSI. Cognitive strategies to be used include Socratic questioning, keeping thought records, and addressing self-derogatory and distorted beliefs about NSSI. Behavioral strategies include contingency management, behavioral activation, and addressing environmental factors maintaining NSSI. In adolescents, individual CBT work might be supplemented with family-based therapy. Dialectical strategies (acceptance and distress tolerance) and skills training (focus on improving emotion regulation, problem-solving, interpersonal, and communication skills) can be used to enhance CBT, but in some cases DBT can be cost prohibitive. If adequate psychotherapy trials are ineffective, a pharmacotherapy trial of emerging drug therapies for NSSI, e.g. naltrexone, N-acetylcysteine, or topiramate to enhance supportive psychotherapy would be recommended. We would encourage patients to continue effective treatment for at least 6 months and would continuously assess for self-harm urges and behaviors. Psychoeducation and adequate treatment of comorbid conditions should be provided on an ongoing basis along with attention to physical self-care and regular exercise.

Behavioral Therapies for Treatment-Seeking Cannabis Users

Narrative reviews conclude that behavioral therapies (BTs) produce better outcomes than control conditions for cannabis use disorders (CUDs). However, the strength and consistency of this effect has not been directly empirically examined. The present meta-analysis combined multiple well-controlled studies to help clarify the overall impact of behavioral interventions in the treatment of CUDs. A comprehensive literature search produced 10 randomized controlled trials (RCTs; n = 2,027) that were included in the final analyses. Analyses indicated an effect of BTs (including contingency management, relapse prevention, and motivational interviewing, and combinations of these strategies with cognitive behavioral therapy) over control conditions (including waitlist [WL], psychological placebo, and treatment as usual) across pooled outcomes and time points (Hedges' g = 0.44). These results suggest that the average patient receiving a behavioral intervention fared better than 66% of those in the control conditions. BT also outperformed control conditions when examining primary outcomes alone (frequency and severity of use) and secondary outcomes alone (psychosocial functioning). Effect sizes were not moderated by inclusion of a diagnosis (RCTs including treatment-seeking cannabis users who were not assessed for abuse or dependence vs. RCTs including individuals diagnosed as dependent), dose (number of treatment sessions), treatment format (either group vs. individual treatment or in-person vs. non-in-person treatment), sample size, or publication year. Effect sizes were significantly larger for studies that included a WL control comparison versus those including active control comparisons, such that BT significantly outperformed WL controls but not active control comparisons.

Don'T stop believing: journeys school.

This report showcases an alternative school for children with emotional and behavioral disorders that is engaging in the practice of behavior analysis. The core principles of behavioral science at work include contingency management, goal setting, teaching self-control, mindfulness, and acceptance and commitment therapy. Student outcomes appear extremely promising.

The Clinical Assessment and Treatment of Nicotine Dependence

In the United States and around the world, nicotine dependence is a leading cause of preventable death. Smoking cessation results in immediate and enduring health benefits. A wide range of clinical interventions have been shown to facilitate smoking cessation and to have a favorable cost-benefit profile. Practice guidelines and national reports have issued calls to action and have made smoking cessation resources readily available. Yet utilization of smoking cessation interventions and resources is lagging. Health care systems and providers have a shared responsibility to ensure that all smokers are offered appropriate interventions. This article summarizes the epidemiology and pathophysiology of nicotine dependence as a background for reviewing the central components of clinical evidence-based smoking cessation interventions: screening, assessment, advice, assistance, and follow-up. Specific patient populations are discussed, as well as emerging strategies to address nicotine dependence.

Cost-effectiveness of computer-assisted training in cognitive-behavioral therapy as an adjunct to standard care for addiction

Aim To determine the cost-effectiveness, from clinic and patient perspectives, of a computer-based version of cognitive-behavioral therapy (CBT4CBT) as an addition to regular clinical practice for substance dependence. Participants, design and measurements This cost-effectiveness study is based on a randomized clinical trial in which 77 individuals seeking treatment for substance dependence at an outpatient community setting were randomly assigned to treatment as usual (TAU) or TAU plus biweekly access to computer-based training in CBT (TAU plus CBT4CBT). The primary patient outcome measure was the total number of drug-free specimens provided during treatment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves (CEACs) were used to determine the cost-effectiveness of TAU plus CBT4CBT relative to TAU alone. Results are presented from both the clinic and patient perspectives and are shown to be robust to (i) sensitivity analyses and (ii) a secondary objective patient outcome measure. Findings The per patient cost of adding CBT4CBT to standard care was $39 ($27) from the clinic (patient) perspective. From the clinic (patient) perspective, TAU plus CBT4CBT is likely to be cost-effective when the threshold value to decision makers of an additional drug-free specimen is greater than approximately $21 ($15), and TAU alone is likely to be cost-effective when the threshold value is less than approximately $21 ($15). The ICERs for TAU plus CBT4CBT also compare favorably to ICERs reported elsewhere for other empirically validated therapies, including contingency management. Conclusions TAU plus CBT4CBT appears to be a good value from both the clinic and patient perspectives.

Truancy Interventions: A Review of the Research Literature

Objectives: This article presents a systematic review of the literature on evaluative studies of truancy interventions. Method: Included studies evaluating truancy interventions appearing in peer-reviewed academic journals from 1990 to 2007. Findings: In total, 16 studies were assessed. Eight studies used group comparison designs and eight studies used one-group pretest/posttest designs. Studies varied on sample sizes, definitions of truant behavior, focus of interventions, and dependent measures. Conclusions: Six studies produced useful and promising interventions including contingency management, school reorganization, punitive measures, community partnerships, and family-oriented activities. The substantial methodological shortcomings, inconsistent definitions, and lack of replication demonstrate a need for more and better evaluation studies to provide a more definitive knowledge base to guide effective truancy interventions for practitioners.

Treatment of Concurrent Substance Dependence, Child Neglect and Domestic Violence: A Single Case Examination Involving Family Behavior Therapy

Although child neglect and substance abuse co-occur in greater than 60% of child protective service cases, intervention outcome studies are deplorably lacking. Therefore, a home-based Family Behavior Therapy is described in the treatment of a woman evidencing child neglect, substance dependence, domestic violence and other co-occurring problems. Treatment included contingency management, self control, stimulus control, communication and child management skills training exercises, and financial management components. Results indicated improvements in child abuse potential, home hazards, domestic violence, and drug use, which were substantiated by objective urinalysis testing, and tours of her home. Validity checks indicated the participant was being truthful in her responses to standardized questionnaires, and assessors were "blind" to study intent. Limitations (i.e., lack of experimental control and follow-up data collection) of this case example are discussed in light of these results.

Chronic abdominal pain in children: what to do following the medical evaluation

The purpose of this article is to provide an empirically informed but clinically oriented review of conventional, alternative, and rehabilitation therapies for chronic or recurrent abdominal pain in children. Cognitive-behavioral procedures, including contingency management training for parents and self-regulation training for children, emerge as a probably efficacious treatment. Symptom-based pharmacological therapies can be helpful, but may be best reserved for children with severe symptoms that have not responded to simple management. Biofeedback therapy, hypnotherapy, and peppermint oil are among the most promising alternative therapies. For patients with severe functional disability, an interdisciplinary rehabilitation approach may be warranted. As more is learned about different therapies for recurrent abdominal pain, an integrative approach that blends these interventions may become increasingly common.