Department of Psychiatry.
Section on Behavioral Interventions.
J Consult Clin Psychol. 2010 Feb;78(1):62-71. doi: 10.1037/a0018323.
Contingency management (CM) effectively treats addictions by providing abstinence incentives. However, CM fails for many who do not readily become abstinent and earn incentives. Shaping may improve outcomes in these hard-to-treat (HTT) individuals. Shaping sets intermediate criteria for incentive delivery between the present behavior and total abstinence. This should result in HTT individuals having improving, rather than poor, outcomes. We examined whether shaping improved outcomes in HTT smokers (never abstinent during a 10-visit baseline).
Smokers were stratified into HTT (n = 96) and easier-to-treat (ETT [abstinent at least once during baseline]; n = 50) and randomly assigned to either CM or CM with shaping (CMS). CM provided incentives for breath carbon monoxide (CO) levels <4 ppm (approximately 1 day of abstinence). CMS shaped abstinence by providing incentives for COs lower than the 7th lowest of the participant's last 9 samples or <4 ppm. Interventions lasted for 60 successive weekday visits.
Cluster analysis identified 4 groups of participants: stable successes, improving, deteriorating, and poor outcomes. In comparison with ETT, HTT participants were more likely to belong to 1 of the 2 unsuccessful clusters (odds ratio [OR] = 8.1, 95% CI [3.1, 21]). This difference was greater with CM (OR = 42, 95% CI [5.9, 307]) than with CMS, in which the difference between HTT and ETT participants was not significant. Assignment to CMS predicted membership in the improving (p = .002) as compared with the poor outcomes cluster.
Shaping can increase CM's effectiveness for HTT smokers.
通过提供戒除激励，应急管理（CM）有效地治疗成瘾。然而，对于许多不易戒除并获得奖励的人来说，CM 失败了。塑造可以改善这些难以治疗（HTT）个体的结果。塑造为激励提供了介于当前行为和完全戒除之间的中间标准。这应该导致 HTT 个体的结果得到改善，而不是恶化。我们研究了塑造是否改善了 HTT 吸烟者（在 10 次就诊基线期间从未戒除过）的结果。
吸烟者被分为 HTT（n = 96）和更容易治疗（ETT [在基线期间至少有一次戒除]；n = 50），并随机分配到 CM 或 CM 与塑造（CMS）。CM 为呼吸一氧化碳（CO）水平<4 ppm（约 1 天的戒除）提供奖励。CMS 通过为参与者的最后 9 个样本中第 7 个最低或<4 ppm 的 CO 提供奖励来塑造戒除。干预持续 60 个连续工作日。
聚类分析确定了参与者的 4 个群体：稳定成功、改善、恶化和不良结局。与 ETT 相比，HTT 参与者更有可能属于 2 个不成功群体之一（优势比[OR] = 8.1，95%置信区间[3.1,21]）。与 CMS 相比，CM （OR = 42，95%置信区间[5.9,307]）的差异更大，而 HTT 和 ETT 参与者之间的差异不显著。分配给 CMS 预测了成员身份改善（p =.002）与不良结局集群。
塑造可以提高 CM 对 HTT 吸烟者的有效性。
