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Biomedical subjects

Nancy M Petry

Publications and source records attributed to Nancy M Petry.

At least 19 recordsLinked to original sources
PubMed2007

What do we get for our money? Cost-effectiveness of adding contingency management.

AIMS: To assess the relative cost-effectiveness of lower versus higher cost prize-based contingency management (CM) treatments for cocaine abuse. DESIGN: Cost-effectiveness analyses based on resource utilization, unit costs and outcomes from a previous CM efficacy trial. SETTING: Two community-based treatment centers. PARTICIPANTS: Patients (n = 120) enrolled in out-patient treatment for cocaine abuse. INTERVENTION: Random assignment to one of three 12-week treatment conditions: standard treatment (STD) alone or two variants of STD combined with prize based CM. In CM, drawing for prizes was available to those submitting drug-free urine samples and completing goal-related activities. There were two levels of pay-out (referred to as $80 versus $240) based on the potential value of prizes won. MEASUREMENTS: Costs per participant associated with counseling utilization, urine and breathalyzer testing, and operation of the prize-drawing procedure were derived from a survey conducted at 16 clinics that had participated in CM studies. The three measures of effectiveness were: (1) longest duration of consecutive abstinence; (2) percentage completing treatment; and (3) percentage of samples drug-free. FINDINGS: The higher magnitude CM produced outcomes at a lower per unit cost than did the lower magnitude prize CM treatment. This was the case for all three outcome measures examined and held across various assumptions in the sensitivity analysis. CONCLUSIONS: Cost-effectiveness analyses can inform policy decisions regarding selection of one treatment model over another. Decisions on adoption of new evidence-based treatments would be aided by more information on society's willingness to pay for incremental gains in effectiveness.

Adolescent↗
PubMed2006

Gambling level and psychiatric and medical disorders in older adults: results from the National Epidemiologic Survey on Alcohol and Related Conditions.

OBJECTIVE: This study examined the association between gambling level and psychiatric and medical disorders in a nationally representative sample of older adults. METHOD: Data on 10,563 U.S. older adults (age 60 or older) were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. RESULTS: A total 28.74% of older adults were lifetime recreational gamblers and 0.85% were lifetime disordered gamblers. Compared with older adults without a history of regular gambling, recreational gamblers had significantly elevated rates of alcohol (30.1% versus 12.8%), nicotine (16.9% versus 8.0%), mood (12.6% versus 11.0%), anxiety (15.0% versus 11.6%), and personality disorders (11.3% versus 7.3%) and obesity (25.6% versus 20.8%), but were less likely to have past-year diagnoses of arteriosclerosis (4.7% versus 6.0%) or cirrhosis (0.2% versus 0.4%). Disordered gamblers were significantly more likely than older adults without a history of regular gambling to have alcohol (53.2% versus 12.8%), nicotine (43.2% versus 8.0%), drug (4.6% versus 0.7%), mood (39.5% versus 11.0%), anxiety (34.5% versus 11.6%), and personality (43.0% versus 7.3%) disorders, and to have past-year diagnoses of arthritis (60.2% versus 44.3%) or angina (22.7% versus 8.8%). These results remained significant even after controlling for demographic, psychiatric, and behavioral risk factors. CONCLUSIONS: Lifetime recreational gamblers were more likely than nonregular gamblers to have psychiatric disorders but were less likely to have some medical conditions. Lifetime disordered gamblers had a range of lifetime psychiatric disorders and were more likely than nonregular gamblers to have past-year diagnoses of angina and arthritis.

Adaptation, Psychological↗
PubMed2006

Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes.

The relationship between psychiatric severity and substance use disorders treatment outcome was assessed in 393 individuals who received either standard treatment or standard treatment plus contingency management. The sample was divided into groups of low, moderate, and high psychiatric severity based upon baseline Addiction Severity Index psychiatric composite scores. Participants in the high psychiatric severity group reported a greater prevalence of psychiatric hospitalization, psychiatric medications, and suicide attempts, as well as poorer baseline psychosocial functioning. In terms of treatment outcome, a significant interaction between psychiatric severity and treatment modality was found in relation to treatment retention. Participants in the standard treatment condition were more likely to dropout of treatment earlier as psychiatric severity increased, while retention was similar across the psychiatric severity groups in the contingency management condition. Psychiatric severity was not linked to longest duration of abstinence achieved during treatment or adherence with contingency management procedures. Overall, these findings suggest contingency management is an efficacious and appropriate intervention for substance use disordered individuals across a range of psychiatric problems.

Alcoholism↗
PubMed2006

Abstinence rates following behavioral treatments for marijuana dependence.

Previous studies have noted particular difficulty in achieving abstinence among those who are marijuana dependent. The present study employed a dismantling design to determine whether adding contingency management (ContM) to motivational enhancement therapy plus cognitive behavioral therapy (MET+CBT), an intervention used in prior studies of treatment for marijuana dependence, would enhance abstinence outcomes. 240 marijuana dependent participants were recruited via advertisements and assigned to either MET+CBT, ContM-only, MET+CBT+ContM, or to a case-management control condition. All interventions involved 9 weekly 1-h sessions, except for the ContM-only condition whose sessions lasted about 15 min. ContM provided reinforcement for marijuana-free urine specimens, in the form of vouchers redeemable for goods or services. Follow-up data were collected at posttreatment and at 3-month intervals for 1 year. The two ContM conditions had superior abstinence outcomes: ContM-only had the highest abstinence rates at posttreatment, and the MET+CBT+ContM combination had the highest rates at later follow-ups. The roles of contingency management and coping skills training in the treatment of marijuana dependence are discussed.

Adult↗
PubMed2006

Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs.

OBJECTIVE: To evaluate the cost-effectiveness of a prize-based intervention as an addition to usual care for stimulant abusers. METHODS: This cost-effectiveness analysis is based on a randomized clinical trial implemented within the National Drug Abuse Treatment Clinical Trials Network. The trial was conducted at eight community-based outpatient psychosocial drug abuse treatment clinics. Four hundred and fifteen stimulant abusers were assigned to usual care (N=206) or usual care plus abstinence-based incentives (N=209) for 12 weeks. Participants randomized to the incentive condition earned the chance to draw for prizes for submitting substance negative samples; the number of draws earned increased with continuous abstinence time. Incremental cost-effectiveness ratios were estimated to compare prize-based incentives relative to usual care. The primary patient outcome was longest duration of confirmed stimulant abstinence (LDA). Unit costs were obtained via surveys administered at the eight participating clinics. Resource utilizations and patient outcomes were obtained from the clinical trial. Acceptability curves are presented to illustrate the uncertainty due to the sample and to provide policy relevant information. RESULTS: The incremental cost to lengthen the LDA by 1 week was 258 US dollars (95% confidence interval, 191-401 US dollars). Sensitivity analyses on several key parameters show that this value ranges from 163 to 269 US dollars. CONCLUSIONS: Compared with the usual care group, the incentive group had significantly longer LDAs and significantly higher costs.

Cost-Benefit Analysis↗
PubMed2006

Psychological experience of gambling and subtypes of pathological gamblers.

Clinical experience and some empirical data suggest that different subtypes of gamblers may exist. This study examined psychometric properties of the Gambling Experience Measure (GEM) to establish support for differing subtypes of gamblers. In total, 149 treatment-seeking pathological gamblers completed the GEM and other instruments. A principal component analysis produced a three-factor solution that included gambling as a way to escape negative emotions (Escape), dissociating (Dissociation), and narcissism/seeking attention (Egotism). Multiple regression analyses revealed that being female and general dissociation was associated with Escape gambling. General dissociation was also related to the Dissociation factor. Male gender and impulsivity were associated with the Egotism factor. These data offer preliminary evidence of the validity and reliability of the GEM in distinguishing subgroups of gamblers.

Adult↗
PubMed2006

Gambling problems and health functioning in individuals receiving disability.

PURPOSE: This study evaluated the rates and correlates of disordered gambling, with a focus on gambling behavior among participants receiving disability. METHOD: The sample consisted of 723 patients seeking free or reduced-cost dental care. Participants completed the South Oaks Gambling Screen (SOGS), Short Form-12 Health Survey, Second Edition (SF-12v2), and questions assessing demographic characteristics and frequency and intensity of current gambling behaviors. RESULTS: Results indicate a significantly higher prevalence of disordered gambling among participants receiving disability (26%) than in the remainder of the sample (14%; p < 0.001). Of the 135 individuals receiving disability, disordered gambling was associated with decreased physical and mental health functioning. CONCLUSIONS: These data indicate that individuals receiving disability have high rates of disordered gambling, and gambling behavior in this population is associated with poorer health functioning. Results suggest that disordered gamblers who receive disability have an increased need for interventions to reduce gambling and associated problems.

Adult↗
PubMed2006

Internet gambling: an emerging concern in family practice medicine?

BACKGROUND: Gambling problems are rarely brought to the attention of family practice physicians, but pathological gambling can be associated with poor emotional and physical health. Recent availability and easy accessibility of Internet gambling may be associated with pathological gambling status, and Internet gambling may confer health risks. OBJECTIVE: This study evaluated the prevalence of Internet gambling, its association with pathological gambling, and the relationship between Internet gambling and health status among patients attending medical and dental clinics. METHODS: The South Oaks Gambling Screen and Short Form 12 were administered to 1414 adults in waiting areas of clinics. RESULTS: Only 6.9% of respondents reported ever gambling on the Internet, with 2.8% indicating frequent Internet wagering. Almost two-thirds (65.9%) of regular Internet gamblers were classified as probable pathological gamblers, compared with 29.8% of ever-Internet gamblers and 7.6% of non-Internet gamblers. Internet gambling was associated with poor mental and physical health, and this association remained significant even after controlling for age, gender, site and pathological gambling status. CONCLUSIONS: These data suggest that Internet gambling is linked to pathological gambling and is independently associated with poor health. Family practice physicians should consider referring patients who gamble on the Internet for further treatment.

Adult↗
PubMed2006

Prize-based contingency management does not increase gambling.

A contingency management (CM) intervention that provides drug-abstinent patients a chance to win prizes of varying magnitudes is efficacious in retaining patients in treatment and reducing drug use. However, this intervention has been criticized as possibly increasing gambling because it contains an element of chance. Gambling behaviors before, during and 3 months after participation in a multi-site study of CM were compared for stimulant users randomly assigned to 12 weeks of standard care with (N=407) or without (N=396) prize-based CM. Among study participants enrolled in outpatient non-methadone drug abuse treatment (N=415), 26% reported gambling during the observation period, and this rate was 37% among participants (N=388) enrolled in methadone maintenance programs. No differences in gambling over time were noted between those assigned to the prize CM versus standard care conditions, indicating that this prize CM procedure does not adversely impact gambling behavior among stimulant abusers.

Adult↗
PubMed2006

Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.

BACKGROUND: Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. OBJECTIVE: To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. DESIGN: Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. SETTING: Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. PARTICIPANTS: Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. INTERVENTION: Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. MAIN OUTCOME MEASURES: Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. RESULTS: Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. CONCLUSION: An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Adult↗
PubMed2006

Posttraumatic stress disorder symptoms in treatment-seeking pathological gamblers.

Little is known about posttraumatic stress disorder (PTSD) among pathological gamblers (PGs), even though the two disorders share several clinical characteristics. We examined the relationship between pathological gambling and PTSD on measures of gambling disorder severity, experience of specific traumas, psychiatric symptoms, impulsivity, and dissociation. A total of 149 treatment-seeking PGs were surveyed. Participants were divided into two groups on the basis of their score on the PTSD Checklist (Weathers, Litz, Herman, Huska, & Keane, 1993). Thirty-four percent (n = 51) reported a high frequency of PTSD symptoms. Participants who had high scores reported greater lifetime gambling severity, psychiatric symptom severity, impulsivity, and dissociation than participants who had low PTSD symptom scores. These findings point to a need for more assessment and research about PTSD in PGs.

Adult↗
PubMed2006

Pre/early adolescent onset of gambling and psychosocial problems in treatment-seeking pathological gamblers.

This study examined the association between pre- or early-adolescent onset of gambling and severity of gambling and psychosocial problems in treatment-seeking adult pathological gamblers. A total of 236 pathological gamblers entering outpatient treatment completed the South Oaks Gambling Screen (SOGS) and the Addiction Severity Index (ASI). Using a quartile split procedure, gamblers who began gambling during their pre- or early-adolescent years (mean age of 10.5 years; 1st quartile) were compared to gamblers who began gambling later in life (mean age of 23.0 years; 2nd to 4th quartiles). Compared to later onset gamblers, pre/early adolescent onset gamblers reported increased severity of psychiatric, family/social, and substance abuse problems on the ASI. They were more likely to report cognitive problems (trouble understanding, concentrating, or remembering), suicidal ideation, and a history of inpatient psychiatric treatment, and were less likely to be satisfied with their current living situation. Pre/early adolescent onset gamblers also reported earlier age of initiation of drinking, and were more likely to have received treatment for an alcohol use disorder, and to have used cannabis and cocaine in their lifetimes. Taken together, these data suggest that pre/early adolescent-onset of gambling may be a risk factor for later-life psychiatric, family/social, and substance abuse problems in treatment-seeking pathological gamblers.

Adolescent↗
PubMed2006

Cognitive-behavioral therapy for pathological gamblers.

Few studies have evaluated efficacy of psychotherapies for pathological gambling. Pathological gamblers (N = 231) were randomly assigned to (a) referral to Gamblers Anonymous (GA), (b) GA referral plus a cognitive- behavioral (CB) workbook, or (c) GA referral plus 8 sessions of individual CB therapy. Gambling and related problems were assessed at baseline, 1 month later, posttreatment, and at 6- and 12-month follow-ups. CB treatment reduced gambling relative to GA referral alone during the treatment period and resulted in clinically significant improvements, with some effects maintained throughout follow-up ( ps = .05). Individual CB therapy improved some outcomes compared with the CB workbook. Attendance at GA and number of CB therapy sessions or workbook exercises completed were associated with gambling abstinence. These data suggest the efficacy of this CB therapy approach.

Adolescent↗
PubMed2006

Contingency management treatments: Reinforcing abstinence versus adherence with goal-related activities.

Contingency management (CM) interventions usually reinforce submission of drug-negative specimens, but they can also reinforce adherence with goal-related activities. This study compared the efficacy of the 2 approaches. Substance-abusing outpatients (N = 131) were randomly assigned to 1 of 3 12-week treatments: standard treatment (ST), ST with CM for submitting negative urine toxicology screens, or ST with CM for completing goal-related activities. CM patients remained in treatment longer and achieved more abstinence than ST patients, but the CM condition that reinforced submission of negative samples resulted in better outcomes than the CM condition that reinforced goal-related activities. Abstinence at 6- and 9-month follow-ups did not differ by group, but longest duration of abstinence achieved during treatment was associated with abstinence posttreatment.

Adult↗
PubMed2006

Health correlates of pathological gambling in a methadone maintenance clinic.

This study compared methadone maintenance patients with and without pathological gambling (n = 167). Participants completed a self-report survey assessing lifetime pathological gambling and past-2-month gambling behavior, and they completed the SF-12v2 Health Survey, a measure of current mental and physical health. In the sample, 52.7% were classified as lifetime pathological gamblers, and the majority of pathological gamblers were actively gambling within the past 2 months. Multivariate analysis of covariance revealed that methadone maintenance patients with pathological gambling had significantly poorer mental and physical health than methadone maintenance patients without pathological gambling. These results suggest that pathological gamblers receiving methadone maintenance may benefit from additional psychosocial services. In fact, most pathological gamblers in the sample expressed interest in gambling-related services. These results extend previous research in other populations that has found that pathological gamblers report poorer mental and physical health than nonpathological gamblers.

Behavior, Addictive↗
PubMed2006

Should the scope of addictive behaviors be broadened to include pathological gambling?

AIMS: Pathological gambling is currently considered an impulse control disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This paper considers the prospect of reclassifying and broadening the substance use disorders to include non-pharmacological addictions such as pathological gambling. METHODS: Literature reviews were conducted on areas relevant to pathological gambling and its classification and similarities to substance use disorders. RESULTS: The diagnostic criteria for pathological gambling are outlined across the three versions of the DSM since its initial introduction. The paper also describes instruments that have been used to assess the disorder, basic epidemiology and some biological and genetic data, especially in terms of potential overlap with substance use disorders. Similarities and differences with respect to treatments are reviewed as well. CONCLUSIONS: Both advantages and disadvantages should be considered with respect to expanding the classification system to include pathological gambling within the context of addictive disorders.

Comorbidity↗
PubMed2006

Contingency management for the treatment of methamphetamine use disorders.

OBJECTIVE: Theory and some preliminary evidence suggest that contingency management may be an effective treatment strategy or adjunct to psychosocial treatment for methamphetamine use disorders. An experimentally rigorous investigation on the topic was provided by a large multisite trial conducted under the auspices of the Clinical Trials Network of the National Institute on Drug Abuse. METHOD: The authors report data on 113 participants who were diagnosed with methamphetamine abuse or dependence. They were randomly assigned to receive 12 weeks of either treatment as usual or treatment as usual plus contingency management. Urine samples were tested for illicit drugs, and breath samples were tested for alcohol. The reinforcers for drug-negative samples were plastic chips, some of which could be exchanged for prizes. The number of plastic chips drawn increased with each week of negative samples but was reset to one after a missed or positive sample. RESULTS: The participants in both groups remained in treatment for equivalent times, but those receiving contingency management in addition to usual treatment submitted significantly more negative samples, and they were abstinent for a longer period of time (5 versus 3 weeks). CONCLUSIONS: These results suggest that contingency management has promise as a component in treatment strategies for methamphetamine use disorder.

Adult↗