Electrophysiological Predictors and Indicators of Contingency Management Treatment Response

NIH RePORTER · VA · IK2 · · view on reporter.nih.gov ↗

Abstract

Electrophysiological methods, including event-related potential and functional connectivity approaches, have strong potential to clarify mechanisms of substance use treatment response and characterize individual differences therein. Veterans are disproportionately affected by disorders of addiction, of which cocaine use disorder (CUD) is particularly problematic due to high relapse rates and the absence of approved pharmaco- therapy treatment options. Behavioral interventions for CUD, have therefore become an important focus of research and Contingency Management (CM) has emerged as the best-supported and most widely used approach. CM involves reinforcing cocaine abstinence (established through objective testing) with reliable, short-term reward, such as chances to win prizes (i.e., Prize-Based CM or PBCM). In response to substantial empirical support, national dissemination of PBCM has been supported by a VHA initiative since 2011. However, PBCM response rates are variable and long-term benefits are limited – problems magnified by the cost of implementation with respect to staffing and prizes. Measurement-based approaches to PBCM implementation have strong promise to improve the effectiveness and efficiency of CM programming but have not yet been investigated within the VA or considered in relation to promising neuromarkers. Importantly, two versions of PBCM are already utilized at VA sites and may differentially benefit individuals with distinct neurocognitive profiles. Specifically, VA PBCM programs employ either abstract (voucher prize) or concrete (tangible prize) incentives, the latter of which may more effectively incentivize abstinence in Veterans with poor future-oriented thinking and planning ability. While selection between existing PBCM variants is currently driven by practical considerations (e.g., provider convenience), measurement of pretreatment neurocognitive functioning could meaningfully and realistically inform clinical decision-making in this regard. This CDA aims to advance measurement-based implementation of CM by testing a novel neurocognitive model of CM with immediate implications for the use of abstract versus concrete PBCM incentives within the VA. Specifically, the future-minded decision-making (FMDM) model posits that CM scaffolds future-oriented goal representation and self-control to support abstinence during in the moment use-related decision-making. For individuals with greater FMDM impairment, concrete, readily-accessible incentives may be more effective than abstract monetary rewards (e.g., vouchers) which require future-oriented thinking and planning to inherit value. To test this model, neurocognitive substrates of FMDM will be examined as predictors of differential treatment response in voucher (VoucherPBCM) versus tangible prize (TangiblePBCM) versions of the intervention used within the VA. Treatment-related change in neural and cognitive-behavioral correlates of FMDM will also be evaluated in PBCM relati...

Key facts

NIH application ID
10818338
Project number
5IK2CX001807-06
Recipient
VETERANS HEALTH ADMINISTRATION
Principal Investigator
SARAH E FORSTER
Activity code
IK2
Funding institute
VA
Fiscal year
2024
Award amount
Award type
5
Project period
2019-01-01 → 2024-08-31