Using Behavioral Incentives to Promote Exercise Compliance in Women with Cocaine Dependence

• Main Author: Islam, Leila
• Format: Others
• Published: VCU Scholars Compass 2013
• Subjects: physical activity; exercise; substance use disorders; drug abuse; women; contingency management; Psychology; Social and Behavioral Sciences
• Online Access: http://scholarscompass.vcu.edu/etd/3231; http://scholarscompass.vcu.edu/cgi/viewcontent.cgi?article=4230&context=etd

To date, low rates of patient compliance have made it impractical to study whether regular exercise can contribute to positive outcomes in women with substance use disorders (SUD). One robust strategy for promoting and maintaining behavior change is contingency management (CM). CM has been used successfully to reinforce drug abstinence, treatment attendance, and other pro-social behaviors. CM delivers incentives (prizes) contingent upon target behaviors, though can be expensive. To reduce costs, CM is often delivered with an escalating variable-ratio schedule, first tested by Petry and colleagues (2005). As a Stage Ib behavioral therapies development project (Rounsaville et al., 2001), the primary aim of the present study was to test the use of behavioral incentives (BI) to promote regular physical activity in a residential SUD treatment setting with cocaine-dependent women. The target was physical activity, which was objectively defined at two levels: 30 minutes of treadmill walking at any pace and treadmill walking at moderate intensity. Specifically, a pilot RCT compared rates of physical activity over a six-week study period in a sample of N = 17 women with Cocaine Dependence. N = 10 were randomized to BI group and n = 7 were placed in the control (C) group. All participants completed baseline assessment, attended a 45-minute health and fitness education class, and were scheduled in exercise sessions three days/week. Those randomized to BI, however, were eligible three days/week, to receive incentives for meeting the target behavior(s). Follow-up assessment occurred at 3-weeks and 6-weeks post-randomization (midpoint and end of intervention), and 4-weeks post-discharge from the residential program. The primary outcome variables (percentage of sessions completed and total time spent in scheduled sessions) were used for effect size estimations, which were then used to perform power analyses so that sample size calculations could be estimated for the design of a Stage II RCT. A significant Group effect demonstrated that the BI group spent a significantly greater number of total minutes in scheduled exercise sessions than the C group. This dissertation provided benchmark data on the utility of BI for promoting physical activity for women with cocaine dependence. These promising findings support the use of BI procedures to promote exercise compliance, which will ultimately allow scientists to better develop SUD programs that directly utilize the mental and physical health benefits of physical activity.