SΔp: The Missing Discriminative Stimulus for Non-Punishment.

As the natural science of behavior evolves, the use of precise terminology is critical to maintain its conceptual and terminological integrity. The current state of terminology in stimulus control is well developed with respect to reinforcement and incomplete with respect to punishment. In this paper, we aim to make the case that the current conceptualization for discriminative stimulus control in relation to punishment would be enhanced by modifying the definition of the discriminative stimulus for punishment (SDp) and by adding a new term to the current taxonomy that denotes when a punishment contingency is inactive.

Preliminary side effect profile, safety, and tolerability of hormonal contraception among women receiving opioid-agonist therapy.

OBJECTIVE(S): To characterize for the first time the side effect profile, safety, and tolerability of hormonal contraception among women receiving opioid-agonist therapy. STUDY DESIGN: We conducted a secondary analysis of data collected from participants in a three-arm randomized controlled trial (N = 138) aimed at increasing effective contraceptive use among women receiving opioid-agonist therapy. Participants in the 2 intervention conditions (n = 90) had free access to hormonal contraception at each of the 14 visits scheduled during the 6-month intervention. Contraceptive use and side effects were recorded at each visit; participants could change methods or discontinue use at any time. Verbatim side effects were classified using Medical Dictionary for Regulatory Activities (MedDRA) terminology. RESULTS: Of 67 participants reporting hormonal contraceptive use, 29 (43%) initiated implants, 14 (21%) intrauterine devices, 13 (19%) combined pills, 11 (16%) progestin-only pills, 10 (15%) injectables, 1 (2%) ring, and 1 (2%) patch; the average (±standard deviation) duration of use was 129 ± 55, 129 ± 60, 108 ± 62, 102 ± 61, 111 ± 31, 145, and 18 days, respectively. A total of 321 side effects were reported by 55 (82%) participants. Fifty (75%) participants reported menstrual cycle changes/uterine bleeding, followed by headaches (16, 24%), weight gain (15, 22%), and abdominal pain or nausea/vomiting (11, 16%). No serious side effects were reported. Twelve participants (18%) changed methods and 13 (19%) discontinued all hormonal contraceptive use. CONCLUSION(S): The hormonal contraceptive side effects reported by this small group of women receiving opioid-agonist therapy appear consistent with those reported by the general population, was generally well-tolerated, and did not raise safety concerns. IMPLICATIONS: These results provide important preliminary evidence that hormonal contraceptive use produces a familiar side effect profile and is well-tolerated by women receiving opioid-agonist therapy, although studies with larger samples followed over longer periods of time with appropriate comparison conditions are needed to fully assess tolerability and safety.

Efficacy and Cost-Benefit of Onsite Contraceptive Services With and Without Incentives Among Women With Opioid Use Disorder at High Risk for Unintended Pregnancy: A Randomized Clinical Trial.

Importance: Rates of in utero opioid exposure continue to increase in the US. Nearly all of these pregnancies are unintended but there has been little intervention research addressing this growing and costly public health problem. Objective: To test the efficacy and cost-benefit of onsite contraceptive services with and without incentives to increase prescription contraceptive use among women with opioid use disorder (OUD) at high risk for unintended pregnancy compared with usual care. Design, Setting, and Participants: A randomized clinical trial of 138 women ages 20 to 44 years receiving medication for OUD who were at high risk for an unintended pregnancy at trial enrollment between May 2015 and September 2018. The final assessment was completed in September 2019. Data were analyzed from October 2019 to March 2021. Participants received contraceptive services at a clinic colocated with an opioid treatment program. Interventions: Participants were randomly assigned to receive 1 of 3 conditions: (1) usual care (ie, information about contraceptive methods and community health care facilities) (n = 48); (2) onsite contraceptive services adapted from the World Health Organization including 6 months of follow-up visits to assess method satisfaction (n = 48); or (3) those same onsite contraceptive services plus financial incentives for attending follow-up visits (n = 42). Main Outcomes and Measures: Verified prescription contraceptive use at 6 months with a cost-benefit analysis conducted from a societal perspective. Results: In this randomized clinical trial of 138 women (median age, 31 years [range, 20-44 years]), graded increases in verified prescription contraceptive use were seen in participants assigned to usual care (10.4%; 95% CI, 3.5%-22.7%) vs contraceptive services (29.2%; 95% CI, 17.0%-44.1%) vs contraceptive services plus incentives (54.8%; 95% CI, 38.7%-70.2%) at the 6-month end-of-treatment assessment (P < .001 for all comparisons). Those effects were sustained at the 12-month final assessment (usual care: 6.3%; 95% CI, 1.3%-17.2%; contraceptive services: 25.0%; 95% CI, 13.6%-39.6%; and contraceptive services plus incentives: 42.9%; 95% CI, 27.7%-59.0%; P < .001) and were associated with graded reductions in unintended pregnancy rates across the 12-month trial (usual care: 22.2%; 95% CI, 11.2%-37.1%; contraceptive services: 16.7%; 95% CI, 7.0%-31.4%; contraceptive services plus incentives: 4.9%; 95% CI, 0.6%-15.5%; P = .03). Each dollar invested yielded an estimated $5.59 (95% CI, $2.73-$7.91) in societal cost-benefits for contraceptive services vs usual care, $6.14 (95% CI, $3.57-$7.08) for contraceptive services plus incentives vs usual care and $6.96 (95% CI, $0.62-$10.09) for combining incentives with contraceptive services vs contraceptive services alone. Conclusions and Relevance: In this randomized clinical trial, outcomes with both onsite contraceptive service interventions exceeded those with usual care, but the most efficacious, cost-beneficial outcomes were achieved by combining contraceptive services with incentives. Colocating contraceptive services with opioid treatment programs offers an innovative, cost-effective strategy for preventing unintended pregnancy. Trial Registration: ClinicalTrials.gov Identifier: NCT02411357.

Contraceptive Knowledge among Females and Males Receiving Medication Treatment for Opioid Use Disorder Compared to Those Seeking Primary Care.

BACKGROUND: Rates of unintended pregnancy among women receiving medication treatment for opioid use disorder (mOUD) are high, likely due in part to low rates of contraceptive use. Lack of knowledge about contraception may be contributing to inadequate contraceptive use. Objectives: To compare contraceptive knowledge among women and men receiving mOUD relative to a comparison group seeking primary care. Methods: We surveyed 332 reproductive-age women and men receiving mOUD or primary care with the recently validated 25-item Contraceptive Knowledge Assessment. We examined overall differences between patient groups and between females and males using two-way analyses of variance; individual item differences were tested using logistic regression. Results: The mean percent of total correct responses was lower among individuals receiving mOUD (n = 167) relative to the comparison group (n = 165), 47.7% vs. 53.8%, respectively (p < .001), and higher among females (n = 169) relative to males (n = 163), 56.1% vs. 45.2%, respectively (p < .001). Individual item analyses revealed patient group and sex differences primarily in the areas of contraceptive efficacy, attributes of contraceptive methods, and fertility awareness. Conclusion: While there were modest differences between patient groups and sexes, the results suggest a deficit in contraceptive knowledge across all groups. Substance use disorder treatment clinics could be an opportunistic setting in which to provide accurate information about contraception to patients with OUD and other substance use disorders.

Adventitious reinforcement during long-duration DRO exposure.

Differential reinforcement of other behavior (DRO) is a procedure often used to decrease problem behavior, but the processes responsible for behavior reduction are not well understood. This study assessed whether adventitious reinforcement of other behavior contributes to DRO effectiveness when, relative to previous research, DRO exposure is prolonged. Two response options were presented on a computer and target responding was reinforced on a variable-ratio schedule. Response rates were then compared during DRO versus yoked variable-time or extinction probes. Across 2 experiments, DRO decreased target responding and increased other responding more than control conditions. However, increases in other responding did not usually maintain despite target responding remaining at low levels. DRO might adventitiously reinforce other responses transiently but the decreases in target behavior could not be entirely explained by adventitious reinforcement of the other response. Instead, reductions in target responding likely depend on the discriminability of the DRO contingency.

Perceptions of long-acting reversible contraception among women receiving medication for opioid use disorder in Vermont.

OBJECTIVES: To evaluate perceptions of long-acting reversible contraceptives (LARC) among women receiving medication for opioid use disorder. STUDY DESIGN: Cross-sectional survey of 200 women receiving medication for opioid use disorder in Vermont. RESULTS: A considerable proportion of women receiving medication for opioid use disorder in Vermont reported previous use of an IUD (40%) and/or a subdermal contraceptive implant (16%); the majority of prior LARC users were satisfied with their IUD (68%) or their implant (74%). Of the 38% of participants who had never considered IUD use, 85% percent (64/75) said that they knew nothing or only a little about IUDs. Of the 61% of participants who had never considered an implant, 81% percent (98/121) said that they knew nothing or only a little about the contraceptive method. The most commonly reported reasons for a lack of interest in the IUD and/or implant were concerns about side effects and preference for a woman-controlled method. CONCLUSIONS: Gaps in LARC knowledge are common among those who have not used LARCs and concerns about side effects and preferences for a woman-controlled method limit some women's interest in these contraceptives. Additionally, reasons for dissatisfaction among past users are generally similar for IUD and implant and include irregular bleeding and having a bad experience with the method. IMPLICATIONS: Efforts to increase awareness of LARC methods among women receiving medication for opioid use disorder should address concerns about side effects and reproductive autonomy and encourage satisfied LARC users to share their experiences with their social networks.

The role of adventitious reinforcement during differential reinforcement of other behavior: A systematic replication.

Differential reinforcement of other behavior (DRO) is commonly used to decrease problem behavior by presenting reinforcers contingent upon the absence of a target response. Although it is well demonstrated that DROs decrease response rates, the processes producing these decreases are not well understood. The present study systematically replicated previous research assessing whether adventitious reinforcement of alternative behavior contributes to the effectiveness of DRO. We presented university students with two options on a computer and reinforced target responding on a variable-ratio schedule. Next, we compared decreases in target-response rates and any increases in alternative responding during DRO schedules versus yoked variable-time schedules or extinction probes. DRO schedules resulted in the lowest target-response rate and highest alternative-response rate. These findings generally provide some support for the adventitious reinforcement of "other" behavior.

Unexpected food outcomes can return a habit to goal-directed action.

Three experiments examined the return of a habitual instrumental response to the status of goal-directed action. In all experiments, rats received extensive training in which lever pressing was reinforced with food pellets on a random-interval schedule of reinforcement. In Experiment 1, the extensively-trained response was not affected by conditioning a taste aversion to the reinforcer, and was therefore considered a habit. However, if the response had earned a new and unexpected food pellet during the final training session, the response was affected by taste aversion conditioning to the (first) reinforcer, and had thus been converted to a goal-directed action. In Experiment 3, 30 min of prefeeding with an irrelevant food pellet immediately before the test also converted a habit back to action, as judged by the taste-aversion devaluation method. That result was consistent with difficulty in finding evidence of habit with the sensory-specific satiety method after extensive instrumental training (Experiment 2). The results suggest that an instrumental behavior's status as a habit is not permanent, and that a habit can be returned to action status by associating it with a surprising reinforcer (Experiment 1) or by giving the animal an unexpected prefeeding immediately prior to the action/habit test (Experiment 3).

Relapse of operant behavior after response elimination with an extinction or an omission contingency.

The present study compared relapse after responding was eliminated by extinction or omission training in rats. In Experiment 1, lever pressing was reinforced with food pellets in Context A and then eliminated with either extinction or omission training in Context B. The response was then tested in Contexts A and B in either the presence or absence of free food pellets delivered on a random time schedule. All rats showed higher responding when tested in Context A than Context B, and there was little evidence that omission training attenuated this ABA renewal effect. Noncontingent pellets increased responding after extinction but not after omission. However, when responding on the last day of response elimination was compared to responding during the test in the response-elimination context, there was some evidence that omission-trained rats showed a small increase in responding even when tested with free pellets. Results of Experiment 2 suggest this increase was not due to differences in the temporal distribution of pellets during elimination and the test, and that the result might be due to mere removal of the omission contingency, but any such effect is small and difficult to detect statistically. The results provide new information about factors generating relapse after omission training.

The Development, Reliability, and Validity of the Social Impact of Repetitive Behavior Scale in Children with Autism Spectrum Disorder.

Introduction: Current measures of restrictive and repetitive behavior (RRB) in people with autism focus on severity and intensity and, to some degree, the global interference of the behavior. In this study we developed the Social Impact of Repetitive Behavior Scale (SIRBS) to capture several different contexts in which repetitive behavior is likely to occur and interfere. Methods: SIRBS items were selected through reviewing the RRB literature, participant chart reviews, and consensus among authors, followed by an initial piloting and further refinement of the tool. Caregivers completed the SIRBS a total of 400 times. Results: Subscales showed high internal consistency and good test-retest reliability, moderate concurrent validity, and average to excellent inter-rater reliability. Conclusion: The SIRBS is a psychometrically reliable and valid measure of the social impact of repetitive behavior with children with autism. Additional research is needed to independently validate it and conduct an initial exploratory factor analysis of subscales.

Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids.

Dramatic increases in the rate of opioid use disorder (OUD) during pregnancy have been paralleled by substantial increases in the number of neonates diagnosed with neonatal abstinence syndrome (NAS). Women with OUD have reliably reported high rates of unintended pregnancy and a number of studies also indicate they desire easier access to contraception. Recent statements from the Centers for Disease Control and Prevention and the American Academy of Pediatrics/American College of Obstetricians and Gynecologists have drawn increased attention to efforts to prevent unintended pregnancy and improve access to contraception among women with OUD. We briefly review a number of innovative clinical approaches in these areas, including efforts to integrate family planning services into substance use disorder (SUD) treatment and other settings that serve people with OUD and interventions that aim to make family planning a higher priority among women with OUD. Results suggest many of these approaches have led to increases in contraceptive use and may aid in efforts to reduce unintended pregnancy and improve access to contraception among women with OUD now and in the future.

Stigma, Discrimination, Treatment Effectiveness, and Policy Support: Comparing Behavior Analysts' Views on Drug Addiction and Mental Illness.

Individuals with substance use disorders (SUDs) often face discrimination. A recent study found that people in the general population hold significantly more negative views toward persons with drug addiction than those with other mental illnesses (Barry et al. in Psychiatric Services, 65(10), 1269-1272, 2014). It is possible that these negative attitudes stem from the historical view of addiction as a moral shortcoming or lack of willpower. Behavior analysts' approach to behavior is guided by the underlying philosophy of behaviorism, which proposes that behavior is determined by genetic and environmental factors, as opposed to the free will of an individual. Because behavior analysts view behavior as determined and do not assign responsibility to an individual for his or her behavior, one would hypothesize that behavior analysts would not view individuals with SUDs more negatively than those with other mental disorders. This study surveyed 288 behavior analysts regarding their views on SUDs and mental disorders. Results showed that behavior analysts have significantly more negative attitudes toward people with SUDs than toward people with other mental disorders. Respondents reported a greater desire for social distance and greater acceptability of discrimination for people with SUDs than for people with mental disorders. They also reported less potential for recovery and lower support for policies to improve equity in insurance coverage and were less supportive of using government funding to improve treatment, housing, and job support for people with SUDs.

A translational analysis of ABA and ABC renewal of operant behavior.

Following reduction, behavior may recur when organisms are exposed to new or different environments. Such recurrences, called treatment relapse, are characterized by an increase of a previously reduced behavior. Renewal is a type of treatment relapse resulting from changes in stimulus contexts despite the ongoing maintenance of treatment. Renewal types include varying arrangements, such as ABA and ABC renewal, where each letter represents a different context. In the present series of translational analyses, we evaluated both ABA and ABC renewal and assessed whether these two renewal arrangements may be present in a single participant's behavior. Results produced evidence of both ABA and ABC renewal, and both types of renewal were detected in an individual participant's behavior.