Getting paid to quit
Kick one habit, pick up another. That's typically the case with methadone users who manage to quit using heroin, but start or continue smoking cigarettes. About 90 percent of all methadone users are smokers, compared with 25 percent of the general population.
The good news? While conventional smoking-cessation treatments, including the nicotine patch, don't seem to work for methadone users, another method shows some promise. Third-year University of Vermont general/experimental psychology graduate student Kelly Dunn recently tested a contingency-management (CM) voucher program on a group of methadone users and found that paying them to stay smoke-free significantly increased users' abstinence from nicotine.
Previous research suggested that rewarding users for abstinence reduces drug use in the general population but didn't work as well for methadone users. Dunn noticed that the studies done with methadone users failed to highly encourage abstinence during the intervention's first few days. Because early abstinence is particularly important to long-term quitting, Dunn says, she decided to see if more intense abstinence messages, combined with CM, would help methadone-using smokers quit.
She recruited 20 adult smokers from a local methadone clinic for a two-week pilot study. The group received a $9 voucher for their first nicotine test that came back negative. After that, the reward increased by $1.50 for every subsequent negative test. To further promote early abstinence, each negative test yielded a $10 bonus during the first week.
Participants in a control group were also given vouchers but were told the rewards would not be linked to their smoking habits.
After two weeks, Dunn found that the CM group was much more successful at abstaining from cigarettes than the control group. What's more, follow-up visits revealed that some participants remained abstinent even after the study ended.
"A small percentage-around 20 percent-of the people in the study stayed abstinent for 90 days, which we didn't expect to happen with a two-week trial," Dunn says.
Now Dunn is running the trial again with a larger sample size, and plans to run it over three months to replicate and enhance the validity of her results. If they pan out, she says, it will make a big difference in helping methadone users-whose mortality rate is four times higher than methadone-using nonsmokers-kick the habit for good.
The mystery of the pacing monkeys
Ever seen an animal in the zoo pace back and forth? That's an example of stereotypy, an abnormal behavior characterized by continuous, repetitive movement. It's common in captive animals and is also found in humans with such conditions as autistic disorder.
Jessica Vandeleest wanted to see if temperaments in infant nonhuman primates could predict stereotypic behavior later in life. Vandeleest, a third-year psychobiology graduate student at the University of California, Davis, became involved in an ongoing experiment in which researchers rear Rhesus macaques under a variety of social conditions. At 3 to 4 months of age, the infants are separated from their primate companions for 24 hours and given a battery of behavioral assessments before returning to their living environments. Vandeleest looked at records of these assessments going back five years to see if she could find a pattern.
Monkeys raised without mothers were most at risk for stereotypy, but among those reared with their mothers in a naturalistic setting-with 80 to 150 other monkeys in outdoor field cages-one factor still seemed to predict stereotypic behavior: low emotionality. When the animals were separated for testing, they shut down-"I kind of think of it as closing up emotionally," Vandeleest says.
These monkeys were much more likely to develop stereotypic behaviors later in life, such as pacing, back flips and rocking. Vandeleest says this is evidence that very early temperament factors can indicate who is at risk for stereotypy.
Vandeleest isn't sure how generalizable these results are to humans but says they might help researchers better understand the general risk factors associated with similar symptoms found in such conditions as autism. Zoos and researchers can likely devise interventions based on her research by identifying at-risk individuals and tweaking their living arrangements, such as providing them with larger cages.
Clinicians avoid stigma but may miss diagnoses
When it comes to diagnosing autistic disorder and Asperger's disorder, it can be difficult for clinicians to tell them apart. This is especially true with very young children who may not yet display certain impairments. Compounding the difficulty is that clinicians tend to over-diagnose cases of Asperger's disorder, says Carey Heller, a first-year clinical psychology doctoral student at George Washington University in Washington, D.C. For his undergraduate honors thesis, Heller looked at the factors that might influence clinicians to diagnose one way or the other.
Symptoms that indicate autistic disorder typically include a significant delay in learning language, low IQ, difficulty making eye contact and problems interacting with others. Asperger's disorder is characterized by similar symptoms, except that it does not feature a language delay or cognitive impairments.
Heller devised a fictional vignette describing the case of "Jeremy," a 6-year-old boy who, according to DSM-IV criteria, should be diagnosed as autistic due to his delayed language acquisition as well as other impairments. Heller then gave the vignette to 63 clinicians and asked them to diagnose Jeremy.
Most of the clinicians diagnosed Jeremy with either Asperger's disorder or Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). Only about a quarter of the clinicians accurately picked autistic disorder, Heller says."I think this shows that some clinicians aren't adhering strictly to DSM criteria," Heller says.
Then on what are they basing their diagnoses? Heller also asked clinicians whether or not they agreed with a statement that Asperger's disorder carries less social stigma than autism. The results indicated that clinicians who diagnosed Jeremy with Asperger's or PDD-NOS agreed pretty strongly with the statement, while those who diagnosed him with autistic disorder only slightly agreed.
Heller says these results support an assertion made in 1999 by the National Autistic Society that some clinicians may diagnose high-functioning people who meet criteria for autistic disorder with Asperger's, simply because it is less stigmatizing.
He doesn't think such misdiagnoses are harmful to disordered people themselves, as treatment tends to be highly individualized anyway. But Heller does believe there are research implications, because many studies include Asperger's and autistic disorders as separate variables.
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