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Opioid use disorder (OUD) is a major public health issue and recovery is a long-term and complex process. Opioid Agonist Treatment (OAT) including medications such as methadone and buprenorphine, is the first-line medical intervention for OUD, however clinical responses among sub-populations differ and concurrent heroin use among individuals in OAT is reported. Contingency management (CM) is a behavioural intervention involving the application of positive reinforcement (e.g., monetary incentives) contingent upon evidence of positive behaviour change. CM is based on the theoretical principles of operant conditioning and is among the most efficacious psychosocial intervention in promoting substance use-related behaviours, including abstinence from smoking, alcohol and illicit drugs, medication adherence, vaccination uptake and attendance. Technology can be leveraged to expand the reach and accessibility of these interventions, automating key components of intervention delivery, including objective behaviour monitoring and immediate reward delivery. Currently, there are no fully remote CM interventions specifically targeting heroin use among individuals undergoing treatment for OUD, highlighting a critical need for innovation in addressing this complex aspect of substance use. Developing and delivering a fully digitalised app-based CM intervention for reducing heroin use among individuals in treatment for OUD holds considerable potential. This paper provides a protocol for a feasibility study that aims to determine the acceptability and feasibility of conducting a future randomised controlled trial of the clinical effectiveness of app-based CM to encourage heroin abstinence among clients receiving OAT in UK drug treatment services. Forty OAT service users in UK drug treatment services who continue to use heroin will be randomly assigned to either (1) OAT plus a smartphone app providing abstinence incentives or (2) standard OAT alone. Participants in the intervention arm will receive financial incentives contingent on heroin-negative toxicology results. Over a 12-week period, participants will receive thrice-weekly push notifications via the smartphone app when an oral saliva test is due. Participants will receive feedback upon submission and verified heroin-negative tests will result in notification of earnings. The primary outcome of this feasibility trial is the number of eligible service users recruited over the 6-month recruitment period. Other feasibility outcomes include intervention adherence, drug screening completion and follow-up rates. Acceptability will be explored among both clinicians and service users. Progression to a larger confirmatory trial will be evaluated based on the pre-specified progression criteria. Research on CM has grown exponentially over the last decade, with remote technologies being leveraged more than ever to expand the reach and scope of these interventions. This study will evaluate the feasibility of a mCM app to support heroin abstinence among OAT recipients. By integrating CM with mobile technology, this approach could enhance treatment accessibility and effectiveness, potentially improving outcomes for a high-risk population.

Limited information exist on tobacco and e-cigarette use patterns in cancer survivors. The purpose of this study is to report on use patterns in cancer survivors compared with non-cancer participants from the Population Assessment of Tobacco and Health (PATH) Study. Sociodemographic data and tobacco product use were analyzed for 32,244 adult participants from the PATH Study in 2013-2014 by cancer status and age. Logistic regression examined the patterns of and factors associated with tobacco use by cancer status. Overall, cancer survivors represented 7.1% (n = 1,527) of participants, were older, and had a higher proportion of females and non-Hispanic whites than non-cancer participants. In cancer survivors, current and former cigarette smoking was reported in 12.7% and 32.9% respectively, compared with 18.5% and 19.0% in non-cancer adults. Current e-cigarette use was reported by 3.8% of survivors compared with 5.7% of non-cancer participants. Dual tobacco use was reported by 25.0% and poly use by 6.9% of cancer survivors who currently smoked. All other forms of current tobacco use were individually reported by <5% of survivors. Young adult cancer survivors (aged 18-44) reported the highest rates of current cigarette smoking (27.9%) and current e-cigarette use (11.8%). The effects of age, sex, race/ethnicity, education, and income on tobacco use status were comparable for cancer survivors and non-cancer participants. Cancer survivors who were younger, male, of lower educational attainment, and those diagnosed with a tobacco-related cancer were more likely to report current tobacco use. Among cancer survivors, cigarette smoking remains the predominant form of tobacco use, although other tobacco/nicotine use and dual/poly use are common. The PATH Study provides detailed tobacco product use patterns in survivors, including their adoption of emerging alternative tobacco products.

Technology-based interventions to promote health are expanding rapidly. Assessing the preliminary efficacy of these interventions can be achieved by employing single-case experiments (sometimes referred to as n-of-1 studies). Although single-case experiments are often misunderstood, they offer excellent solutions to address the challenges associated with testing new technology-based interventions. This paper provides an introduction to single-case techniques and highlights advances in developing and evaluating single-case experiments, which help ensure that treatment outcomes are reliable, replicable, and generalizable. These advances include quality control standards, heuristics to guide visual analysis of time-series data, effect size calculations, and statistical analyses. They also include experimental designs to isolate the active elements in a treatment package and to assess the mechanisms of behavior change. The paper concludes with a discussion of issues related to the generality of findings derived from single-case research and how generality can be established through replication and through analysis of behavioral mechanisms.

Higher rates of delay discounting, or impulsive choice, may be related to relapse during abstinence reinforcement interventions for cigarette smoking, and a transdermal nicotine patch may attenuate delay discounting. The objectives of this study are to assess the relation between delay discounting and smoking after nicotine deprivation in a laboratory model of abstinence reinforcement and the effects of a transdermal nicotine patch on discounting and smoking. Smokers with no self-reported intention to quit were randomly assigned to an active (14 mg) or placebo patch group (n = 15 per group). In each of three sessions, after a 3-h deprivation period, participants completed a delay discounting task, mood, and craving measures and finally engaged in a laboratory model of abstinence reinforcement. Three abstinence reinforcement conditions were presented in counterbalanced order across the three sessions. During the control session, monetary consequences were delivered every 30 s regardless of smoking. During the low (5.00 dollars available) and high (20.00 dollars available) sessions, participants could earn a progressively increasing amount of money for each 30 s period of abstinence. The low and high conditions significantly increased the latency to smoke relative to control and significantly decreased the amount of smoking. The nicotine patch decreased negative affect, but it did not significantly affect delay discounting or smoking. Individuals who smoked during the low and high conditions showed higher rates of discounting. The patch did not attenuate delay discounting or smoking after a period of deprivation, but contingencies for abstinence significantly decreased smoking. Higher rates of delay discounting were related to smoking in a model of abstinence reinforcement treatment.

Problematic internet use (PIU) is of increasing concern to society and is correlated with negative behavioral and health issues. Human laboratory procedures to assess economic demand for internet use may be useful in translational efforts to better understand PIU and to assess potential treatments. One such procedure involves hypothetical purchases of access to internet use. Little is known about how such hypothetical purchases relate to actual behavior. In the current study, we assessed the correlation between measures of demand via an internet purchase task (IPT) and breakpoints on a progressive ratio (PR) schedule (n = 52). Participants responded on a computer-based task on an escalating work requirement that resulted in 30-s of access to their internet-enabled smartphone. We found a statistically significant correlation between demand intensity (Qo) and total responses (r(29) = .83, p < .001), and between Omax (maximum response expenditure) and total responses (r(29) = .34, p = .03) on the PR schedule. We did not find a relationship between measures of demand elasticity and measures of PR behavior. Because Omax is reflective of both demand and elasticity and Q0 is primarily influenced by demand alone, the results of this study indicate that demand intensity of internet use may be a better predictor of real-world behavior than other measures of demand. These results suggest that demand intensity for internet access may be a valuable proxy for behavior-based measures in the assessment and treatment of PIU.

Smoking is the leading cause of preventable death in the United States and imposes a substantial economic cost. Despite the well-established potential harm, relapse rates remain high during quit attempts. In the realm of applied behavior analysis, functional assessment has long been recognized as a reliable method to increase effectiveness of treatments for a variety of problem behaviors. Functional assessment may aid in designating targeted treatment for smokers based on the maintaining function(s) of the behavior. The current study (N = 414) sought to assess the reliability and validity of the Functional Assessment of Smoking for Treatment Recommendations (FASTR) and provide preliminary evidence towards a hypothesized factor structure. The full FASTR included five subscales derived from the field of functional behavior assessment: 1) Automatic Positive Reinforcement, 2) Social Positive Reinforcement, 3) Automatic Negative Reinforcement, 4) Social Negative Reinforcement, and 5) Antecedent Stimuli. The full battery of subscales was found to be adequately reliable and valid, with overall sample reliability coefficients ranging from α = 0.69 to α = 0.90. Confirmatory factor analysis of the five-factor model produced acceptable fit indices (CFI = 0.908, TLI = 0.896, RMSEA = 0.059, SRMR = 0.071). A five-factor model performed favorably across several fit indices, providing preliminary validity for the FASTR. Further research should aim to replicate the observed factor structure in other samples and establish the clinical utility of the FASTR.

Background: Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise. Objective: The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients. Methods: For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research (NIH RePORTER) and clinical trials databases (ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included. Results: Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered. Conclusions: Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

Binge Eating Disorder (BED) is the most prevalent eating disorder and is associated with psychiatric comorbidities, health impairments, and decreased quality of life. Emerging evidence suggests that psilocybin-assisted therapy may promote cognitive and emotional flexibility and disrupt maladaptive behavioral patterns, making it a promising candidate for BED treatment. This open-label pilot study evaluated the feasibility, safety, and preliminary therapeutic effects of a single 25 mg dose of psilocybin administered in the context of Acceptance and Commitment Therapy (ACT)-based psychotherapy in adults with BED ( N  = 5). Primary outcomes included safety measures, and exploratory outcomes included self-reported binge eating frequency, depression, anxiety, psychological flexibility, anthropometric indices, and neuroimaging biomarkers assessed over a 14-week follow-up. Psilocybin was well tolerated, with no serious adverse events. Reductions in self-reported binge eating frequency were observed across all participants and sustained through week 14. Improvements were also noted in depression, anxiety, and psychological inflexibility. Three participants showed reductions in body mass index and waist circumference. Given the open label design and small sample size, causality cannot be inferred. fMRI analyses generated preliminary signals of change—such as increased functional activation from pre- to post-intervention in the middle frontal gyrus, angular gyrus, and supramarginal gyrus in response to processed versus unprocessed food cues. Psilocybin-assisted therapy was feasible and well-tolerated in individuals with BED. The clinical and neurobiological observations provide directions for future adequately powered trials. Plain English summary Binge Eating Disorder (BED) is the most common eating disorder and can have a serious impact on mental health, physical health, and overall quality of life. Many people with BED struggle with repeated patterns of eating that feel hard to change, even when they want to. New treatments are needed to help people break these cycles in safe and supportive ways. This small pilot study explored whether a single dose of psilocybin, given alongside a type of talk therapy focused on values, acceptance, and behavior change, could be safely used with adults who have BED. Five adults took part in the study and were followed for about three months. The treatment was well tolerated, and no serious safety concerns were found. All participants reported fewer binge eating episodes after the treatment, and these improvements lasted throughout the follow-up period. Many also reported feeling less depressed and anxious and more able to respond flexibly to difficult thoughts and emotions. Some participants showed small reductions in weight and waist size. Brain scans suggested possible changes in how participants responded to food-related images. Because this was a small study without a comparison group, stronger conclusions cannot yet be made. However, the findings suggest this approach may be promising and worth studying further in larger trials.

Delay discounting refers to a reinforcer’s loss of subjective value as a function of delay to its receipt. Higher rates of discounting have been linked to a variety of substance use disorders including cigarette smoking. Observation of impulsive or self-controlled intertemporal choices, such as smoking or engaging in healthy behavior, may influence the rate of discounting. If choices on discounting tasks are influenced by observation of intertemporal choice, then it may not matter whether the observation is from the first- or third-person perspective. Participants ( n  = 65) were shown two videos: one of a woman smoking a cigarette and one of another woman eating an apple. Following each video, participants completed a delay discounting task as a surrogate decision-maker for each woman in the videos (i.e., choices were made from the perspective of the woman). Discounting rates were consistently higher from the perspective of the smoker compared to the apple eater. In addition, over half of the participants indicated that their responses were influenced by differences in observed health behavior in an open-ended response. These findings suggest that observing patterns of impulsive or self-controlled choice may influence surrogate delay discounting rates. An implication is that high discounting rates in cigarette smokers may be similarly influenced by observation of their own intertemporal choices.

Smoking, obesity, and insufficient physical activity are modifiable health risk behaviors. Self-regulation is one fundamental behavior change mechanism often incorporated within digital therapeutics as it varies momentarily across time and contexts and may play a causal role in improving these health behaviors. However, the role of momentary self-regulation in achieving behavior change has been infrequently examined. Using a novel momentary self-regulation scale, this study examined how targeting self-regulation through a digital therapeutic impacts adherence to the therapeutic and two different health risk behavioral outcomes. This prospective interventional study included momentary data for 28 days from 50 participants with obesity and binge eating disorder and 50 participants who smoked regularly. An evidence-based digital therapeutic, called Laddr™, provided self-regulation behavior change tools. Participants reported on their momentary self-regulation via ecological momentary assessments and health risk behaviors were measured as steps taken from a physical activity tracker and breathalyzed carbon monoxide. Medical regimen adherence was assessed as daily Laddr usage. Bayesian dynamic mediation models were used to examine moment-to-moment mediation effects between momentary self-regulation subscales, medical regimen adherence, and behavioral outcomes. In the binge eating disorder sample, the perseverance [  = 0.17, 95% CI = (0.06, 0.45)] and emotion regulation [  = 0.12, 95% CI = (0.03, 0.27)] targets of momentary self-regulation positively predicted Laddr adherence on the following day, and higher Laddr adherence was subsequently a positive predictor of steps taken the same day for both perseverance [  = 0.335, 95% CI = (0.030, 0.717)] and emotion regulation [  = 0.389, 95% CI = (0.080, 0.738)]. In the smoking sample, the perseverance target of momentary self-regulation positively predicted Laddr adherence on the following day [  = 0.91, 95% CI = (0.60, 1.24)]. However, higher Laddr adherence was not a predictor of CO values on the same day [  = -0.09, 95% CI = (-0.24, 0.09)]. This study provides evidence that a digital therapeutic targeting self-regulation can modify the relationships between momentary self-regulation, medical regimen adherence, and behavioral health outcomes. Together, this work demonstrated the ability to digitally assess the transdiagnostic mediating effect of momentary self-regulation on medical regimen adherence and pro-health behavioral outcomes. ClinicalTrials.gov, identifier (NCT03774433).