Randomized controlled trial of a positive affect intervention for methamphetamine users
Open accessAbstract
Background Contingency management (CM) is an evidence-based intervention providing rewards in exchange for biomarkers that confirm abstinence from stimulants such as methamphetamine. We tested the efficacy of a positive affect intervention designed to boost the effectiveness of CM with HIV-positive, methamphetamine-using sexual minority men.Methods This attention-matched, randomized controlled trial of a positive affect intervention delivered during CM was registered on www.clinicaltrials.gov (NCT01926184). In total, 110 HIV-positive sexual minority men with biologically confirmed, recent methamphetamine use were enrolled. Five individual sessions of a positive affect intervention (n = 55) or an attention-control condition (n = 55) were delivered during three months of CM. Secondary outcomes examined over the 3-month intervention period included: 1) psychological processes relevant to affect regulation (i.e., positive affect, negative affect, and mindfulness); 2) methamphetamine craving; 3) self-reported stimulant use (past 3 months); and 4) cumulative number of urine samples that were non-reactive for stimulants (i.e., methamphetamine and cocaine) during CM.Results Those randomized to the positive affect intervention reported significant increases in positive affect during individual sessions and increases in mindfulness over the 3-month intervention period. Intervention-related improvements in these psychological processes relevant to affect regulation were paralleled by concurrent decreases in methamphetamine craving and self-reported stimulant use over the 3-month intervention period.Conclusions Delivering a positive affect intervention may improve affect regulation as well as reduce methamphetamine craving and stimulant use during CM with HIV-positive, methamphetamine-using sexual minority men.
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Existing MBI trials with sexual minority men have focused on gay and bisexual men living with HIV.
“Extant MBI trials with sexual minority men have focused on gay and bisexual men living with HIV (Carrico et al., 2018, 2019; Gayner et al., 2012).”
From Mindfulness for Reducing Minority Stress and Promoting Health Among Sexual Minority Men: Uncovering Intervention Principles and Techniques (2022) · cites this paper as Carrico et al., 2018
The Abstract (Methods) identifies this as a randomized trial enrolling HIV-positive sexual minority men. However, Methods (Interventions) describes ARTEMIS as a multicomponent positive-affect intervention that includes mindfulness, rather than identifying it as a mindfulness-based intervention. The paper supports the population and trial aspects of the claim, but not that classification without qualification. (LLM, conf=0.82)
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BackgroundRandomized controlled trial of a positive affect intervention for people newly diagnosed with HIV.
Moskowitz, J. T., Carrico, A. W., Duncan, L. G., Cohn, M. A., Cheung, E. O., Batchelder, A., Martinez, L., Segawa, E., Acree, M., & Folkman, S. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000188 · Cited by 220 · cited 2× · see citing works
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Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M., BLAINE, J. D., Macdonald, M. J., DiMaria, J., Lucero, L., et al. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.11.1993 · Cited by 196 · cited 2× · see citing works
“CM has demonstrated effectiveness as a stand-alone therapy, and it has been shown to enhance the effectiveness of substance use disorder treatment with methamphetamine users (Roll et al., 2006; Shoptaw et al., 2005).”
BackgroundContingency Management for the Treatment of Methamphetamine Use Disorders
Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., Blaine, J., MacDonald, M., DiMaria, J., Lucero, L., et al. (2006) · American Journal of Psychiatry · doi:10.1176/appi.ajp.163.11.1993 · Cited by 196 · see citing works
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BackgroundResultCell phones for ecological momentary assessment with cocaine-addicted homeless patients in treatment
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“Consistent with prior research (Carrico et al., 2015a; Freedman et al., 2006), participants also rated the intensity of their current craving for methamphetamine before each of the five individual sessions using a visual analogue scale from zero (no craving at all) to 100 (some of the worst craving ever).”
MethodAmphetamine-group substances and HIV
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“Given growing evidence that positive affect has unique beneficial psychological and physical health effects, researchers have begun testing interventions that target positive affect and found emerging evidence of efficacy in various populations (Boutin-Foster et al., 2016; Cohn et al., 2014; Huffman et al., 2015; Mosk…”
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“This intervention was adapted from prior clinical research testing a positive affect intervention for recently diagnosed HIVpositive persons (Moskowitz et al., 2017; Moskowitz et al., 2012).”
MethodSelf-citationVolkow, N. D., Tomasi, D. G., Wang, G.-J., Fowler, J. S., Telang, F., Goldstein, R. Z., Alia‐Klein, N., Woicik, P. A., Wong, C., Logan, J., et al. (2011) · Molecular Psychiatry · doi:10.1038/mp.2011.30 · Cited by 109 · cited 2× · see citing works
“This underscores the need for integrative approaches that target fundamental neurobehavioral processes such as withdrawal and anhedonia that may undermine the benefits of CM (Baker et al., 2004; Goldstein and Volkow, 2011).”
BackgroundSHOPTAW, S. J., Klausner, J. D., Reback, C. J., Tierney, S., Stansell, J., Hare, C. B., Gibson, S., Siever, M. D., King, W. D., Kao, U. H., et al. (2006) · BMC Public Health · doi:10.1186/1471-2458-6-214 · Cited by 94 · cited 1× · see citing works
“return to their place in the escalating reinforcement schedule after producing three consecutive urine samples that were non-reactive for methamphetamine and cocaine (Shoptaw et al., 2006).”
BackgroundSelf-citationContingency Management among Homeless, Out-of-Treatment Men who have Sex with Men
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“methamphetamine-dependent sexual minority men (Reback et al., 2010; Shoptaw et al., 2005), some individuals can experience difficulties with achieving consistent abstinence during CM (Menza et al.”
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Positive affect promotes engagement in care after HIV diagnosis.
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“The experience of positive affect such as happiness or gratitude could assist with managing symptoms of stimulant withdrawal during CM and sensitize individuals to natural sources of reward (Carrico, 2014).”
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“, 2005), some individuals can experience difficulties with achieving consistent abstinence during CM (Menza et al., 2010).”
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“Because stimulant use fuels the HIV/AIDS epidemic in high priority populations like gay, bisexual, and other men who have sex with men (referred to here as sexual minority men), boosting the effectiveness of behavioral interventions for stimulant users may also have important implications for both HIV prevention and c…”
BackgroundSelf-citationCarrico, A. W., Zepf, R., Meanley, S., Batchelder, A., & Stall, R. D. (2016) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001102 · Cited by 62 · cited 6× · see citing works
“Although behavioral interventions have demonstrated modest effectiveness (Carrico et al., 2016b; Colfax et al., 2010), novel approaches are needed to achieve greater reductions in stimulant use.”
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“, 2005), including those living with alcohol and substance use disorders (Carrico et al., 2015a; Krentzman et al., 2015).”
BackgroundTreatment Effectiveness Score as an Outcome Measure in Clinical Trials
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“We counted the total number of urine samples that were nonreactive for stimulants, which is also referred to as the treatment effectiveness score (Ling et al., 1997).”
BackgroundSelf-citationPositive affect and processes of recovery among treatment-seeking methamphetamine users
Carrico, A. W., Woods, W. J., Siever, M. D., Discepola, M. V., Dilworth, S. E., Neilands, T. B., Miller, N., & Moskowitz, J. T. (2013) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2013.04.018 · Cited by 46 · cited 4× · see citing works
“Positive affect is theorized to reinvigorate coping efforts in the midst of chronic stress (Folkman and Moskowitz, 2000), and this could assist individuals with avoiding the stimulant use and changing other important health behaviors (Carrico and Moskowitz, 2014; Carrico et al., 2013; Pressman and Cohen, 2005).”
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“Given growing evidence that positive affect has unique beneficial psychological and physical health effects, researchers have begun testing interventions that target positive affect and found emerging evidence of efficacy in various populations (Boutin-Foster et al., 2016; Cohn et al., 2014; Huffman et al., 2015; Mosk…”
BackgroundCarrico, A. W., Jain, J. P., Discepola, M. V., Olem, D., Andrews, R., Woods, W. J., Neilands, T. B., SHOPTAW, S. J., Gómez, W., Dilworth, S. E., et al. (2016) · BMC Public Health · doi:10.1186/s12889-016-3325-1 · Cited by 37 · see citing works
Self-citationCarrico, A. W., Nation, A., Gómez, W., Sundberg, J., Dilworth, S. E., Johnson, M. O., Moskowitz, J. T., & Rose, C. D. (2014) · Psychology of Addictive Behaviors · doi:10.1037/adb0000031 · Cited by 31 · see citing works
Self-citationOptimizing Contingency Management With Methamphetamine-Using Men Who Have Sex With Men
Gómez, W., Olem, D., Andrews, R., Discepola, M. V., Ambrose, P., Dilworth, S. E., & Carrico, A. W. (2017) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.08.003 · Cited by 21 · cited 3× · see citing works
“CM visits were completed at the San Francisco AIDS Foundation, and all other trial-related activities occurred at a separate field site at the Alliance Health Project.”
MethodInfluentialSelf-citation
Flagged first, then by citations
Research works printed but not linked: 2
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Contingency management for the treatment of methamphetamine use disorder: A systematic review
Brown, H. D., & DeFulio, A. (2020) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2020.108307 · Cited by 171 · see citing works
Dark Times: The Role of Negative Reinforcement in Methamphetamine Addiction
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“This was demonstrated in a sample of 110 MA sexual minority men positive for human immunodeficiency virus (HIV), who were randomly assigned to receive either CM combined with a positive affect (CM+PA) intervention or an attention-control condition (54).”
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Current and Emerging Treatments for Methamphetamine Use Disorder
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“[87]) found no synergistic or additive effects.”
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“We have previously demonstrated the efficacy of a positive affect intervention for improving psychological adjustment and achieving durable reductions in viral load for people living with HIV [39] , including MSM living with HIV who use methamphetamine [40, 41] .”
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Self-citationPsychosocial interventions for stimulant use disorder
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Adaptation of contingency management for stimulant use disorder during the COVID-19 pandemic
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Self-citationA mindfulness-based, stress and coping model of craving in methamphetamine users
Mutumba, M., Moskowitz, J. T., Neilands, T. B., Lee, J.-Y., Dilworth, S. E., & Carrico, A. W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0249489 · Cited by 15 · see citing works
“A detailed description of the study protocol is published elsewhere [37, 38].”
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Self-citationSizemore, K. M., Gray, S., Wolfer, C., Forbes, N., Talan, A. J., Millar, B. M., Park, H. H., Saslow, L. R., Moskowitz, J. T., & Rendina, H. J. (2022) · Journal of Happiness Studies · doi:10.1007/s10902-022-00587-2 · Cited by 14 · see citing works
Self-citationPilot Randomized Controlled Trial of a Syndemics Intervention with HIV-Positive, Cocaine-Using Women
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“Studies showed that 8 weeks of aerobic exercise can improve the executive and autonomic nervous system function of patients with MUD by enhancing the availability of striatal D2/3 receptors, therefore effectively alleviating symptoms of depression and anxiety [14,15].”
BackgroundA pilot RCT of an online mindfulness‐based cognitive intervention for chemsex
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Getting to Zero: Targeting Psychiatric Comorbidities as Drivers of the HIV/AIDS Epidemic
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Self-citationOlem, D., Earle, M. A., Gómez, W., Coffin, L. S., Cotten, P. D., Jain, J. P., Moskowitz, J. T., & Carrico, A. W. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.09.007 · Cited by 8 · see citing works
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“Based on this finding and former research, we believe that behavioral interventions should consider utilizing strategies to promote emotional regulation through enhancing positive emotion and sensitizing individuals to natural rewards [44].”
Self-citationLee, J.-Y., Lee, J. E., Moskowitz, J. T., Feaster, D. J., Neilands, T. B., Dilworth, S. E., Rodriguez, A. E., & Carrico, A. W. (2021) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2021.108752 · Cited by 7 · see citing works
Self-citationKrentzman, A. R., Hoeppner, S. S., Hoeppner, B. B., & Barnett, N. P. (2024) · Journal of Substance Use and Addiction Treatment · doi:10.1016/j.josat.2024.209410 · Cited by 7 · see citing works
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Self-citationLee, J.-Y., Glynn, T. R., Moskowitz, J. T., Fuchs, D., Neilands, T. B., Dilworth, S. E., Feaster, D. J., Rodriguez, A. E., & Carrico, A. W. (2021) · Journal of NeuroVirology · doi:10.1007/s13365-020-00937-x · Cited by 6 · see citing works
Self-citationAge moderates the association of optimism on craving during substance use disorder treatment
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Self-citationIs the thought-action repertoire a viable intervention target in substance use populations?
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Disorders due to Substance Use: Stimulants
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Ross, E. J., Jimenez, D. E., Ghanooni, D., Dilworth, S. E., Carrico, A. W., & Williams, R. S. (2024) · Journal of Homosexuality · doi:10.1080/00918369.2024.2440344 · Cited by 2 · see citing works
“This suggests it may be clinically useful to explore positive psychological interventions that promote positive affect and emotional well-being to increase optimism and decrease pessimism in SMM given their promise in SMM populations (Carrico et al., 2018; Moskowitz et al., 2012, 2017, 2019).”
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“Specifically, using a randomized control trial, positive emotion interventions increase flourishing-based resources (e.g., affect regulation, mindfulness) over a 3-month period for sexual minority men with reported substance use difficulties (Carrico et al., 2018).”
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“Stress and coping frameworks have been an important part of HIV research, particularly among multiply oppressed communities, such as meth-using SMM [28–33].”
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“Moreover, studies from the West region were over-represented as all were conducted in California.”
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- Authors
- Carrico, A. W., Gόmez, W., Jain, J., Shoptaw, S., Discepola, M. V., Olem, D., Lagana-Jackson, J., Andrews, R., Neilands, T. B., Dilworth, S. E., Evans, J. L., Woods, W. J., & Moskowitz, J. T.
- Affiliations
- University of Miami (US)
- University of California San Diego (US)
- University of California, Los Angeles (US)
- San Francisco AIDS Foundation (US)
- University of California, San Francisco (US)
- Northwestern University (US)
- Corresponding author
- Carrico, Adam W.
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 192
- Pages
- 8-15
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6200638
- OpenAlex
- W2890956924
- Cited by
- 56
- References
- 57
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 12 · 2023: 3 · 2022: 7 · 2021: 12 · 2020: 8 · 2019: 5 · 2018: 1 · 2017: 1
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01-DA033854)
- National Institute of Mental Health (K24-MH093225)
- University of California, San Francisco Center for AIDS Research’s Virology Core (P30-AI027763)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- methamphetamine use, contingency management, HIV-positive men who have sex with men, sexual minority men, emotion regulation, mindfulness, positive affect, negative affect, cocaine use, urinary biomarkers
- MeSH terms
- Sexual and Gender Minorities, Adult, Central Nervous System Stimulants, Behavior Therapy, Follow-Up Studies, HIV Seropositivity, Humans, Male, Methamphetamine, Middle Aged, Reward, Homosexuality, Male, Early Intervention, Educational, Amphetamine-Related Disorders, Mindfulness
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