SECTION ON LAW & ETHICS
Section Director: David S. Festinger, Ph.D.

Selected Projects: Practice Improvement

Ethics of Participant Payment in Substance Abuse Research: David S. Festinger, Ph.D. Outpatient substance abuse clients were randomly assigned to receive cash payments of $10, $40, or $70, or the equivalent in gift certificates. Results indicated that neither mode nor magnitude of payment differentially affected rates of new drug use or participants’ perceptions of coercion, but that larger-magnitude cash payments were associated with higher follow-up rates and reduced tracking efforts. A subsequent NIDA-funded study examined these effects with even higher magnitude research payments ($100, $130, and $160) in either cash or gift certificates. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion.

Improving the Ethics of Consent in Drug Abuse Research: David S. Festinger, Ph.D. This randomized study examined the effectiveness of two novel informed consent procedures to improve comprehension and information retention among criminally involved, substance-abusing research subjects. In the corrected feedback procedure, participants’ recall of consent information at various intervals is tested and erroneous responses corrected. In the research intermediary procedure, a neutral third party monitors the consent process and intervenes on behalf of participants. The study examined whether the corrected feedback procedure improves participants’ retention of consent information, and whether the research intermediary reduces implicit or explicit coercion to participate. Findings revealed that corrected feedback led to significant increases in recall of consent information. The intermediary procedure led to reductions in perceived coercion but had no effect on understanding or recall. Despite the significant effects of corrected feedback, participants receiving this intervention recalled an average of only 65% of the consent information. Cognitive and intellectual factors explain only a portion of the variance in consent recall (Festinger et al., 2007). This suggests that remedial interventions alone may be insufficient to facilitate adequate learning and recall of consent information.

The Role of Judicial Status Hearings in Drug Court: Douglas B. Marlowe, J.D., Ph.D. (October 2009 update). As a follow-up to this program of research, TRI conducted a study prospectively matching misdemeanor drug court clients to the optimal schedule of status hearings depending on their risk status, and comparing outcomes to treatment as usual. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. Moreover, high-risk participants graduated at a higher rate, provided more drug-negative urine specimens at 6 months post-admission, and reported significantly less drug use and alcohol intoxication at 6 months post-admission when they were matched to bi-weekly hearings as compared to the usual schedule of hearings. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts. Following this line of research, an ongoing study (see Adaptive Services in Drug Court) is examining the incremental utility gained by re-adjusting the dosage of both court hearings and clinical case-management sessions in response to participants’ on-going performance in the program.

Services Research on Sanctions and Rewards in Drug Court: Douglas B. Marlowe, J.D., Ph.D. This study experimentally examined the effects of adapting a tangible incentive program for use within a felony pre-adjudication drug court. Participants earned gift certificates at each court hearing in which they were determined by staff to have been compliant in the program. Participants in one condition earned gift certificates that gradually escalated by $5.00 increments. Participants in a second condition began by earning higher magnitude gift certificates on a continuous schedule and the reinforcement was tapered to intermittent schedules over time. In a randomized comparison against drug court as usual, no main effects were detected. This appears to have been attributable to a ceiling effect from the programmatic contingencies and intensive monitoring and treatment already delivered in the drug court, and possibly also to the low density of reinforcement in the experimental interventions. However, pre-planned interaction analyses suggested high-risk participants who had more serious criminal backgrounds or were younger may have performed better in the incentive conditions. Although the magnitude of the effects were small, if these preliminary findings are replicated this could suggest that tangible incentive programs may be best suited for incorrigible drug offenders who are not predisposed to respond adequately in traditional court-monitored programs.

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