Possession of a large amount of money is a well-recognized relapse trigger, and it has been asserted that unrestricted access to money may actually exacerbate substance use. We seek a renewal and extension of our Stage 1 grant to conduct a Stage 2 efficacy trial of the money management-based therapy we have developed, Advisor-Teller Money Manager (the acronym is ATM). ATM is targeted to patients with concomitant psychiatric and substance use disorders, a population in whom management of funds is common and particularly harmful. ATM involves 1) storage of patient funds; 2) training around money management; 3) allocating money for specified plans and goals. At weekly appointments, patients and therapists review recent expenditures including expenditures for drugs. Patients then plan a budget that is incompatible with drug use by pre-paying bills such as rent, budgeting funds for abstinence-linked activities and saving for longer-term goals. Based on this budget, patients then access their funds from their money manager. We conducted a pilot study of two versions of ATM. The first version, with modest restriction of access to funds, showed preliminary evidence that ATM increased abstinence rates, increased the amount of money patients saved and was well received. A second trial of ATM, with more restriction of patient access to funds, showed promise among patients who engaged in it. Patients in the pilots who did not participate in ATM reduced the effects seen, and therefore participation will be facilitated in the proposed Stage 2 randomized clinical trial of ATM by (a) allowing patients to choose how their funds will be stored and (b) having a longer pre-randomization period to enrich the study sample for patients who have the ability to deposit funds with a therapist if they are assigned to ATM. A Stage 2 study is needed to test the efficacy of the optimized version of ATM, follow patients for long enough to detect consolidation of gains in patients who participate, and enroll an adequate sample. In a 36-week trial, 120 dually diagnosed patients will be randomly assigned to either ATM or a control condition in which patients are given rudimentary financial instruction. The primary outcome measure will be the percentage of weeks abstinent. We will conduct exploratory analyses of ATM's effect on proximate outcomes (e.g. utilization of different components of the therapies, how much money patients save in their accounts, and how much money is spent on different expenses including drugs and alcohol) and secondary outcomes (global psychiatric acuity, service utilization and cost).
| Thornhill, Thomas A; Black, Anne C; Rosen, Marc I (2018) Financial Capability: Clinicians' Assessment of Beneficiaries with Dual Diagnoses. J Dual Diagn :1-21 |
| Lazar, Christina M; Black, Anne C; McMahon, Thomas J et al. (2016) All-data approach to assessing financial capability in people with psychiatric disabilities. Psychol Assess 28:362-371 |
| Moore, Brent A; Black, Anne C; Rosen, Marc I (2016) Factors Associated with Money Mismanagement Among Adults with Severe Mental Illness and Substance Abuse. Int J Ment Health Addict 14:400-409 |
| Black, Anne C; McMahon, Thomas J; Potenza, Marc N et al. (2015) Gender moderates the relationship between impulsivity and sexual risk-taking in a cocaine-using psychiatric outpatient population. Pers Individ Dif 75:190-194 |
| Lazar, Christina M; Black, Anne C; McMahon, Thomas J et al. (2015) Ambiguity in determining financial capability of SSI and SSDI beneficiaries with psychiatric disabilities. Psychiatr Serv 66:279-84 |
| Serowik, Kristin L; Rowe, Michael; Black, Anne C et al. (2014) Financial motivation to work among people with psychiatric disorders. J Ment Health 23:186-90 |
| Rosen, Marc I; Ablondi, Karen; Black, Anne C et al. (2014) Pathways to assignment of payees. Community Ment Health J 50:270-4 |
| Rowe, Michael; Serowik, Kristin L; Ablondi, Karen et al. (2013) Recovery and money management. Psychiatr Rehabil J 36:116-8 |
| Claycomb, Meredith; Black, Anne C; Wilber, Charles et al. (2013) Financial victimization of adults with severe mental illness. Psychiatr Serv 64:918-20 |
| Rosen, Marc I; Afshartous, David R; Nwosu, Samuel et al. (2013) Racial differences in veterans' satisfaction with examination of disability from posttraumatic stress disorder. Psychiatr Serv 64:354-9 |
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