Nancy M Petry

University of Connecticut, Storrs, Connecticut, United States

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Publications (317)1028.5 Total impact

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    ABSTRACT: To develop a comprehensive etiological model of pathological gambling (PG) for men and women based on Kendler's development model for major depression, which groups 22 risk factors in 5 developmental tiers (childhood, early adolescence, late adolescence, adulthood, last year). We hypothesized that: 1) All risk factors would be significantly associated with PG; 2) The effect of risk factors in earlier developmental tiers would be accounted for by later tiers; and, 3) There would be few gender differences. Separate models were built for lifetime gambling and for 12-month PG among those with lifetime gambling. Data drawn from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) in the USA. Respondents to NESARC Wave 1 (n = 43093). Odds ratios (OR) and Adjusted OR (AOR) were used to determine the risk factors in multiple models. After mutually adjusting for other risk factors, family history of substance use disorders (SUD) or depression, impulsivity, childhood-onset anxiety, number of Axis I and II disorders, history of SUD, nicotine dependence, social deviance in adulthood, and past-year history of SUD, nicotine dependence, and independent stressful life events predicted lifetime gambling. Past history of PG, number of personality disorders and past year nicotine dependence were significantly associated with 12-month PG (all p < .05). There were no significant gender interactions for 12-month PG. A modification of Kendler's model for major depression provides a foundation for the development a comprehensive developmental model of pathological gambling. Lifetime history of gambling and 12-month pathological gambling appear to be determined by risk factors in several developmental levels, with the effect of earlier development tiers accounted for by later ones. This article is protected by copyright. All rights reserved.
    Addiction 04/2015; DOI:10.1111/add.12946 · 4.60 Impact Factor
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    ABSTRACT: Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users. A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 03/2015; DOI:10.1037/a0039021 · 4.85 Impact Factor
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    ABSTRACT: Pathological gambling (PG) is now aligned with substance use disorders in the DSM-5 as the first officially recognized behavioral addiction. There is growing interest in examining obesity as an addictive disorder as well. The goal of this study was to investigate whether epidemiological data provide support for the consideration of PG and obesity as addictive disorders. Factor analysis of data from a large, nationally representative sample of US adults (N=43,093), using nicotine dependence, alcohol dependence, drug dependence, PG and obesity as indicators. It was hypothesized that nicotine dependence, alcohol dependence and drug use dependence would load on a single factor. It was further hypothesized that if PG and obesity were addictive disorders, they would load on the same factor as substance use disorders, whereas failure to load on the addictive factor would not support their conceptualization as addictive disorders. A model with one factor including nicotine dependence, alcohol dependence, drug dependence and PG, but not obesity, provided a very good fit to the data, as indicated by CFI=0.99, TLI=0.99 and RMSEA=0.01 and loadings of all indicators >0.4. Data from this study support the inclusion of PG in a latent factor with substance use disorders but do not lend support to the consideration of obesity, as defined by BMI, as an addictive disorder. Future research should investigate whether certain subtypes of obesity are best conceptualized as addictive disorders and the shared biological and environmental factors that account for the common and specific features of addictive disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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    ABSTRACT: This paper reports estimates of the price elasticity of demand for heroin based on a newly constructed dataset. The dataset has two matched components concerning the same sample of regular heroin users: longitudinal information about real-world heroin demand (actual price and actual quantity at daily intervals for each heroin user in the sample) and experimental information about laboratory heroin demand (elicited by presenting the same heroin users with scenarios in a laboratory setting). Two empirical strategies are used to estimate the price elasticity of demand for heroin. The first strategy exploits the idiosyncratic variation in the price experienced by a heroin user over time that occurs in markets for illegal drugs. The second strategy exploits the experimentally induced variation in price experienced by a heroin user across experimental scenarios. Both empirical strategies result in the estimate that the conditional price elasticity of demand for heroin is approximately 0.80. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Health Economics 02/2015; 41C. DOI:10.1016/j.jhealeco.2015.01.008 · 2.25 Impact Factor
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    ABSTRACT: : Background and aims: Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations. Design: Large-scale, state-representative school survey using a standardized questionnaire. Setting: Germany (Lower Saxony). Participants:A total of 11 003 ninth-graders aged 13–18 years (mean = 14.88, 51.09% male). Measurements: IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD. Findings: In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling ‘addicted to gaming’ than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were ‘escape adverse moods’ (5.30%) and ‘preoccupation’ (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria ‘give up other activities’, ‘tolerance’ and ‘withdrawal’ were of key importance for identifying IGD as defined by DSM-5. Conclusions: Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to ‘give up other activities’, ‘tolerance’ and ‘withdrawal’ are most relevant for IGD diagnosis in this age group.
    Addiction 01/2015; DOI:10.1111/add.12849 · 4.60 Impact Factor
  • Leonardo F Andrade, Levi Riven, Nancy M Petry
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    ABSTRACT: Numerous studies show that individuals with substance use and gambling problems discount delayed and probabilistic outcomes at different rates than controls. Few studies, however, investigated the association of discounting with antisocial personality disorders (ASPD), and none evaluated whether sex impacts these relationships. Because females with ASPD exhibit different patterns of antisocial behavior than their male counterparts, they may also differ in their decision-making tendencies. This study examined the effects of ASPD and sex on discounting in pathological gamblers. Results revealed effects of ASPD, and an interaction between ASPD and sex, on probability discounting rates. None of these variables, however, were related to delay discounting. Females with ASPD highly preferred probabilistic outcomes, suggesting that female gamblers with ASPD are particularly impulsive when it comes to probabilistic rewards. Greater understanding of sex differences in ASPD might help guide the selection of more effective sex-specific prevention and treatment programs.
    The Psychological record 12/2014; 64(4):639-644. DOI:10.1007/s40732-014-0085-0 · 0.96 Impact Factor
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    ABSTRACT: This pilot study evaluated a reinforcement intervention to improve adherence to antihypertensive therapy. Twenty-nine participants were randomized to standard care or standard care plus financial reinforcement for 12 weeks. Participants in the reinforcement group received a cell phone to self-record videos of adherence, for which they earned rewards. These participants sent videos demonstrating on-time adherence 97.8% of the time. Pill count adherence differed significantly between the groups during treatment, with 98.8%±1.5% of pills taken during treatment in the reinforcement condition vs 92.6%±9.2% in standard care (P<.002). Benefits persisted throughout a 3-month follow-up, with 93.8%±9.3% vs 78.0%±18.5% of pills taken (P<.001). Pill counts correlated significantly (P<.001) with self-reports of adherence, which also differed between groups over time (P<.01). Systolic blood pressure decreased modestly over time in participants overall (P<.01) but without significant time-by-group effects. These results suggest that reinforcing medication adherence via cellular phone technology and financial reinforcement holds potential to improve adherence.
    Journal of Clinical Hypertension 11/2014; 17(1). DOI:10.1111/jch.12441 · 2.96 Impact Factor
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    ABSTRACT: Objective: Contingency management (CM) reduces cocaine use in methadone patients, but only about 50% of patients respond to CM interventions. This study evaluated whether increasing magnitudes of reinforcement will improve outcomes. Method: Cocaine-dependent methadone patients (N = 240) were randomized to 1 of 4 12-week treatment conditions: usual care (UC); UC plus standard prize CM, in which average expected prize earnings were about $300; UC plus high magnitude prize CM, in which average expected prize earnings were about $900; or UC plus voucher CM, with an expected maximum of about $900 in vouchers. Results: All 3 CM conditions yielded significant reductions in cocaine use relative to UC, with effect sizes (d) ranging from 0.38 to 0.59. No differences were noted between CM conditions, with at least 55% of patients in each CM condition achieving 1 week or more of cocaine abstinence versus 35% in UC. During the 12 weeks after the intervention ended, CM increased time until relapse relative to UC, but the effects of CM were no longer significant at a 12-month follow-up. Conclusions: Providing the standard magnitude of $300 in prizes was as effective as larger magnitude CM in cocaine-dependent methadone patients in this study. Given its strong evidence base and relatively low costs, standard magnitude prize CM should be considered for adoption in methadone clinics to encourage cocaine abstinence, but new methods need to be developed to sustain abstinence. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Journal of Consulting and Clinical Psychology 09/2014; DOI:10.1037/a0037888 · 4.85 Impact Factor
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    Addiction 09/2014; 109(9):1412-1413. DOI:10.1111/add.12653 · 4.60 Impact Factor
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    ABSTRACT: Physical inactivity is a leading cause of mortality. Reinforcement interventions appear to be useful for increasing activity and preventing adverse consequences of sedentary lifestyles. This study evaluated a reinforcement-thinning schedule for maintaining high activity levels. Sedentary adults (N = 77) were given pedometers and encouraged to walk ≥10,000 steps per day. Initially, all participants earned rewards for each day they walked ≥10,000 steps. Subsequently, 61 participants were randomized to a monitoring-only condition or a monitoring-plus-reinforcement-thinning condition, in which frequencies of monitoring and reinforcing walking decreased over 12 weeks. The mean (± SD) percentage of participants in the monitoring-plus-reinforcement-thinning condition who met walking goals was 83% ± 24% and was 55% ± 31% for participants in the monitoring-only condition, p < .001. Thus, monitoring plus reinforcement thinning maintained high rates of walking when it was in effect; however, groups did not differ at a 24-week follow-up. Monitoring plus reinforcement thinning, nevertheless, hold potential to extend benefits of reinforcement interventions at low costs.
    Journal of Applied Behavior Analysis 09/2014; 47(3). DOI:10.1002/jaba.147 · 1.19 Impact Factor
  • Lindsay M. Weiss, Nancy M. Petry
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    ABSTRACT: Early onset drug use is associated with increased risk of developing substance use disorders, but relatively little is known about the correlates of early drug use among adults receiving treatment. A retrospective analysis of a randomized study of contingency management treatment compared cocaine-dependent patients who reported initial cocaine use at age 14 or younger (n = 41) to those who began using after age 14 (n = 387). Patients with early onset cocaine use had more legal and psychiatric problems than those who initiated cocaine use later. Patients with early-onset cocaine use also dropped out of treatment sooner and achieved less sustained abstinence than those who began using at older ages, but the interaction between age of first use and treatment condition was not significant. Early-onset cocaine use is associated with persistent psychosocial problems and an overall poor response to treatment. However, contingency management is efficacious in improving outcomes in early onset cocaine users.
    Journal of Substance Abuse Treatment 08/2014; DOI:10.1016/j.jsat.2014.04.003 · 3.14 Impact Factor
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    ABSTRACT: Background Adjunctive behavioral smoking cessation treatments have the potential to improve outcomes beyond standard care. The present study had two aims: 1) compare standard care (SC) for smoking (four weeks of brief counseling and monitoring) to SC plus prize-based contingency management (CM), involving the chance to earn prizes on days with demonstrated smoking abstinence (carbon monoxide (CO) ≤6 ppm); and 2) compare the relative efficacy of two prize reinforcement schedules - one a traditional CM schedule, and the second an early enhanced CM schedule providing greater reinforcement magnitude in the initial week of treatment but equal overall reinforcement. Methods Participants (N = 81 nicotine-dependent cigarette smokers) were randomly assigned to one of the three conditions. Results Prize CM resulted in significant reductions in cigarette smoking relative to SC. These reductions were not apparent at follow-up. We found no meaningful differences between the traditional and enhanced CM conditions. Conclusions Our findings reveal that prize CM leads to significant reductions in smoking during treatment relative to a control intervention, but the benefits did not extend long-term.
    Drug and alcohol dependence 07/2014; 140. DOI:10.1016/j.drugalcdep.2014.03.032 · 3.28 Impact Factor
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    ABSTRACT: Abstract Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07-3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11-0.88) and medical problems (AOR = 0.40, 95% CI = 0.17-0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.
    Journal of psychoactive drugs 07/2014; 46(3):208-214. DOI:10.1080/02791072.2014.915363 · 1.10 Impact Factor
  • Drug and Alcohol Dependence 07/2014; 140:e117-e118. DOI:10.1016/j.drugalcdep.2014.02.336 · 3.28 Impact Factor
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    Addiction 07/2014; 109(7):1209-11. DOI:10.1111/add.12555 · 4.60 Impact Factor
  • Sheila M Alessi, Nancy M Petry
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    ABSTRACT: Individuals with substance use disorders (SUDs) experience increased smoking-related morbidity and mortality but severely compromised smoking treatment benefits. Residential SUD treatment settings may be particularly positioned to target smoking, with ever-increasing smoking bans and culture shifts, but most smokers continue smoking. This study examined the effects of contingency management (CM) for increasing smoking abstinence in residential patients. Smokers interested in quitting were recruited from a residential SUD program for men and were randomized to frequent smoking monitoring with behavioral support (monitoring; n = 21) or that plus smoking abstinence-contingent (expired carbon monoxide [CO] a parts per thousand currency sign 6 ppm; urinary cotinine a parts per thousand currency sign 30ng/ml) incentives (CM, n = 24) for 4 weeks. After setting a quit date, procedures included daily behavioral support and smoking self-reports, 2 CO samples (a.m./p.m.) Monday through Friday, and cotinine tests on Mondays. CM participants received escalating draws for prizes ($1, $20, and $100 values) for negative tests; positive and missed samples reset draws. Follow-ups involved samples, self-reported smoking, and self-efficacy (weeks 4, 8, 12, and 24). Percent days CO-negative was higher with CM (median [interquartile range] 51.7% [62.8%]) compared to monitoring (0% [32.1%]) (p = .002). Cigarettes per day declined and point-prevalence abstinence increased through follow-up (p < .01), without significant group by time effects (p > .05). Abstinence self-efficacy increased overall during the intervention and more with CM compared to monitoring and was associated with abstinence across conditions through follow-up. CM improved some measures of response to smoking treatment in residential SUD patients.
    Nicotine & Tobacco Research 06/2014; 16(11). DOI:10.1093/ntr/ntu095 · 2.81 Impact Factor
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  • Leonardo F Andrade, Nancy M Petry
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    ABSTRACT: Impulsivity is a core process underlying addictive behaviors, including nonpharmacological addictive behaviors such as problem gambling. Although considerable attention has been given to the investigation of delay discounting within the context of addiction-related behaviors, relatively little research has examined the relationship between discounting and individual variables, such as race/ethnicity. The purpose of this study was to compare discounting rates in the three most prevalent racial/ethnic groups in the United States: Whites, African Americans, and Hispanics. The study was conducted with 315 problem gamblers. Participants completed a delay-discounting questionnaire involving choices between a smaller amount of money delivered immediately and a larger amount delivered later. A hyperbolic discounting function estimated delay-discounting rates based on participants' indifference points obtained via the questionnaires. Results showed significant effects of race/ethnicity on delay discounting. White gamblers discounted delayed money at lower rates than African Americans and Hispanics, even after controlling for confounding variables. These data suggest that among individuals who develop problem gambling, Whites are less impulsive than African Americans and Hispanics, at least in terms of choosing between delayed and immediate reinforcers. These results have implications for evaluating the onset and treatment of addictive disorders from a health-disparities perspective. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychology of Addictive Behaviors 06/2014; 28(2):599-606. DOI:10.1037/a0036153 · 2.09 Impact Factor
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Publication Stats

11k Citations
1,028.50 Total Impact Points


  • 1999–2014
    • University of Connecticut
      • Department of Psychiatry
      Storrs, Connecticut, United States
  • 2009–2012
    • Cardiology Wellness Center
      Nashville, Tennessee, United States
    • Washington State University
      Pullman, Washington, United States
    • New York State Psychiatric Institute
      • Anxiety Disorders Clinic
      New York City, New York, United States
    • University of Minnesota Twin Cities
      • Department of Psychiatry
      Minneapolis, MN, United States
  • 1999–2012
    • UConn Health Center
      • • Pat and Jim Calhoun Cardiology Center
      • • Department of Medicine
      • • Department of Psychiatry
      Farmington, CT, United States
  • 2005–2011
    • Johns Hopkins University
      • Department of Psychiatry and Behavioral Sciences
      Baltimore, Maryland, United States
  • 2006–2009
    • Columbia University
      • Department of Psychiatry
      New York, New York, United States
    • Portland VA Medical Center
      Portland, Oregon, United States
  • 2007
    • Wayne State University
      • Department of Psychiatry and Behavioral Neurosciences
      Detroit, MI, United States
  • 2001
    • Yale University
      New Haven, Connecticut, United States
  • 1997–2001
    • University of Vermont
      • • Department of Psychiatry
      • • Department of Psychology
      Burlington, Vermont, United States
  • 1994–1998
    • Harvard University
      • Department of Psychology
      Cambridge, Massachusetts, United States