Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less
Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less
复制标题
DOI：
10.1111/j.1360-0443.2012.03877.x
复制
发表时间：
2012-09-01
期刊：
影响因子：
6
通讯作者：
Petry, Nancy M.
中科院分区：
文献类型：
--
作者：
Carroll, Kathleen M.;Nich, Charla;Petry, Nancy M.
目的评估互惠增强（结合治疗，以抵消其相对弱点）作为改善大麻治疗结果的策略。应急管理（CM）与强化作业完成和会议出席被用作一种策略，以加强认知行为疗法（CBT）通过更多的技能培训，CBT被用作一种策略，以提高持久性的CM与奖励禁欲。背景：美国康涅狄格州纽黑文市的社区门诊治疗项目。设计为期10周的随机临床试验，包括4种治疗条件：单独或结合CBT的CM禁欲，单独或结合CBT的CM与CBT课程出勤和家庭作业完成的奖励。参与者共有127名寻求治疗的年轻成年人（84.3%男性，81.1%少数民族，93.7%由刑事司法系统转介，平均年龄25.7岁）。每周尿液样本大麻检测呈阳性，通过时间线跟踪方法使用大麻的天数。结果在治疗中，加强家庭作业和出勤并没有显着改善CBT的结果，并增加CBT恶化的结果时，添加到CM的禁欲（75.5%与57.1%的无大麻尿标本，F = 2.25，P = 0.02）。戒烟条件的CM具有最低的大麻阴性尿液标本的百分比和最高的连续无大麻尿液标本的平均数（3.3，F = 2.33，P = 0.02）。在单独的CBT条件下，Atabia更高，但随机效应回归分析表明，这种条件与整体变化率最大相关。在1年随访期间，两个增强组的大麻使用增加最快。结论：结合应急管理和认知行为疗法似乎并不能提高涉及刑事司法系统的客户大麻依赖治疗的成功率。
Aims To evaluate reciprocal enhancement (combining treatments to offset their relative weaknesses) as a strategy to improve cannabis treatment outcomes. Contingency management (CM) with reinforcement for homework completion and session attendance was used as a strategy to enhance cognitivebehavioral therapy (CBT) via greater exposure to skills training; CBT was used as a strategy to enhance durability of CM with rewards for abstinence. Setting Community-based out-patient treatment program in New Haven, Connecticut, USA. Design Twelve-week randomized clinical trial of four treatment conditions: CM for abstinence alone or combined with CBT, CBT alone or combined with CM with rewards for CBT session attendance and homework completion. Participants A total of 127 treatment-seeking young adults (84.3% male, 81.1% minority, 93.7% referred by criminal justice system, average age 25.7 years). Measurements Weekly urine specimens testing positive for cannabis, days of cannabis use via the time-line follow-back method. Findings Within treatment, reinforcing homework and attendance did not significantly improve CBT outcomes, and the addition of CBT worsened outcomes when added to CM for abstinence (75.5 versus 57.1% cannabis-free urine specimens, F = 2.25, P = 0.02). The CM for abstinence condition had the lowest percentage of cannabis-negative urine specimens and the highest mean number of consecutive cannabis-free urine specimens (3.3, F = 2.33, P = 0.02). Attrition was higher in the CBT alone condition, but random effect regression analyses indicated this condition was associated with the greatest rate of change overall. Cannabis use during the 1-year follow-up increased most rapidly for the two enhanced groups. Conclusions Combining contingency management and cognitivebehavioural therapy does not appear to improve success rates of treatment for cannabis dependence in clients involved with the criminal justice system.