Buprenorphine Medication Versus Voucher Contingencies in Promoting Abstinence From Opioids and Cocaine
Buprenorphine Medication Versus Voucher Contingencies in Promoting Abstinence From Opioids and Cocaine
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DOI：
10.1037/a0016597
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发表时间：
2009-08-01
影响因子：
2.3
通讯作者：
Bickel, Warren K.
中科院分区：
文献类型：
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作者：
Chopra, Mohit P.;Landes, Reid D.;Bickel, Warren K.
在为期12周的干预期间，阿片类药物依赖参与者（N = 120）维持每周三次（M，W，F）丁丙诺啡加治疗师和基于计算机的咨询，随机接受：（a）药物应急（MC =每周三次给药方案vs.每日出勤和在提交阿片类药物和/或可卡因阳性尿样后实施的单日50%剂量减少）;（B）凭证应急（VC =阿片类药物和/或可卡因阴性样本的递增时间表，药物阳性样本重置）;或（c）标准治疗（SC），对尿分析结果无计划后果。与MC（58%; p = 0.009）相比，VC导致更好的12周保留率（85%），但与SC（76%保留率）无差异。在调整就业的基线差异后，与SC相比，MC组实现了1.5周的阿片类药物/可卡因联合戒断（p = 0.030）。而VC组的禁欲期总共多2周（p = 0.048）。药物使用结果表明，这两种干预措施都是有效的，主要影响阿片类药物而不是可卡因测试结果。调查结果应根据与基于药物的意外事件相关的更大自然减员与基于凭证的意外事件的更大货币成本来解释。
During a 12-week intervention, opioid dependent participants (N = 120) maintained on thrice-a-week (M, W, F) buprenorphine plus therapist and computer-based counseling were randomized to receive: (a) medication contingencies (MC = thrice weekly dosing schedule vs. daily attendance and single-day 50% dose reduction imposed upon submission of an opioid and/or cocaine positive urine sample); (b) voucher contingency (VC = escalating schedule for opioid and/or cocaine negative samples with reset for drug-positive samples); or (c) standard care (SC), with no programmed consequences for urinalysis results. VC resulted in better 12-week retention (85%) compared to MC (58%; p = 0.009), but neither differed from SC (76% retained). After adjusting for baseline differences in employment, and compared to SC, the MC group achieved 1.5 more continuous weeks of combined opioid/cocaine abstinence (p = 0.030). while the VC group had 2 more total weeks of abstinence (p = 0.048). Drug use results suggest that both the interventions were efficacious, with effects primarily in opioid rather than cocaine test results. Findings should be interpreted in light of the greater attrition associated with medication-based contingencies versus the greater monetary costs of voucher-based contingencies.