Examining Longitudinal Stimulant Use and Treatment Attendance as Parallel Outcomes in Two Contingency Management Randomized Clinical Trials.
Examining Longitudinal Stimulant Use and Treatment Attendance as Parallel Outcomes in Two Contingency Management Randomized Clinical Trials.
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DOI：
10.1016/j.jsat.2015.08.008
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发表时间：
2016-02
影响因子：
3.9
通讯作者：
Roll J
中科院分区：
文献类型：
--
作者：
McPherson S;Brooks O;Barbosa-Leiker C;Lederhos C;Lamp A;Murphy S;Layton M;Roll J
本研究的主要目的是检查兴奋剂的使用和纵向治疗出勤率在一个“平行结果”的模型，以确定这两个结果是如何在治疗过程中相互关联，并量化干预如何影响这两个目标和脱靶结果不同。数据来自两项针对兴奋剂使用的应急管理（CM）的多中心随机临床试验（RCT）。我们使用平行多水平模型来检查多个预先指定的协变量的影响，包括选定的成瘾严重程度指数（ASI）评分，年龄和性别，以及CM对两个独立分析中同时出勤和兴奋剂使用的影响，即，每次试验一个。在一项试验中，CM在整个试验期间与参加治疗呈正相关（β = 0.060，p < 0.05）。在第二项试验中，CM预测12周治疗期间尿分析阴性（−UA）（β = 0.069，p < 0.05）。在这两项试验中，出勤率和−UA提交之间存在显著的正相关关系，但在第一项试验中，基线和随时间推移的−UA与随时间推移的出勤率相关（r = 0.117; r = 0.013，分别），而在第二项试验中，基线时的−UA提交与随时间推移的出勤率增加相关（r = 0.055）。这些研究结果表明，随着时间的推移，兴奋剂的使用和治疗出勤率是相关的，但不同的结果，当同时分析时，描绘了一个更翔实的图片，他们的预测和各自的轨迹。两个临床上有意义的目标（直接强化行为）和脱靶（间接强化行为）结果之间的“间接强化”需要进一步检查，以充分利用物质使用障碍治疗试验中可能实现的潜在临床益处。
The primary aim of this study was to examine stimulant use and longitudinal treatment attendance in one ‘parallel outcomes’ model in order to determine how these two outcomes are related to one another during treatment, and to quantify how the intervention impacts these two on- and off-target outcomes differently. Data came from two multi-site randomized clinical trials (RCTs) of contingency management (CM) that targeted stimulant use. We used parallel multilevel modeling to examine the impact of multiple pre-specified covariates, including selected Addiction Severity Index (ASI) scores, age and sex, in addition to CM on concurrent attendance and stimulant use in two separate analyses, i.e., one per trial. In one trial, CM was positively associated with attending treatment throughout the trial (β = 0.060, p < 0.05). In the second trial, CM predicted negative urinalysis (−UA) over the 12-week treatment period (β = 0.069, p < 0.05). In both trials, there was a significant, positive relationship between attendance and −UA submission, but in the first trial a −UA at both baseline and over time was related to attendance over time (r = 0.117; r = 0.013, respectively) and in the second trial, a −UA submission at baseline was associated with increased attendance over time (r = 0.055). These findings indicate that stimulant use and treatment attendance over time are related but distinct outcomes that, when analyzed simultaneously, portray a more informative picture of their predictors and the separate trajectories of each. This ‘indirect reinforcement’ between two clinically meaningful on-target (directly reinforced behavior) and off-target (indirectly reinforced behavior) outcomes is in need of further examination in order to fully exploit the potential clinical benefits that could be realized in substance use disorder treatment trials.