Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence -: Efficacy of contingency management and significant other involvement
Targeting behavioral therapies to enhance naltrexone treatment of opioid dependence -: Efficacy of contingency management and significant other involvement
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DOI：
10.1001/archpsyc.58.8.755
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发表时间：
2001-08-01
影响因子：
--
通讯作者：
Rounsaville, BJ
中科院分区：
文献类型：
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作者：
Carroll, KM;Ball, SA;Rounsaville, BJ
背景资料：应急管理（CM）和其他重要参与（SO）的战略，以提高治疗保留，服药依从性，和结果纳洛酮治疗阿片类dependance.Methods：127个最近脱毒阿片类药物依赖的个人被随机分配到3个条件提供了12周：（1）标准纳洛酮治疗，每周3次;（2）纳洛酮治疗加应急管理（CM），根据纳洛酮依从性和无药物尿液标本提供代金券;或（3）纳洛酮治疗，CM，加上重要的其他参与（SO），其中家庭成员被邀请参加多达6次家庭咨询会议。主要结果是保留在治疗中，与纳洛酮治疗的依从性，和无药物的尿液标本的数量。结果：第一，CM与治疗保留显着改善（7.4与5.6周; P= 0.05）和减少阿片类药物的使用（19与14无阿片类药物的尿液标本; P= 0.04）相比，标准纳洛酮治疗。其次，分配到SO没有显着改善保留，遵守，或药物滥用的结果相比，CM。SO条件对CM的保留、依从性和药物使用结果的显著影响仅见于至少参加I次家庭咨询会议的亚组。SO条件与显着（P= 0.02）改善家庭functioning.Conclusion：行为疗法，如CM，可以有针对性地解决特定的药物治疗，如不遵守的弱点，从而可以发挥很大的作用，扩大可用的药物治疗的效用。
Background: Contingency management (CM) and significant other involvement (SO) were evaluated as strategies to enhance treatment retention, medication compliance, and outcome for naltrexone treatment of opioid dependence.Methods: One hundred twenty-seven recently detoxified opioid-dependent individuals were randomly assigned to I of 3 conditions delivered for 12 weeks: (1) standard naltrexone treatment, given 3 times a week; (2) naltrexone treatment plus contingency management (CM), with delivery of vouchers contingent on naltrexone compliance and drug-free urine specimens;, or (3) naltrexone treatment, CM, plus significant other involvement (SO), where a family member was invited to participate in up to 6 family counseling sessions. Principal outcomes were retention in treatment, compliance with naltrexone therapy, and number of drug-free urine specimens.Results: First, CM was associated with significant improvements in treatment retention (7.4 vs 5.6 weeks; P=.05) and in reduction in opioid use (19 vs 14 opioid-free urine specimens; P=.04) compared with standard naltrexone treatment. Second, assignment to SO did not significantly improve retention, compliance, or substance abuse outcomes compared with CM. Significant effects for the SO condition over CM on retention, compliance, and drug use outcomes were seen only for the subgroup who attended at least I family counseling session. The SO condition was associated with significant (P=.02) improvements in family functioning.Conclusion: Behavioral therapies, such as CM, can be targeted to address weaknesses of specific pharmacotherapies, such as noncompliance, and thus can play a substantial role in broadening the utility of available pharmaco therapies.