Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence
Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence
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DOI：
10.1016/j.drugalcdep.2006.12.006
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发表时间：
2007-05-01
影响因子：
4.2
通讯作者：
Kolodner, Ken
中科院分区：
文献类型：
--
作者：
Brooner, Robert K.;Kidorf, Michael S.;Kolodner, Ken
这项为期 6 个月的随机临床试验（含 3 个月的随访）采用 2 x 2 设计来比较旨在改善寻求治疗的阿片类药物依赖患者 (n=236) 结局的两种干预措施的独立和联合有效性：积极阶梯式护理 (MSC) 和临时凭证激励 (CVI)。 MSC 是一种适应性治疗策略，使用消极、强化和回避原则来激励参加不同级别的咨询服务和短暂禁欲 [Brooner, R.K., Kidorf, M., 2002。使用行为强化来提高美沙酮治疗参与度。科学。练习。透视。 1、38-46； Brooner, R.K.、Kidorf, M.S.、King, V.L.、Peirce, J.M.、Bigelow, G.E.、Kolodner, K., 2004。改进的“阶梯式护理”方法，用于改善寻求阿片类药物滥用者治疗的出勤行为。 J. Subst。滥用治疗。 27、223-232]。相比之下，CVI [Higgins, S., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, B.A., Fenwick, J.W., 1991。实现初步可卡因戒断的行为方法。是。精神病学。 148, 1218-1224]依靠正强化来激励戒毒。结果表明，在评估的随机组和 3 个月随访组中，联合方法 (MSC + CVI) 与药物阴性尿样的最高比例相关。仅 CVI 和仅 MSC 条件下药物阴性尿液样本的比例相似，均显着高于标准护理 (SC) 对照组。基于凭证的强化与更好的保留相关，而适应性阶梯式护理与更好地遵守预定的咨询课程相关。这些结果表明，对于减少阿片类药物依赖门诊患者的药物使用，CVI 和 MSC 都比常规护理更有效，并且通过增加积极强化，MSC 的总体益处进一步增强。 (c) 2007 Elsevier Ireland Ltd. 保留所有权利。
This 6-month randomized clinical trial (with 3-month follow-up) used a 2 x 2 design to compare the independent and combined effectiveness of two interventions designed to improve outcomes in treatment-seeking opioid-dependent patients (n=236): motivated stepped care (MSC) and contingent voucher incentives (CVI). MSC is an adaptive treatment strategy that uses principles of negative, reinforcement and avoidance to motivate both attendance to varying levels of counseling services and brief periods of abstinence [Brooner, R.K., Kidorf, M., 2002. Using behavioral reinforcement to improve methadone treatment participation. Sci. Pract. Perspect. 1, 38-46; Brooner, R.K., Kidorf, M.S., King, V.L., Peirce, J.M., Bigelow, G.E., Kolodner, K., 2004. A modified "stepped care" approach to improve attendance behavior in treatment seeking opioid abusers. J. Subst. Abuse Treat. 27, 223-232]. In contrast, CVI [Higgins, S., Delaney, D.D., Budney, A.J., Bickel, W.K., Hughes, J.R., Foerg, B.A., Fenwick, J.W., 1991. A behavioral approach to achieving initial cocaine abstinence. Am. Psychiatr. 148, 1218-1224] relies on positive reinforcement to motivate drug abstinence. The results showed that the combined approach (MSC + CVI) was associated with the highest proportion of drug-negative urine samples during both the randomized and 3-month follow-up arms of the evaluation. The CVI-only and the MSC-only conditions evidenced similar proportions of drug-negative urine samples that were both significantly greater than the standard care (SC) comparison group. Voucher-based reinforcement was associated with better retention, while adaptive stepped-based care was associated with better adherence to scheduled counseling sessions. These results suggest that both CVI and MSC are more effective than routine care for reducing drug use in opioid dependent outpatients, and that the overall benefits of MSC are enhanced further by adding positive reinforcement. (c) 2007 Elsevier Ireland Ltd. All rights reserved.