Promoting abstinence from cocaine and heroin with a methadone dose increase and a novel contingency.
Promoting abstinence from cocaine and heroin with a methadone dose increase and a novel contingency.
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DOI：
10.1016/j.drugalcdep.2008.11.006
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发表时间：
2009-04-01
影响因子：
4.2
通讯作者：
Preston, Kenzie L.
中科院分区：
文献类型：
--
作者：
Epstein, David H.;Schmittner, John;Umbricht, Annie;Schroeder, Jennifer R.;Moolchan, Eric T.;Preston, Kenzie L.
为了测试应急管理和美沙酮剂量增加的组合是否会促进海洛因和可卡因的戒断，我们进行了一项随机对照试验，采用2 × 3（剂量×应急）析因设计，其中剂量分配是双盲的。参与者是252名海洛因和可卡因滥用美沙酮维持门诊患者。他们被随机分配到美沙酮剂量（70或100毫克/天，双盲）和凭证条件（非偶然，可卡因阴性尿液的偶然，或“分裂”）。“分裂”应急是一种新的应急，它加强了对任何一种药物的戒断，同时双重加强了对两种药物的同时戒断：激励的总价值在药物之间“分裂”，以控制成本。主要的结果指标是海洛因、可卡因和两者同时阴性的尿液标本的百分比;在标准治疗的5周基线（以确定研究资格）、12周干预和10周维持期（以检查恢复至基线条件的干预效果）期间对这些进行监测。在研究退出时评估持续药物依赖的DSM-IV标准。尿液筛查结果显示，美沙酮剂量的增加减少了海洛因的使用，但没有减少可卡因的使用。Split 100 mg组是唯一一个同时阴性持续时间长于相同剂量非偶然对照组的组。在积极干预组中，DSM-IV阿片类药物和可卡因依赖诊断的频率下降。对于分开的应急措施来促进同时戒除可卡因和海洛因，相对高剂量的美沙酮似乎是必要的，但还不够;可能还需要增加总激励金额。
To test whether a combination of contingency management and methadone dose increase would promote abstinence from heroin and cocaine, we conducted a randomized controlled trial using a 2 X 3 (Dose X Contingency) factorial design in which dose assignment was double-blind. Participants were 252 heroin- and cocaine-abusing outpatients on methadone maintenance. They were randomly assigned to methadone dose (70 or 100 mg/day, double blind) and voucher condition (noncontingent, contingent on cocaine-negative urines, or “split”). The “split” contingency was a novel contingency that reinforced abstinence from either drug while doubly reinforcing simultaneous abstinence from both: the total value of incentives was “split” between drugs to contain costs. The main outcome measures were percentages of urine specimens negative for heroin, cocaine, and both simultaneously; these were monitored during a 5-week baseline of standard treatment (to determine study eligibility), a 12-week intervention, and a 10-week maintenance phase (to examine intervention effects in return-to-baseline conditions). DSM-IV criteria for ongoing drug dependence were assessed at study exit. Urine-screen results showed that the methadone dose increase reduced heroin use but not cocaine use. The Split 100mg group was the only group to achieve a longer duration of simultaneous negatives than its same-dose Noncontingent control group. The frequency of DSM-IV opiate and cocaine dependence diagnoses decreased in the active intervention groups. For a split contingency to promote simultaneous abstinence from cocaine and heroin, a relatively high dose of methadone appears necessary but not sufficient; an increase in overall incentive amount may also be required.
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影响因子：
1.9
作者：
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通讯作者：
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影响因子：
2.3
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作者：
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作者：
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作者：
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