Adding an Internet-Delivered Treatment to an Efficacious Treatment Package for Opioid Dependence
Adding an Internet-Delivered Treatment to an Efficacious Treatment Package for Opioid Dependence
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DOI：
10.1037/a0037496
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发表时间：
2014-12-01
影响因子：
5.9
通讯作者：
Bickel, Warren K.
中科院分区：
文献类型：
--
作者：
Christensen, Darren R.;Landes, Reid D.;Bickel, Warren K.
目的：研究将互联网提供的行为疗法添加到丁丙诺啡药物治疗计划和基于代金券的激励措施中的益处。方法：在170例阿片类药物依赖成人患者（平均年龄= 34.3岁; 54.1%为男性; 95.3%为白色）中进行了一项区组随机、非盲、平行、12周治疗试验。参与者接受了基于互联网的社区强化方法干预加应急管理（CRA+）和丁丙诺啡或单独应急管理（CM-单独）加丁丙诺啡。在治疗过程中测量的主要结局是最长持续戒烟时间、总戒烟时间和治疗保留天数。结果如下：与仅接受CM的受试者相比，CRA+受试者的禁欲时间平均增加了9.7天（95%置信区间[CI = 2.3，17.2]），并且退出治疗的风险降低（风险比= 0.47; 95% CI [0.26，0.85]）。阿片类药物依赖的既往治疗显著调节了最长连续戒断天数的CRA+的额外改善。结论：这些结果进一步证明了基于互联网的CRA+治疗是有效的，并为阿片类药物依赖的应急管理/药物治疗计划增加了临床获益。
Objective: To examine the benefit of adding an Internet-delivered behavior therapy to a buprenorphine medication program and voucher-based motivational incentives. Method: A block-randomized, unblinded, parallel, 12-week treatment trial was conducted with 170 opioid-dependent adult patients (mean age = 34.3 years; 54.1% male; 95.3% White). Participants received an Internet-based community reinforcement approach intervention plus contingency management (CRA+) and buprenorphine or contingency management alone (CM-alone) plus buprenorphine. The primary outcomes, measured over the course of treatment, were longest continuous abstinence, total abstinence, and days retained in treatment. Results: Compared to those receiving CM-alone, CRA+ recipients exhibited, on average, 9.7 total days more of abstinence (95% confidence interval [CI = 2.3, 17.2]) and had a reduced hazard of dropping out of treatment (hazard ratio = 0.47; 95% CI [0.26, 0.85]). Prior treatment for opioid dependence significantly moderated the additional improvement of CRA+ for longest continuous days of abstinence. Conclusions: These results provide further evidence that an Internet-based CRA+ treatment is efficacious and adds clinical benefits to a contingency management/medication based program for opioid dependence.