TREATING COCAINE ABUSE--A BEHAVIORAL APPROACH

可卡因依赖可能仍然是美国严重的公共健康问题 整个90年代的问题S。为了解决这个问题，我们 一直在研究一种多成分门诊患者的疗效 基于以下原则的可卡因依赖治疗 行为分析和行为药理学。这种疗法很有效。 将依赖可卡因的成年人保留在门诊治疗中并产生 临床上--持续戒除可卡因的重要时期。这个 本申请中提出的研究的目的是进一步分析 这种多组分治疗的哪些成分有助于 用它观察到了积极的结果。这类拆卸研究是 对以经验为基础的有效治疗的发展至关重要 用于药物依赖，并与研究目标一致 在RFA#DA-94-02“行为疗法发展计划”中概述， 这就是我们正在回应的RFA。 我们之前的一次试验表明，一个激励计划 患者获得的代金券可兑换零售商品，视情况而定 提交不含可卡因的尿液样本是其中一个活跃的组成部分。 治疗。然而，这项研究没有确定这些激励措施是否 通过强化或采取行动直接增加可卡因戒断率 间接通过增加治疗保留率和服务量 在这方面取得了进展，并以这种方式改善了结果。此应用程序的研究1 将系统地复制我们之前的发现，并将其扩展到 分离对保留和可卡因戒断的影响。研究2将 评估双硫兰治疗成分是否用于治疗酒精滥用 在这个滥用多种药物的人群中， 如果是这样，我们使用的药物依从性程序是否 实施这一疗法是一个有效的特点。初步结果 从我们的诊所和其他人表明，在这个治疗酒精滥用 通过双硫胺治疗和药物治疗的可卡因依赖人群- 合规程序大大减少了饮酒和可卡因的使用。 研究3将评估是否将重要的其他人纳入治疗 过程改善了结果，如果是这样的话，行为契约是否 我们在此组件中使用的过程是一个有效的功能。初步 我们的临床结果表明，包括其他重要的人在 治疗和教导他们大量使用行为契约 增加患者达到临床显著水平的可能性 持续戒除可卡因的时期。 每一项拟议的试验都将为 这种有希望的行为疗法的特定成分的疗效 对可卡因的依赖。这些信息将使我们能够经验性地 将这种干预精简到其必要的组成部分。此外， 这些研究将有助于我们的长期目标，即既产生 综合治疗包和特定的治疗组件 传播是门诊患者人工指导的有效干预措施 可卡因依赖的治疗。

Cocaine dependence is likely to remain a serious U.S. public-health problem throughout the 1990's. In an effort to address that problem, we have been researching the efficacy of a multicomponent, outpatient treatment for cocaine dependence that is based on the principles of behavior analysis and behavioral pharmacology. This treatment effectively retains cocaine-dependent adults in outpatient treatment and engenders clinically-significant periods of continuous cocaine abstinence. The purpose of the studies proposed in this application is to analyze further which components of this multicomponent treatment contribute to the positive outcomes observed with it. Such dismantling studies are essential to the development of empirically-based and effective treatments for drug dependence, and are consistent with the research objectives outlined in RFA #DA-94-02 "Behavioral Therapies Development Program", which is the RFA to which we are responding. One of our prior trials demonstrated that an incentive program wherein patients earned vouchers exchangeable for retail items contingent on submitting cocaine-free urine specimens was an active component of this treatment. However, that study did not determine whether the incentives directly increased cocaine abstinence via reinforcement or acted indirectly by increasing treatment retention and the amount of services received and in that manner improved outcome. Study 1 of this application will systematically replicate our prior findings and extend them by dissociating effects on retention and cocaine abstinence. Study 2 will assess whether a disulfiram-therapy component used to treat alcohol abuse in this multiple-drug abusing population contributes to positive outcomes, and, if so, whether the medication-compliance procedures we use in implementing this therapy are an effective feature. Preliminary results from our clinic and others indicate that treating alcohol abuse in this cocaine-dependent population via disulfiram therapy and medication- compliance procedures significantly reduces drinking and cocaine use. Study 3 will assess whether including significant others in the treatment process improves outcome, and , if so, whether the behavioral-contracting procedures we use in this component are an effective feature. Preliminary results from our clinic indicate that including significant others in treatment and teaching them to use behavioral contracts significantly increases the probability of patients achieving clinically-significant periods of continuous cocaine abstinence. Each of the proposed trials will contribute important new information on the efficacy of specific components of this promising behavioral treatment for cocaine dependence. This information will permit us to empirically streamline this intervention down to its necessary components. Moreover, these studies will contribute to our longer-term goal of producing both a comprehensive treatment package and specific treatment components for dissemination as manual-guided and effective interventions for outpatient treatment of cocaine dependence.