EVALUATION OF TREATMENTS OF DRUG DEPENDENCE IN HIV INFECTED PATIENTS

本节继续研究药理学和行为学 药物滥用的治疗以及这两种形式之间的相互作用 治疗方法。 这些研究的主要目的是消除药物 使用可卡因并降低艾滋病毒传播的可能性-和/或 海洛因依赖患者 几乎所有的研究对象都注射了 吸毒者和感染和传播艾滋病毒的高风险人群。 物质滥用的两种主要非药物治疗，应急 管理和认知/行为疗法，正在评估中。 我们实验室的早期研究表明， 加强应急措施有效地产生重大影响， 在市中心的可卡因和鸦片类药物的戒断期， 接受标准美沙酮维持治疗的静脉注射多种药物滥用者 治疗 药物滥用的认知/行为咨询方法 我们实验室开发的治疗方法正在被整合到 行为应急管理计划，以增加持续时间 行为治疗单独产生的禁欲， 药物使用和其他艾滋病毒风险行为的长期变化。 过去 今年，我们扩大了应急管理的应用范围 提高纳洛酮维持治疗依从性的技术。 非身体依赖性阿片类药物滥用者入组门诊 治疗研究计划，并随机分为3组， 英纳洛酮代金券奖励（特遣队），代金券 独立于纳洛酮摄入（非应急组），或无凭证 （对照组）。 这些代金券可以兑换商品和服务。 结果表明，所给的代金券依赖于纳洛酮， 摄入选择性地增加了对纳洛酮的粘附 给药方案。 医学监督下的阿片类药物戒断 是一种常用的治疗方法，但通常对建立 长期禁欲 启动纳洛酮维持治疗的程序 在戒断治疗期间，已经开发出提供更多的 有效的停药后治疗，包括药理学 阿片类拮抗剂治疗。 开始纳洛酮给药 在为期四天的丁丙诺啡海洛因解毒方案的第2天 与仅使用丁丙诺啡相比， 完成后4天开始纳洛酮维持治疗的组 丁丙诺啡疗法 未来的努力将针对 将丁丙诺啡-纳洛酮戒断方案与门诊患者 无药物或纳洛酮治疗与应急管理相结合 保持治疗依从性和禁欲，降低艾滋病毒风险 行为。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and interactions between these two forms of treatments. A primary objective of these studies is to eliminate drug use and decrease the probability of HIV transmission in cocaine- and/or heroin-dependent patients. Nearly all of the population studied inject drugs and are at high risk for contracting and spreading HIV infection. Two major non-pharmacological treatments of substance abuse, contingency management and cognitive/behavioral therapy, are under evaluation. Earlier research in our laboratory has shown that abstinence reinforcement contingencies are effective in producing significant periods of abstinence from cocaine and opiates in inner-city, intravenous, polydrug abusers receiving standard methadone maintenance treatment. A Cognitive/Behavioral counseling approach to substance abuse treatment developed in our laboratory is being integrated into the behavioral contingency management program to increase the duration of abstinence produced by the behavioral treatment alone by encouraging long-term changes in drug use and other HIV risk behaviors. In the past year we have extended the application of the contingency management technique to improving compliance with naltrexone maintenance treatment. Non-physically dependent opioid abusers were enrolled in an outpatient treatment research program and randomized to 3 groups who received either voucher incentives for ingesting naltrexone (Contingent Group), vouchers independent of naltrexone ingestion (NonContingent Group), or no vouchers (Control Group). The vouchers were exchangeable for goods and services. The results showed that the vouchers given contingent on naltrexone ingestion selectively increased adherence to the naltrexone administration regimen. Medically supervised withdrawal from opioids is a commonly used treatment but is usually not effective in establishing long-term abstinence. A procedure for initiating naltrexone maintenance during withdrawal treatment has been developed to provide a more effective post-withdrawal treatment that includes pharmacological treatment with opioid antagonists. Naltrexone administration initiated on Day 2 of a four-day buprenorphine regimen for heroin detoxification produced only moderate opiate withdrawal compared to a buprenorphine-only group that initiated naltrexone maintenance four days after completion of the buprenorphine regimen. Future efforts will be directed toward linking the buprenorphine-naltrexone withdrawal regimen with outpatient drug-free or naltrexone treatment enhanced with contingency management to maintain treatment compliance and abstinence and decrease HIV risk behaviors.