PSYCHOLOGICAL AND METHODOLOGICAL ISSUES IN SUBSTANCE ABUSE TREATMENT/RESEARCH

临床试验受试者的心理评估 已成为该科研究的一个重要部分。 一个 在过去的一年里，一个重要的发现是反社会与 人格障碍和应急管理治疗的反应。 在过去的两年里，我们一直在评估 基于凭证强化应急管理的有效性 产生持续可卡因戒除的程序。 患者可以 用代金券换取符合规定的商品或服务。 发展无毒品的生活方式。 这项研究是在 美沙酮维持治疗计划中的患者， 可卡因使用者 大约50%的患者被分配到 应急管理（实验性治疗），禁欲7 在为期12周的研究过程中， 的患者 非偶然收到的凭单（控制处理）显示 继续使用可卡因。 在56名暴露于 基于凭证的应急管理程序，11例患者符合 DSM III R反社会人格诊断标准 （ASP）。 符合ASP标准的患者平均达到1.0 持续数周的可卡因戒断;相比之下， 达到ASP标准的平均时间为6周。 因此将 似乎，尽管有明确的突发事件和立即 加强可卡因戒断，ASP是治疗的风险因素 失败 改善临床试验中药物使用监测的研究继续使用 定性尿液毒理学和汗块。 在程序研究中 为了在临床试验中确定改善的结局变量， 可卡因代谢物和肌酐的定量尿分析 校正技术以及这些数据与 自我报告的药物使用情况进行了评估，数据收集在一个临床 应急管理行为治疗试验（N = 37） 干预 制定规则是为了区分不同的情况 新的使用和携带阳性定性尿液检测。 初步分析表明：定性和定量尿液检测 显示出比自我报告显示的更高的吸毒率; 定量测试提供了一种区分 残留结转中的新药物使用; 定量测试可能有助于调和 通过定性尿液筛查和自我报告表明药物使用。

The psychological assessment of subjects participating in clinical trials has become an important part of the section's research interest. An important finding in the past year was the association between Antisocial Personality Disorder and response to contingency management treatment. Over the course of the past two years we have been evaluating the effectiveness of voucher-based reinforcement contingency management procedures in producing sustained cocaine abstinence. Patients could exchange the vouchers for goods or services which were consonant with the development of a drug-free life style. The study was conducted in patients in a Methadone Maintenance treatment program who were consistent users of cocaine. Approximately 50 % of the patients assigned to the contingency management (experimental treatment) were abstinent for 7 weeks or longer over the course of the twelve week study. Patients who received the vouchers non-contingently (control treatment) showed continued cocaine use. Among the 56 patients who were exposed to the voucher-based contingency management procedures, eleven of patients met the DSM III R criteria for the diagnosis of Anti-Social Personality (ASP). Patients who met criteria for ASP achieved an average of 1.0 weeks of sustained cocaine abstinence; in contrast, patients who did not meet the criteria for ASP achieved an average of 6 weeks. It would thus appear that despite the clear-cut contingencies and immediate reinforcement for cocaine abstinence, ASP was a risk factor for treatment failure. Studies to improve drug use monitoring in clinical trials continue using qualitative urine toxicology and sweat patches. In procedural studies to identify improved outcome variable in clinical trials, the usefulness of quantitative urinalysis for cocaine metabolite and creatinine correction techniques and the relationship between these data and self-reported drug use were assessed with data collected in a clinical trial (N = 37) of a contingency management behavioral treatment intervention. Rules were developed to differentiate between occasions of new use and carry-over in positive qualitative urine tests. Preliminary analyses suggest: qualitative and quantitative urine testing show greater rates of drug use than that shown by self report; quantitative testing provides a means of differentiating incidences of new drug use from residual carry-over; the identification of new use with quantitative testing may help to reconcile differences between rates of drug use indicated by qualitative urine screens and self-report.