EVALUATION OF NON-PHARMACOLOGICAL TREATMENTS OF SUBSTANCE ABUSE

该科继续调查两个主要的非药理学 药物滥用的治疗、应急管理和 认知/行为疗法。禁欲强化应急措施， 根植于行为的实验和应用分析，是基于 关于药物滥用是可操作性行为的经验性假设 根据其后果进行维护和修改，因此对 实验室已显示的环境变量类型和 应用研究，以影响广泛的操作行为。我们的第一次 研究验证了加固原理的应用，即 可卡因治疗中操作性条件反射的中心原则 使用无序。我们的第二项主要研究已在去年完成。 参与者是市中心的静脉注射多药滥用者 标准美沙酮维持治疗。实验患者是 暴露在增援应急情况下，在这些情况下他们收到了凭证 不含可卡因的尿液。这些代金券具有货币价值，并且 可换取旨在支持无毒的商品和服务 生活方式。该程序的一个独特而重要的方面是 凭单的货币价值随着连续数的增加而增加 无可卡因尿液增加；可卡因阳性尿液重置该值 将下一张凭证的值恢复到初始的低值。控制患者 收到在模式和金额上匹配的非或有凭证 到戒毒强化患者收到的凭单。病人 暴露在戒酒强化的意外情况下 持续戒除可卡因的时间比 控制。到目前为止，我们的研究表明，基于凭证的 紧急增援可能会导致持续的可卡因戒断， 即使是在市中心，静脉注射，多药滥用者，他们历史上 很难通过其他方法进行治疗，而且 加强治疗是决定治疗结果的重要因素。 两项针对美沙酮维持治疗患者的后续研究正在进行中。 应急管理程序也被应用于一项研究，以 提高纳曲酮治疗的依从性

The section has continued to investigate two major non-pharmacological treatments of substance abuse, contingency management and cognitive/behavioral therapy. Abstinence reinforcement contingencies, rooted in the Experimental and Applied Analysis of Behavior, are based on the empirically-derived assumption that drug abuse is operant behavior maintained and modifiable by its consequences and thus sensitive to the types of environmental variables which have been shown in laboratory and applied research to affect a wide range of operant behaviors. Our first study validated the application of the principle of reinforcement, the central principle in operant conditioning, to the treatment of cocaine use disorder. Our second major study was completed in the past year. Participants were inner-city, intravenous, polydrug abusers receiving standard methadone maintenance treatment. Experimental patients were exposed to reinforcement contingencies in which they received vouchers for cocaine-free urines. The vouchers had monetary values and were exchangeable for goods and services designed to support drug-free lifestyles. A unique and important aspect of the procedure is that the monetary value of the vouchers increased as the number of consecutive cocaine-free urines increased; cocaine-positive urines reset the value of the next voucher back to the initial low value. Control patients received noncontingent vouchers that were matched in pattern and amount to the vouchers received by abstinence reinforcement patients. Patients exposed to the abstinence reinforcement contingencies achieved significantly longer periods of sustained cocaine abstinence than controls. To date our studies have shown that voucher-based reinforcement contingencies can produce sustained cocaine abstinence, even in inner-city, intravenous, polydrug abusers who historically have been very difficult to treat by other means, and that the schedule of reinforcement is an important factor in determining treatment outcome. Two follow-up studies in methadone maintenance patients are in progress. The contingency management procedure is also being applied in a study to improve compliance with naltrexone treatment