EVALUATION OF NON-PHARMACOLOGICAL TREATMENTS OF SUBSTANCE ABUSE

本节继续研究了两种主要的非药理学 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， 植根于行为的实验和应用分析，是基于 基于药物滥用是操作性行为的假设 保持和修改其后果，因此敏感的 环境变量的类型已在实验室和 应用研究来影响广泛的操作行为。 我们的第一 研究验证了加固原理的应用， 操作性条件反射的核心原理，对可卡因的治疗 使用障碍。 我们的第二项主要研究已于去年完成。 参与者是市中心，静脉注射，多种药物滥用者， 标准美沙酮维持治疗 实验患者为 在收到代金券的情况下， 不含可卡因的尿液 这些凭单具有货币价值， 可兑换为旨在支持无毒品的商品和服务 生命形式有些 该程序的一个独特而重要的方面是， 随着连续发放的数量的增加， 无可卡因尿液增加;可卡因阳性尿液重置该值 下一个凭证回到初始低值。 对照患者 收到的非或有凭单在形式和数额上都是一致的 到禁欲强化患者收到的代金券。 患者 暴露于禁欲强化应急实现 持续的可卡因戒断时间明显长于 对照 迄今为止，我们的研究表明， 强化的偶然性可以产生持续的可卡因戒断， 即使是在市中心，静脉注射，多种药物滥用者谁历史上有 很难用其他方法治疗，而且 强化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随访研究正在进行中。 应急管理程序也被应用于一项研究， 改善纳洛酮治疗依从性

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