METHADONE TREATMENT--BEHAVIORAL/PHAMACOLOGICAL VARIABLES

描述：(申请人摘要) 在美沙酮维持治疗患者中，使计划特权取决于 提交无毒尿液可降低非法吸毒率。 然而，这种尿液分析(UA)应急计划似乎只起作用 对于一小部分患者来说，并不是在所有的治疗中都实用 设置。因此，需要其他有效的治疗方法 可与UA或有事项一起使用，或代替UA或有事项使用。一 强化戒酒的另一种选择是对 替代行为(DRA)。在这项研究中，我们检查了可复制性和 DRA计划的可移植性在小型研究诊所中被发现有效 在一家大型退伍军人医疗中心进行测试。除了复制 前景看好的研究，建议：1)检查转让的可行性 将行为技术应用于更类似于典型社区的环境 与我们大学的研究诊所相比，我们的DRA计划与 已知有效性的干预(UA或有事件)，3)评估 行为上、心理上 和与区别治疗反应相关的社会因素，以及4) 评估随时间推移的治疗效果的持久性。 在之前的一项研究中(井口、贝尔丁等人，在出版中)，患者接受了 每周提供客观证据的价值高达15美元的代金券 完成与辅导员一起计划的任务，以塑造近似的行为 治疗计划目标(TP-15美元组)。接受这种DRA治疗的患者 比那些没有接受编程强化或 每周收集的三个尿液中的每一个5美元，用于检测无毒。此外， TP-$15受试者在停止治疗后继续改善 干预。在这项研究的拟议扩展中，132个新的 在弗吉尼亚州费城登记的美沙酮维持患者被分配 给以下三个组之一：TP-$20组有资格赚取价值 STD组接受标准的VA治疗，每周最高可达20美元，不 程序化增援，UA-TH组有资格获得最多4 每周通过提交不含药物的尿液获得带回家的药物剂量。 干预在10周的基准期之后开始，一直持续到 30周。评估在入院时和第10、20、30和52周(以下)进行 向上)。结果衡量标准包括尿检结果、自我报告的药物使用情况 和危险行为，以及心理社会措施。这一事件的意义 项目包括对UA的替代方案或附属方案进行潜在验证 使用DRA产生更持久的行为变化的意外情况 程序。

DESCRIPTION: (Applicant's Abstract) In methadone maintenance patients, making program privileges contingent upon the submission of drug-free urines reduces the rate of illicit drug use. Nevertheless, such urinalysis (UA) contingency programs appear to work only for a subgroup of patients, and may not be practical in all treatment settings. There is a need, therefore, for other effective treatments that may be used in conjunction with, or instead of, UA contingencies. One alternative to reinforcing abstinence is the differential reinforcement of alternative behaviors (DRA). In this study we examine the replicability and portability of a DRA program found effective in a small research clinic by testing it in a large VA Medical Center. In addition to replicating a promising study, the proposal: 1) examines the viability of transferring behavioral technologies to a setting more similar to a typical community clinic than our university research clinic, 2) compares our DRA program with an intervention of known effectiveness (UA contingencies), 3) assesses the behavioral, psychological and social factors associated with differential treatment response, and 4) evaluates the durability of treatment effects over time. In a prior study (Iguchi, Belding et al., in press), patients received vouchers worth up to $15 per week for providing objective evidence of completing tasks planned with counselors to shape behaviors approximating treatment plan goals (TP-$15 group). Patients receiving this DRA condition improved more than those receiving either no programmatic reinforcement or $5 for each of three urines collected per week testing drug-free. Moreover, TP-$15 subjects continued to improve following cessation of the intervention. In the proposed extension of this research, 132 newly enrolled methadone maintenance patients at the Philadelphia, VA are assigned to one of three groups: the TP-$20 group is eligible to earn vouchers worth up to $20 per week, the STD group receives the standard VA treatment and no programmed reinforcement, and the UA-TH group is eligible to earn up to 4 take-home doses of medication per week by submitting drug-free urines. Interventions begin following a 10 week baseline period and continue until week 30. Assessments occur at intake and weeks 10, 20, 30, and 52 (follow up). Outcome measures include urinalysis results, self-reported drug-use and risk-behaviors, and psychosocial measures. The significance of the project includes potential validation of an alternative or adjunct to UA contingencies that produces more durable behavior change using a DRA procedure.