COMMUNITY REINFORCEMENT APPROACH & NALTREXONE FOR OPIOID DEPENDENCE

越来越多的人认为药物滥用治疗的结果 可以通过增加心理社会方法来加强和扩展。 纳洛酮令人失望的记录，一种优秀的长效阿片类药物 药物滥用治疗系统中的拮抗剂，可能部分是由于 未能将其与心理社会方法结合起来， 依从纳得酮并奖励禁欲。 希金斯及其同事开发的多方面CRA方法是 作为改善纳曲酮治疗结果的策略， 治疗，因为它的几个组成部分可以针对 直接解决纳洛酮的弱点 例如补偿 纳洛酮缺乏药理学奖励，应急管理 通过使用代金券系统，可以用来奖励和提高 纳洛酮摄入。 同样，重要他人的参与 通过互惠关系咨询的治疗可以用来 提供更多的激励措施，以留住人才，并鼓励坚持下去 尽管长期戒断， 使用拆解 战略，我们将评估增加这两个不同的价值 Higgins治疗包的组成部分与标准纳洛酮 上维护 180名最近戒毒的阿片类药物成瘾者将被随机分配到 （1）应急管理加上其他重要参与， 除了标准的纳洛酮治疗，（2）应急管理 除标准纳洛酮治疗外，或（3）标准纳洛酮 单独治疗，包括每周三次门诊访视， 纳洛酮，每周三次监督尿液毒理学筛查， 团体咨询 主要结局将是保留率、依从性 纳曲酮治疗，减少阿片类药物、可卡因和其他 物质使用。 所有治疗都将由人工指导， 经验丰富的临床医生，他们将接受培训和持续监督 以防止在研究过程中发生漂移。 监督尿液将 每周收集三次。 所有的咨询过程都会被录像 进行治疗师监督和过程评估。 随访 在应急措施停止后3、6、9和12个月进行 管理和关系咨询将评估持久性 治疗效果

There is increasing consensus that outcomes for substance abuse treatment can be enhanced and extended with the addition of psychosocial approach. The disappointing record of naltrexone, an excellent, long acting opioid antagonist, in the substance abuse treatment system, may in part be due to failure to combine it with psychosocial approaches to enhance compliance with naltexone and reward abstinence. The multifaceted CRA approach developed by Higgins and colleagues is particularly attractive as a strategy to improve outcomes in naltraxone treatment because several of its components could be targeted to directly address naltrexone's weakness. For example, to compensate for naltrexone's lack of pharmacological reward, contingency management through use of a voucher system could be used to reward and enhance naltrexone ingestion. Similarly, involvement of significant others in treatment through reciprocal relationship counseling could be used to provide increased incentives for retention and encouragement to persist with treatment despite protracted withdrawal. Using a dismantling strategy, we will evaluate the value of adding these two distinct components of Higgins' treatment package to standard naltrexone maintenance. 180 recently detoxified opioid addicts will be randomly assigned to either (1) contingency management plus significant other involvement in addition to standard naltrexone treatment, (2) contingency management in addition to standard naltrexone treatment, or (3) standard naltrexone treatment alone, consisting of thrice weekly clinic visits for naltrexone, thrice weekly supervised urine toxicology screens, and weekly group counseling. Primary outcomes will be retention, compliance with naltraxone treatment, and reduction in opioid, cocaine, and other substance use. All treatments will be manual-guided and delivered by experienced clinicians, who will receive training and ongoing supervision to prevent drift during the course of the study. Supervised urines will be collected thrice weekly. All counseling sessions will be videotaped for ongoing therapist supervision and process assessment. Follow-ups conducted 3, 6, 9 and 12 months after the cessation of the contingency management and relationship counseling will assess the durability of treatment effects.