SOUTHEAST BALTIMORE DRUG TREATMENT PROGRAM

该项目将系统地调查对药物滥用的影响 行为结构变化程度的治疗结果 由治疗方案提供。这些研究将在一个 提供阿片类药物的社区药物滥用治疗门诊 维持性药物治疗--美沙酮或左旋-α-酮-- 乙酰美沙酮（LAAM）。维持药物治疗的阿片类药物滥用者通常 非阿片类药物使用率很高，许多人被诊断为 反社会人格障碍（APD），这是与穷人 治疗依从性差，治疗反应差，艾滋病毒风险增加。 这些研究将评估一种新的行为应急程序， 提高对同时非药物治疗的依从性， 改善治疗效果。一个重要的次要目标是评估 个体差异与治疗结果的关系 精神/行为特征。特别是，我们将评估 反社会人格障碍和同时使用非法可卡因的作用 滥用作为治疗结果的可能标志物或调节剂。研究1 和2评估行为权变药物治疗程序， 持续的药物治疗取决于参与 行为治疗在这两项研究中，志愿患者将 随机分配到权变治疗和非权变治疗。研究1将 在美沙酮药物治疗期间评估这种行为干预。 研究2将评估LAAM期间的行为干预 药物治疗.两种情况下的结果可能不同，因为 药物治疗需要不同的诊所访问频率，这 行为结构的差异可能会影响 行为偶然性研究3将具体评估是否 门诊就诊频率的差异影响治疗结果。LAAM 患者将被随机分配到3天与7天的诊所就诊 每周几天。在所有三项研究中评估的结局指标 包括治疗保留，出席/参与行为 治疗服务尿分析药物使用证据，加上全球临床 结果指数，如成瘾严重程度指数。这些研究将 提供有关行为学疗效的重要信息， 权变药物治疗程序，关于行为结构的作用 在治疗效果，以及关于反社会的关系， 人格和可卡因使用与治疗反应的关系结果将 对指导综合行为- 药物滥用的药物治疗和指导药物滥用的发展 有效的患者治疗匹配策略。

This project will systematically investigate the effect upon drug abuse treatment outcomes of variations in the degree of behavioral structure provided by the treatment program. The studies will be conducted in a community outpatient drug abuse treatment clinic providing opioid maintenance pharmacotherapy -- either methadone or levo-alpha- acetylmethadol (LAAM). Opioid abusers in maintenance pharmacotherapy often have high rates of nonopioid drug use, and many have the diagnosis of antisocial personality disorder (APD), which is associated with poor treatment compliance, poor treatment response, and increased HIV risk. These studies will evaluate a novel behavioral contingency procedure for enhancing compliance with concurrent nonpharmacological treatments and for improving treatment outcomes. An important secondary goal is to assess the relationship to treatment outcome of individual differences in patients' psychiatric/behavioral characteristics. In particular, we will assess the role of antisocial personality disorder and of concurrent illicit cocaine abuse as possible markers or modulators of treatment outcome. Studies 1 and 2 evaluate a behaviorally contingent pharmacotherapy procedure in which continued pharmacotherapy is contingent upon participation in the prescribed behavioral treatments. In both studies volunteer patients will be randomized to contingent versus noncontingent treatment. Study 1 will evaluate this behavioral intervention during methadone pharmacotherapy. Study 2 will evaluate the behavioral intervention during LAAM pharmacotherapy. Outcomes in the two contexts may differ because the two pharmacotherapies require different clinic visit frequencies, and this difference in behavioral structure may influence the efficacy of the behavioral contingency. Study 3 will specifically evaluate whether differences in clinic visit frequency influence treatment outcome. LAAM patients will be randomly assigned to visit the clinic 3 days versus 7 days per week. Outcome measures to be assessed in all three studies include treatment retention, attendance/participation in the behavioral treatment services urinalysis evidence of drug use, plus global clinical outcome indices such as the Addiction Severity Index. These studies will provide important information about the efficacy of the behaviorally contingent pharmacotherapy procedure, about the role of behavior structure in treatment efficacy, and about the relationship of antisocial personality and cocaine use to treatment response. The results will be valuable for guiding the development of integrated behavioral- pharmacological treatments for drug abuse and for guiding the development of effective strategies for patient-treatment matching.