TREATING COCAINE ABUSE--A BEHAVIORAL APPROACH

可卡因依赖可能仍然是美国一个严重的公共健康问题。 整个90年代的问题。为了解决这个问题，我们 一直在研究一种多成分的门诊病人 可卡因依赖的治疗是基于以下原则： 行为分析和行为药理学。这种治疗有效 使依赖可卡因的成年人继续接受门诊治疗， 持续可卡因戒断的临床显著时期。的 本申请中提出的研究的目的是进一步分析 这种多组分治疗的哪些组分有助于 积极的成果观察。这种拆卸研究是 对于开发基于药物的有效治疗至关重要 药物依赖，并与研究目标一致 在RFA #DA-94-02“行为疗法开发项目”中概述， 这就是我们正在应对的RFA。 我们之前的一项试验表明， 病人赚取的代金券可兑换为零售物品， 提交不含可卡因的尿液样本是这项研究的一个积极组成部分， 治疗然而，这项研究并没有确定激励措施是否 通过强化或作用直接增加可卡因戒断 间接地通过增加治疗保留率和服务量 并以这种方式改善结果。本申请的研究1 将系统地复制我们先前的发现，并将其扩展到 对保留和可卡因戒断的解离作用。研究2将 评估用于治疗酒精滥用的双硫仑治疗成分是否 在这种多种药物滥用人群中， 如果是的话，我们使用的药物合规程序是否 实施该疗法是有效的特征。初步结果 从我们的诊所和其他人表明，治疗酒精滥用， 可卡因依赖人群通过双硫仑治疗和药物治疗- 遵守程序大大减少了饮酒和可卡因的使用。 研究3将评估治疗中是否包括重要的其他人 过程改善了结果，如果是这样，行为契约是否 我们在此组件中使用的程序是一个有效的功能。初步 我们诊所的结果表明， 治疗和教导他们使用行为契约， 增加患者达到临床显著性的概率 持续的可卡因戒断期 每一项拟议的试验都将提供重要的新信息， 这种有前途的行为治疗的特定成分的功效 对可卡因的依赖这些信息将使我们能够凭经验 将这一干预精简到其必要组成部分。此外，委员会认为， 这些研究将有助于实现我们的长期目标， 综合治疗包和特定治疗成分， 作为门诊病人手册指导的有效干预措施进行传播 治疗可卡因依赖。

Cocaine dependence is likely to remain a serious U.S. public-health problem throughout the 1990's. In an effort to address that problem, we have been researching the efficacy of a multicomponent, outpatient treatment for cocaine dependence that is based on the principles of behavior analysis and behavioral pharmacology. This treatment effectively retains cocaine-dependent adults in outpatient treatment and engenders clinically-significant periods of continuous cocaine abstinence. The purpose of the studies proposed in this application is to analyze further which components of this multicomponent treatment contribute to the positive outcomes observed with it. Such dismantling studies are essential to the development of empirically-based and effective treatments for drug dependence, and are consistent with the research objectives outlined in RFA #DA-94-02 "Behavioral Therapies Development Program", which is the RFA to which we are responding. One of our prior trials demonstrated that an incentive program wherein patients earned vouchers exchangeable for retail items contingent on submitting cocaine-free urine specimens was an active component of this treatment. However, that study did not determine whether the incentives directly increased cocaine abstinence via reinforcement or acted indirectly by increasing treatment retention and the amount of services received and in that manner improved outcome. Study 1 of this application will systematically replicate our prior findings and extend them by dissociating effects on retention and cocaine abstinence. Study 2 will assess whether a disulfiram-therapy component used to treat alcohol abuse in this multiple-drug abusing population contributes to positive outcomes, and, if so, whether the medication-compliance procedures we use in implementing this therapy are an effective feature. Preliminary results from our clinic and others indicate that treating alcohol abuse in this cocaine-dependent population via disulfiram therapy and medication- compliance procedures significantly reduces drinking and cocaine use. Study 3 will assess whether including significant others in the treatment process improves outcome, and , if so, whether the behavioral-contracting procedures we use in this component are an effective feature. Preliminary results from our clinic indicate that including significant others in treatment and teaching them to use behavioral contracts significantly increases the probability of patients achieving clinically-significant periods of continuous cocaine abstinence. Each of the proposed trials will contribute important new information on the efficacy of specific components of this promising behavioral treatment for cocaine dependence. This information will permit us to empirically streamline this intervention down to its necessary components. Moreover, these studies will contribute to our longer-term goal of producing both a comprehensive treatment package and specific treatment components for dissemination as manual-guided and effective interventions for outpatient treatment of cocaine dependence.