COMMUNITY REINFORCEMENT APPROACH & NALTREXONE FOR OPIOID DEPENDENCE

越来越多的人一致认为，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。 纳曲酮，一种优秀的长效阿片类药物，令人失望的记录 在药物滥用治疗系统中，拮抗剂可能在一定程度上是 未能将其与心理社会方法相结合以加强 纳络酮的依从性和奖励戒断。 希金斯和他的同事开发的多方面CRA方法是 作为一种改善纳曲酮疗效的策略特别有吸引力 治疗，因为它的几个成分可能被靶向 直接解决纳曲酮的弱点。例如，为了补偿 纳曲酮缺乏药物奖励，应急管理 通过使用代金券系统可以用来奖励和提高 纳曲酮摄入。同样，重要其他人的参与 通过互惠关系咨询的治疗可以用来 为留住员工提供更多激励措施，鼓励他们坚持下去 尽管长期戒断，但仍接受治疗。使用拆卸 策略，我们将评估将这两个不同的 希金斯标准纳曲酮治疗包的组成 维修。 180名新近戒毒的阿片成瘾者将被随机分配到 或者(1)应急管理加上重大的其他参与 除标准纳曲酮治疗外，(2)应急管理 除标准纳曲酮治疗外，或(3)标准纳曲酮 单独治疗，包括每周三次门诊治疗 纳曲酮，每周三次监督尿毒学筛查，每周 团体咨询。主要结果将是保留、遵守 纳曲酮治疗以及减少阿片类药物、可卡因和其他 物质使用。所有治疗都将由人工指导并由 经验丰富的临床医生，他们将接受培训和持续监督 以防止研究过程中的漂移。受监管的小便池将 每周收集三次。所有的咨询过程都将被录像 用于持续的治疗师监督和过程评估。后续行动 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 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.