EVALUATION OF TREATMENTS OF OPIOID AND COCAINE DEPENDENCE

本节继续调查药物滥用的药物和行为治疗，并探讨治疗的组合。NIDA/IRP治疗研究已经证明了行为干预（加强可卡因阴性尿样）在大规模的市中心静脉注射多种药物滥用者样本中的有效性。最近完成的一项研究评估了行为干预是否可以通过最初加强禁欲的中间步骤（降低尿液可卡因代谢物浓度）而变得更有效。在整个研究过程中，所有患者均接受每日口服美沙酮维持（50 mg/天）和每周咨询。在5周的基线治疗后，继续使用可卡因的患者被随机分配到两个为期8周的干预措施之一：1）根据可卡因阴性尿液标本提供代金券（戒断组）;或2）与前3周样本相比，可卡因代谢物浓度降低至少50%的凭证，然后仅对可卡因阴性尿液标本进行5周（逐步组）。收集观察到的尿液标本进行MWF;进行定性和定量尿分析。许可证具有货币价值，可以交换货物和服务。在8周的干预期间，两组的可卡因戒断率（可卡因阴性尿液样本%）均增加。虽然逐步时间表是有效的，强化时间表似乎同样有效地产生可卡因戒断。在过渡到禁欲时间表时，逐步治疗组显示出禁欲组中未观察到的显著额外改善。因此，逐步的时间表可能已经为禁欲做好了准备。（普雷斯顿KL，Umbricht A，Wong C，and Epstein D.药物依赖问题学院第61届年度科学会议，1999年。另一项NIDA/IRP研究证明了纳洛酮缩短阿片类药物解毒与丁丙诺啡的安全性、有效性和患者可接受性。（Umbricht A，Montoya ID，Hoover DR，Demuth KL，Chiang CT和普雷斯顿KL. Drug & Alcohol Dependence 56（3）：181-190，1999.）一项即将完成的研究将应急管理方法（可卡因阴性尿液的强化）与我们诊所开发的认知行为复发预防疗法相结合;研究人员假设应急管理将创造一个禁欲的时间窗口，在此期间可以引入复发预防疗法，以促进更持久的行为改变。- 物质滥用、物质滥用治疗、海洛因、阿片类药物、可卡因、美沙酮、应急管理、丁丙诺啡、纳洛酮-人类受试者

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. NIDA/IRP treatment studies have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine- negative urine samples) in large inner-city samples of intravenous polydrug abusers. One recently completed study evaluated whether a behavioral intervention could be made more effective by initial reinforcement of an intermediate step toward abstinence (decreases in urine cocaine metabolite concentration). Throughout the study, all patients received daily oral methadone maintenance (50 mg/day) and weekly counseling. Following a 5-week baseline treatment, patients who continued to use cocaine were randomly assigned to one of two 8-week interventions: 1) vouchers contingent on cocaine-negative urine specimens (abstinence group); or 2) vouchers contingent on at least a 50% decrease in cocaine metabolite concentration compared to the previous specimen for 3 weeks, then only for cocaine-negative urine specimens for 5 weeks (stepwise group). Observed urine specimens were collected MWF; qualitative and quantitative urinalysis was performed. Vouchers had monetary value and were exchangeable for goods and services. Cocaine abstinence (% cocaine-negative urine specimens) increased during the 8-week intervention in both groups. While the stepwise schedule was in effect, the reinforcement schedules appeared equally effective in producing cocaine abstinence. At the transition to the abstinence schedule, the stepwise-treatment group showed significant additional improvement not seen in the abstinence group. Thus, the stepwise schedule may have prepared patients for abstinence. (Preston KL, Umbricht A, Wong C, and Epstein D. 61st Annual Scientific Meeting of the College of Problems on Drug Dependence, 1999.) Another NIDA/IRP study demonstrated the safety, efficacy, and patient acceptability of naltrexone-shortened opioid detoxification with buprenorphine. (Umbricht A, Montoya ID, Hoover DR, Demuth KL, Chiang CT, and Preston KL. Drug & Alcohol Dependence 56(3): 181-190, 1999.) A study nearing completion combines the contingency-management approach (reinforcement of cocaine-negative urines) with a cognitive-behavioral relapse-prevention therapy developed at our clinic; the investigators hypothesize that contingency management will create a temporal window of abstinence during which relapse-prevention therapy can be introduced to foster more durable changes in behavior. - substance abuse, substance abuse treatment, heroin, opiates, cocaine, methadone, contingency management, buprenorphine, naltrexone - Human Subjects