IMPROVING COMBINED BUPRENORPHINE-BEHAVIORAL TREATMENT

社区强化方法（CRA）与应急管理是一种有效的药物滥用治疗。不幸的是，疗效本身不足以使治疗方案采用治疗。 如果能够以成本较低的方式提供应急管理，可能会促进采用应急管理的CRA。 本建议的目的是研究两个修改CRA与应急管理，使其成本较低的提供的有效性。 第一种方法将包括通过基于计算机的交互技术提供CRA。 这种技术可以通过减少咨询师接触时间来降低治疗成本。 第二种方法将通过使用奖励制度来降低成本，该制度采用丁丙诺啡特权，视戒毒情况而定，而不是基于金钱的奖励。 我们建议在阿片类药物依赖的丁丙诺啡维持治疗的背景下检查这些降低成本的方法的有效性。虽然类阿片依赖性经常被认为是城市地区的一个公共卫生问题，但在农村地区却很少被认为是一个问题。 然而，阿片类药物依赖在农村地区可能是一个严重的问题，特别是由于药物滥用者的高风险行为造成的艾滋病威胁。该项目的目的是解决这一严重的公共卫生问题，继续开办佛蒙特州第一家也是唯一一家为阿片类药物依赖提供药物治疗的门诊诊所。在治疗期间，患者将参加两项随机临床试验。 在第一项试验中，患者将被随机分配接受三种治疗之一：（1）计算机交付CRA与代金券激励系统（例如，根据药物戒断情况提供货币代金券），（2）治疗师提供的CRA与代金券激励系统，或（3）标准咨询。 在第二次治疗中，患者将被随机分配接受三种治疗之一：（1）CRA与丁丙诺啡相关的应急管理（替代剂量方案和剂量调整），（2）CRA与代金券激励计划，或（3）标准咨询。 两项试验中的应急管理程序将针对该人群中的阿片类药物和可卡因戒断。 主要的结果指标将包括禁欲，保留和成本效益。还将对艾滋病毒风险行为采取措施。总体而言，本研究将提供新的实证信息，确定两种方法的有效性，降低成本的CRA与应急管理治疗。 这些信息可能有助于采用这种有效的治疗方法。 这项研究还将探讨计算机化药物滥用治疗的效用。 某些药物滥用治疗服务的计算机化是一种新的做法，可能对药物滥用治疗服务的未来产生积极影响。 最后，通过提供佛蒙特州唯一的阿片类药物依赖门诊药物治疗服务，该项目将为该地区的公共卫生做出积极贡献。

The Community Reinforcement Approach (CRA) with contingency management is an efficacious drug abuse treatment. Unfortunately, efficacy alone is not sufficient for a treatment to be adopted by treatment programs. Adoption of CRA with contingency management may be facilitated if it could be delivered in ways that are less costly. The aim of this proposal is to examine the efficacy of two modifications to CRA with contingency management that make it less costly to provide. The first method will consist of delivering CRA via computer-based interactive technology. Such technology may render the treatment less costly by decreasing counselor contact time. The second method will reduce costs by using an incentive system that employs buprenorphine privileges contingent on drug abstinence as opposed to monetary-based incentives. We propose to examine the efficacy of these cost-reducing methods in the context of buprenorphine maintenance treatment of opioid dependence. While opioid dependence is frequently acknowledged as a public health problem of urban areas, it is less frequently acknowledged as an issue for rural areas. Opioid dependence, however, can be a serious problem in rural areas, especially with the current threat of AIDS due to high-risk behavior by substance abusers. The aims of this project are to address this serious public health concern by continuing the first and only outpatient clinic to provide pharmacotherapies for opioid dependence in the State of Vermont. While in treatment, patients will participate in two randomized clinical trials. In the first trial, patients will be randomly assigned to receive one of three treatments: (1) computer- delivery CRA with the voucher incentive system (e.g., provision of monetary vouchers contingent on drug abstinence), (2) therapist-delivered CRA with the voucher incentive systems, or (3) standard counseling. In the second treatment, patients will be randomly assigned to receive one of three treatments: (1) CRA with buprenorphine-related contingency management (alternative dose regimens and dose adjustment), (2) CRA with the voucher incentive program, or (3) standard counseling. Contingency management procedures in both trials will target both opioid and cocaine abstinence in this population. Primary outcome measures will include abstinence, retention and cost-effectiveness. Measures will also be taken of HIV-risk behavior. Overall, this research will contribute new empirical information by identifying the efficacy of two methods of reducing costs of CRA with contingency management treatment. Such information may contribute to the adoption of this efficacious treatment. This research will also examine the utility of computerizing substance abuse treatment. The computerization of some substance abuse treatment services is a novel approach that may positively impact the future of drug abuse treatment services. Finally, by providing the only outpatient pharmacotherapy services for opioid dependence in the State of Vermont, this project will contribute positively to this region's public health.