EVALUATION OF TREATMENTS OF OPIOID AND COCAINE DEPENDENCE

该科继续调查药理学 以及药物滥用和相互作用的行为治疗 在这两种治疗方式之间。的主要目标是 这些研究是为了消除药物使用并降低患上 艾滋病毒在可卡因和/或海洛因依赖者中的传播。 戒酒强化--一种行为治疗方法 哪些患者获得戒毒奖励，以及 美沙酮维持治疗是两种有效的药物治疗方法 虐待。我们已经进行了一项评估节欲的研究 强化、美沙酮剂量增加及其组合 与不增加剂量的标准治疗相比。病人 世卫组织在美沙酮的前5周继续使用阿片类药物 维持量(50毫克/天)随机分配到以下4组中的一组 试验组：阿片类药物阴性尿液或有凭证 样本加20毫克美沙酮剂量增加；或有 代金券加美沙酮剂量不增加；20毫克美沙酮剂量 增加加非或有凭证；以及非或有凭证 另加不增加剂量的对照组。阿片类药物的使用量在 所有三组接受以下两种干预的干预期 或有凭证或剂量增加或两者兼而有之，但不在 对照组。然而，只有那些接收特遣队的团体 代金券的持续期显著增加 禁欲。因此，加强戒断和美沙酮剂量 增加在减少阿片类药物使用方面同样有效， 禁欲强化选择性地增加了持续禁欲。 然而，剂量增加和戒断强化相结合 并不比任何一种单独治疗更有效。早期研究 在我们的实验室里显示了戒酒的强化 或有事件有效地产生了大量的 市中心、静脉注射、多药滥用者中的可卡因戒断情况。这个 然而，这种治疗的效果在许多情况下往往是短暂的 病人。认知/行为预防复吸咨询 我们实验室开发的药物滥用治疗方法 正在整合到行为应急管理中 方案，以增加节欲的持续时间，由 通过鼓励长期的改变来单独进行行为治疗 吸毒和其他艾滋病毒危险行为。一项评估的研究 加强戒酒与预防复发相结合 咨询工作正在进行中。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and interactions between these two forms of treatments. A primary objective of these studies is to eliminate drug use and decrease the probability of HIV transmission in cocaine- and/or heroin-dependent patients. Abstinence reinforcement, a behavioral treatment approach in which patients receive incentives for drug abstinence, and methadone maintenance are both effective treatments for drug abuse. We have conducted a study evaluating abstinence reinforcement, methadone dose increase, and their combination compared to standard treatment without dose increase. Patients who continued to use opiates during the first 5 weeks of methadone maintenance (50 mg/day PO) were randomly assigned to one of 4 experimental groups: contingent vouchers for opiate-negative urine specimens plus a 20 mg methadone dose increase; contingent vouchers plus no methadone dose increase; 20 mg methadone dose increase plus noncontingent vouchers; and noncontingent vouchers plus no dose increase control group. Opiate use decreased during the intervention period in all three groups receiving either contingent vouchers or dose increase or both group, but not in the control group. However, only those groups receiving contingent vouchers had significantly increased periods of sustained abstinence. Thus, abstinence reinforcement and methadone dose increase were equally effective in decreasing opioid use, and abstinence reinforcement selectively increased sustained abstinence. However, combined dose increase and abstinence reinforcement was not more effective than either treatment alone. Earlier research in our laboratory showed that abstinence reinforcement contingencies are effective in producing significant periods of cocaine abstinence in inner-city, intravenous, polydrug abusers. The effects of this treatment, however, tend to be short lived in many patients. A cognitive/behavioral relapse prevention counseling approach to substance abuse treatment developed in our laboratory is being integrated into the behavioral contingency management program to increase the duration of abstinence produced by the behavioral treatment alone by encouraging long-term changes in drug use and other HIV risk behaviors. A study evaluating the combination of abstinence reinforcement and relapse prevention counseling is underway.