BOSTON UNIVERSITY CRU FOR ALCOHOLISM TREATMENT

描述：该提案包括两项研究，以评估合并 酒精依赖的行为和药物治疗。的 初步研究旨在检查阿坎酸在 结合简短的干预（动机增强疗法 [MET]）对渴求、线索诱导反应以及 饮酒行为开始后的酒精与 安慰剂对照组仅接受MET。在美国进行的以医学为基础的研究 已经为我们提供了证据表明，纳洛酮减少线索诱导的 反应性和渴望，可能还有酒精的价值，但 阿坎酸的类似作用机制尚未被探索。的 初步研究的目的是确定 和心理生理反应性介导阿坎酸对 喝酒为此，受试者将被分配到阿坎酸或阿坎酸。 安慰剂组12周。基于实验室的线索反应性测量 将在药物试验前后对方案进行评估。的 初步研究的第二阶段将为所有无应答者提供 替代药物，以确定测序的影响 干预措施。治疗12周后，对阿坎酸或 安慰剂将接受阿坎酸加安慰剂、阿坎酸加安慰剂或阿坎酸加安慰剂。 纳洛酮、纳洛酮加安慰剂或安慰剂。这一阶段将使我们 来评估药物组合是否比 单独使用药物维持禁欲， 对无反应者的治疗有助于降低复发率。的 主要研究（11）旨在检查两种方法的相对有效性 不同强度的行为治疗（MET和认知行为治疗） 治疗[CBT]）与以下组合之一联合使用 药物（阿坎酸加安慰剂、纳洛酮加安慰剂、阿坎酸 加纳洛酮，或安慰剂加安慰剂）。将招募受试者， 6个月的治疗试验，随后是12个月的随访期， 让我们有机会评估行为治疗 不同的强度也不同的有效性，在治疗酒精 依赖这项研究还将使我们能够审查是否 已知两种药物的组合可有效减少饮酒 比单独使用每种药物都有好处， 预测治疗结果的个体患者特征。最后， 拟议的初步研究将允许评价以下因素的相互作用： 两个层次的心理治疗与不同的组合， 提供的药物。这将是第一项提供长期研究的研究。 纳洛酮与行为疗法联合治疗的结果数据， 一种以上的药物与行为疗法相结合， 联合使用药物治疗 酒精依赖

DESCRIPTION: This proposal incorporates two studies to assess combined behavioral and pharmacological treatments of alcohol dependence. The preliminary study is designed to examine the effect of acamprosate in combination with a brief intervention (motivational enhancement therapy [MET]) on craving, cue-induced reactivity, and the subjective effects of alcohol following the initiation of drinking behavior compared to placebo-controls receiving only MET. Laboratory-based studies in the US have provided us with evidence that naltrexone decreases cue-induced reactivity and craving, and possibly the rewarding value of alcohol, but similar mechanisms of action for acamprosate have not been explored. The purpose of the preliminary study is to determine whether changes in craving and psychophysiological reactivity mediate the effects of acamprosate on drinking. To this end, subjects will be assigned to the acamprosate or placebo group for 12 weeks. Measures from a laboratory based cue reactivity protocol will be evaluated before and after the medication trial. The second phase of the preliminary study will provide all nonresponders with alternative medications to determine the effects of sequencing interventions. After 12 weeks of treatment, nonresponders to acamprosate or placebo will receive either acamprosate plus placebo, acamprosate plus naltrexone, naltrexone plus placebo, or placebo. This phase will allow us to assess whether a combination of medications offers more benefits than either medication alone in sustaining abstinence and whether sequential treatment for nonresponders is helpful in reducing relapse rates. The primary study (11) is designed to examine the relative effectiveness of two behavioral treatments that vary in intensity (MET and cognitive-behavioral treatment [CBT]) combined with one of the following combinations of medications (acamprosate plus placebo, naltrexone plus placebo, acamprosate plus naltrexone, or placebo plus placebo). Subjects will be recruited for a six month treatment trial followed by a 12 month follow-up period that will provide us with the opportunity to evaluate whether behavioral treatments varying in intensity also vary in their effectiveness in treating alcohol dependence. This study will also permit us to examine whether the combination of two medications known to be effective in reducing drinking has benefits over using each medication alone, and whether there are individual patient characteristics that predict treatment outcome. Finally, the proposed primary study will permit an evaluation of the interaction of the two levels of psychological treatment with the varying combination of medications provided. This will be the first study that provides long-term outcome data on the combination of naltrexone with behavior therapy, the combination of more than one medication with behavior therapy, and the combination of a brief intervention with medication in the treatment of alcohol dependence.