Brief Introductory Therapy for Opioid Dependence

描述（由申请人提供）：

DESCRIPTION (provided by applicant): Contracting and Behavioral Activation Therapy (CBAT) is an introductory treatment designed to prevent treatment failure for the sizable subgroup of patients entering methadone maintenance treatment (MMT) with persistent depressive symptoms or demoralization but who do not meet syndromal criteria for Major Depression. CBAT, a highly structured, manual driven, prescriptive treatment, can be provided by regular drug counselors in MMT and uses short-term behavioral contracting and activation procedures and positively framed advice to help patients achieve an initial period of abstinence, increase activity levels, and, through accomplishment of specific, short-term behavioral goals, counter pessimism about the possibility of success. Data from the current study support the feasibility of training regular MMT drug counselors to provide CBAT and the potential efficacy for reducing illicit opiate use of CBAT (provided in 6 sessions during the first 4 weeks following methadone induction) compared to 2 cohorts of similar patients treated with regular drug counseling or professional therapy (historical controls). This Stage Ib application proposes a 12-week, randomized clinical trial to obtain data regarding the efficacy of CBAT compared to concurrent control, manual-guided Methadone Drug Counseling (MDC), that approximates standard MMT drug counseling (Specific Aim 1); to finalize treatment manuals, training procedures and materials, and a competence and adherence rating scale for the treatments (Specific Aim 2); and to evaluate manual adherence and proficiency of drug counselors providing the treatments and the ability to discriminate between CBAT and MDC (Specific Aim 3). Patients (N=60) with persistent depressive symptoms (BDI>16 following 2 weeks of methadone induction) will be randomly assigned to CBAT for 4 weeks followed by MDC or to MDC from the outset of treatment. CBAT and MDC will be provided by regular drug counselors in MMT. Reductions in illicit opioid use will be assessed by twice weekly urine toxicology testing and weekly self-report. Independent ratings of therapy videotapes will assess manual adherence and performance and will be used to assess the reliability of the ratings and the ability of the rating scales to discriminate between CBAT and MDC. Data obtained from the study will be used to evaluate the effect size of the differences between CBAT and MDC to determine the necessary sample size for a Stage II study comparing CBAT and MDC.