TREATING COCAINE ABUSE: A BEHAVIORAL APPROACH

治疗可卡因滥用：行为方法

• 批准号: 6952684
• 负责人: Stephen T Higgins
• 金额: $ 71.65万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-30 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6952684
• 关键词: behavior therapy; behavioral /social science research tag; clinical research; clinical trials; cocaine; counseling; drug abuse therapy; drug addiction; human subject; human therapy evaluation; interview; longitudinal human study; medical appointment; motivation; outcomes research; outpatient care; reinforcer; therapy compliance; urinalysis

Cocaine dependence remains a major U.S. public health problem for which effective treatments are sorely needed. Towards that end, our group has been researching a multicomponent, outpatient treatment for cocaine dependence. The treatment integrates two key components: a voucher-based incentive program and Community Reinforcement Approach therapy. This treatment is one of the few reliably efficacious interventions for retaining cocaine-dependent adults in outpatient treatment and for engendering cocaine abstinence. The studies proposed in this competing continuation programmatically extend this treatment approach. Our current focus is on understanding how to increase post-treatment cocaine abstinence. Interestingly, evidence from us and others indicates that increasing during-treatment abstinence may be the most effective strategy for improving longer-term abstinence in cocaine-dependent outpatients. Experimental and correlational data from our clinic, for example, indicate that sustaining three or months of continuous cocaine abstinence during treatment increases greater than 3-fold the odds of cocaine abstinence at follow-up. Our prior trials also indicate clearly that the voucher-based incentive program is the most effective element in this multicomponent treatment for increasing during-treatment abstinence. Hence, the proposed studies will experimentally analyze how changes in the value of the voucher-based incentive program as well as length of treatment with it affects during-treatment and post-treatment cocaine abstinence. Additionally, while strong evidence exists supporting the efficacy of this voucher program, there is a striking dearth of information available on how alterations in its basic parameters affect outcome. Thus, the proposed trials also will provide practically important new parametric information on this intervention. We have proposed two trials. Trial 1 will use a randomized, parallel-groups design to examine the during- and post-treatment effects of this multicomponent treatment with the vouchers set at one-half, full, and twice their usual monetary value. Trial 2 will use the same design, but instead of manipulating the value of the vouchers, the length of time that patients receive them will be set at one-half, full, and twice the usual duration. Overall, these clinical trials will further understanding of cocaine-dependence treatment in at least two ways: First, they will rigorously evaluate the hypothesis that increasing during-treatment abstinence increases longer-term cocaine abstinence. If that hypothesis is supported, it will provide a concrete target for facilitating longer-term cocaine abstinence in future treatment efforts. Secondly, the trials will provide rigorous, experimental analyses of the relationships between the value of voucher-based incentives and length of treatment with them and treatment outcome. Such information is essential to a thorough evaluation of this emerging treatment technology.

可卡因依赖仍然是美国一个主要的公共卫生问题，迫切需要有效的治疗。 为此，我们小组一直在研究一种多组分的可卡因依赖门诊治疗方法。 该治疗方法包括两个关键组成部分：基于代金券的激励计划和社区强化方法治疗。 这种治疗是少数几种可靠有效的干预措施之一，可以使可卡因依赖的成年人继续接受门诊治疗，并使可卡因戒断。 本竞争延续中提出的研究以编程方式扩展了这种治疗方法。我们目前的重点是了解如何增加治疗后可卡因戒断率。 有趣的是，来自我们和其他人的证据表明，增加治疗期间的禁欲可能是改善可卡因依赖门诊患者长期禁欲的最有效策略。例如，来自我们诊所的实验和相关数据表明，在治疗期间持续三个月或几个月的可卡因戒断会使随访时可卡因戒断的几率增加3倍以上。 我们之前的试验也清楚地表明，基于代金券的激励计划是这种多组分治疗中最有效的因素，可以增加治疗期间的禁欲。 因此，拟议的研究将实验性地分析基于代金券的激励计划的价值以及治疗时间的变化如何影响治疗期间和治疗后的可卡因戒断。 此外，虽然有强有力的证据支持这种代金券计划的有效性，但关于其基本参数的改变如何影响结果的信息却非常缺乏。 因此，拟议的试验也将提供有关这种干预措施的实际重要的新参数信息。我们提出了两项试验。 试验1将采用随机、平行组设计，检查这种多组分治疗的治疗期间和治疗后效果，将代金券设置为通常货币价值的一半、全部和两倍。 试验2将使用相同的设计，但不是操纵代金券的价值，而是将患者获得代金券的时间长度设置为通常时间的一半，全部和两倍。总的来说，这些临床试验将至少在两个方面进一步了解可卡因依赖治疗：首先，他们将严格评估增加治疗期间戒断增加长期可卡因戒断的假设。 如果这一假设得到支持，它将为今后的治疗工作提供一个促进长期可卡因戒断的具体目标。 其次，试验将提供严格的，基于凭证的激励措施的价值和治疗时间与治疗结果之间的关系的实验分析。 这些信息对于彻底评估这种新兴的治疗技术至关重要。