Evaluation Of Treatments Of Drug Dependence In HIV Infec

我们最近完成了一项随机临床试验，研究将应急管理与认知行为疗法（CBT）结合起来减少双重（可卡因和海洛因）依赖门诊患者的药物使用。本研究的第二个目的是检查是否通过在基于凭证的应急管理中加入CBT来实现持续的艾滋病毒保护行为。接受CBT干预的市中心美沙酮维持可卡因滥用者被教导：1)识别并寻找不会带来艾滋病毒风险的强化来源；2)发展以问题为中心和以情绪为中心的适应性应对反应，以应对可能引发艾滋病毒风险行为的一般和药物特异性压力源。目前正在进行的分析将检查临床样本中压力，应对策略和艾滋病毒风险行为之间的关系，并确定在研究过程中接受CBT作为研究干预一部分的参与者的艾滋病毒风险行为的变化是否不同。

We recently completed a randomized clinical trial of the efficacy combining contingency management with cognitive behavioral therapy (CBT) for reducing drug use in dually (cocaine- and heroin-) dependent outpatients. A secondary objective of this study is to examine whether sustained HIV-protective behaviors are achieved by adding CBT to voucher-based contingency management. Inner-city methadone-maintained cocaine abusers receiving the CBT intervention were taught: 1) to identify and seek out sources of reinforcement that do not carry risks of HIV; and 2) to develop adaptive problem-focused and emotion-focused coping responses to general and drug-specific stressors that might otherwise trigger HIV-risk behaviors. Analyses are currently underway that will examine the relationship between stress, coping strategies, and HIV risk behaviors in this clinical sample, and determine whether changes in HIV risk behaviors over the course of the study differed for participants who received CBT as part of their study intervention. Another study included preliminary validation of a brief screening instrument for identifying current opiate dependence in HIV-positive inpatients. Patients admitted to an inpatient AIDS ward who indicated past heroin use were administered an 8-item questionnaire assessing aspects of opiate dependence such as tolerance, withdrawal, and compulsive use; these patients provided a urine sample that was tested on-site for the presence of opiates, and they were assesed for symptoms of opioid withdrawal. With the goal of determining the shortest version of the screening instrument with acceptable validity for identifying current opiate dependence (urine positive for opiates and/or symptoms of opiate withdrawal), the sensitivity, specificity, and positive predictive value of various short versions of the questionnaire were calculated. The version of the questionnaire selected consisted of four questions and had sensitivity of 74.1%, specificity 64.4%, and positive predictive value of 71.4%. These results provide a starting point for further development and validation of short screens for opiate dependence in HIV-positive patients.