Evaluation Of Treatments Of Opioid And Cocaine Dependenc

该科继续调查药物滥用的药理和行为治疗方法，并探索治疗方法的组合。我们已经证明了行为干预(加强可卡因阴性尿样)在市中心静脉注射多药滥用者的大样本中的有效性，我们正在继续评估应用这种治疗的最佳方法。分析正在进行中。为了控制成本和技术转让，我们正在进行试点研究，其中增强剂是彩票抽奖而不是代金券，因为其他人的工作表明，基于彩票的增援程序可以由社区制造商和商人的捐款来资助。最初的试点研究表明，抽奖程序在研究参与者中激发了相当大的热情，在技术上比代金券计划更容易。在另一项正在进行的试点研究中，我们正在比较两种不同的抽奖程序和两种不同的强化密度。我们计划将抽签程序纳入一项更雄心勃勃的研究中，在这项研究中，各种低成本或零成本的激励措施针对的是广泛的行为改变，而不仅仅是减少药物使用。我们目前研究的另一个重点来自实验室动物数据，这些数据表明，阿尔法肾上腺素能激动剂洛非西定可以防止应激诱导的可卡因和/或海洛因寻求的恢复。在过去的一年里，我们完成了一项剂量范围的研究，以确定洛非西定如何才能最安全地与美沙酮在人类身上联合使用。我们计划在此之后进行一项临床试验，在此试验中，在凭证开始戒断之后，继续服用洛非西定(或安慰剂)，以防止应激诱导的复发。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. We have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine-negative urine samples) in large inner-city samples of intravenous polydrug abusers, and we continue to evaluate the best ways to apply the treatment. In the past year we completed the active-treatment phase of a study to address the question of how a hypothetical methadone-maintenance clinic could best allocate its resources (both pharmacological and nonpharmacological) to reduce both heroin and cocaine abuse, if the clinic were to institute voucher-based contingency management. By combining an intervention primarily aimed at decreasing cocaine use through behavioral reinforcement (contingency management) with another intervention focused on decreasing illicit-opiate use through pharmacological treatment (high-dose methadone maintenance), we hypothesize that we will see greater abstinence from cocaine and illicit opiates than has been seen when either approach was applied separately. Analyses are ongoing. In the interest of cost containment and technology transfer, we are conducting pilot studies in which the reinforcers are lottery draws rather than vouchers, since work by others has shown that a lottery-based reinforcement procedure can be funded by donations from community manufacturers and merchants. The initial pilot study indicated that the lottery procedure generated substantial enthusiasm among study participants and is technically easier than the voucher program. In a further ongoing pilot study we are comparing two different lottery procedures and two different densities of reinforcement. We plan to incorporate the lottery procedure into a more ambitious study in which a variety of low- or no-cost incentives are targeted toward a broad range of behavioral changes beyond reductions in drug use. Another current focus of our research derives from laboratory-animal data showing that stress-induced reinstatement of cocaine-seeking and/or heroin-seeking can be prevented with the alpha-adrenergic agonist lofexidine. In the past year we completed a dose-ranging study to determine how lofexidine can most safely be co-administered with methadone in humans. We plan to follow this with a clinical trial in which voucher-initiated abstinence is followed by maintenance on lofexidine (or placebo) for prevention of stress-induced relapse.