Improving Combined Buprenorphine-Behavioral Treatment

描述(由申请人提供)： 在这一竞争的延续中，我们建议继续并扩大我们先前的目标。首先，我们将继续研究电脑化治疗。在先前的试验中，计算机提供的带有应急管理(CM)的社区强化方法(CRA)与治疗师提供的带有CM的CRA一样有效。然而，这项研究的设计并没有表明计算机提供的CRA是否比单独使用CM程序产生的治疗结果更好。因此，我们建议将计算机化治疗对治疗结果的贡献分离出来。其次，我们将检查CRA的一个组成部分的有效性，即治疗师提供的治疗目标的便利化和无法计算机化的外展服务(FOS)。FOS的疗效以前没有被检查过。 在这一过程中，我们将解决农村阿片类药物依赖这一鲜为人知的问题。该项目的目的是解决这一严重的公共卫生问题，在佛蒙特州继续开设第一家也是仅有的两家为阿片类药物依赖提供药物治疗的门诊诊所之一。 阿片依赖门诊患者将在两个临床试验中接受丁丙诺啡维持治疗。在第一种治疗中，患者将随机接受两种治疗之一：(1)计算机辅助CRA和CM；或(2)单独使用CM。在第二种治疗中，患者将被随机分为两种治疗方案之一：(1)治疗师提供的FOS加计算机提供的CRA和CM；或(2)计算机提供的CRA和CM。CM程序将在两个试验中同时针对阿片类药物和可卡因戒断。主要结果衡量标准将包括禁欲、艾滋病毒风险行为、保留和成本效益。 总体而言，本研究将为两种为客户关系管理提供服务的方法的有效性提供新的经验信息。这样的信息可能导致更具成本效益的治疗，并促进传播。此外，药物滥用治疗的计算机化可能会对治疗领域产生积极的影响。最后，该项目将通过提供佛蒙特州阿片类药物依赖的所有门诊药物治疗服务的很大一部分，为该地区的公共卫生作出积极贡献。

DESCRIPTION (provided by applicant): In this competing continuation we propose to continue and expand our prior aims. First, we will continue our study of computerized treatment. In a prior trial, computer-delivered Community Reinforcement Approach (CRA) with contingency management (CM) was as effective as therapist-delivered CRA with CM. The design of that study, however, did not indicate whether the computer-delivered CRA produced increases in therapeutic outcomes over that produced by the CM procedures alone. Thus, we propose to isolate the contribution of the computerized treatment to therapeutic outcomes. Second, we will examine the efficacy of a component of CRA, therapist-delivered facilitation of treatment goals and outreach services (FOS) that cannot be computerized. The efficacy of FOS has not been previously examined. In the process, we will address the infrequently acknowledged problem of rural opioid dependence. The aim of this project is to address this serious public health concern by continuing the first and one of only two outpatient clinics providing pharmacotherapies for opioid dependence in the State of Vermont. Opioid-dependent outpatients will receive buprenorphine maintenance across two clinical trials. In the first, patients will be randomized to one of two treatments: (1) computer-delivered CRA along with CM; or (2) CM alone. In the second, patients will be randomized to one of two treatments: (1) therapist-delivered FOS with computer-delivered CRA and CM; or (2) computer-delivered CRA and CM. CM procedures will target both opioid and cocaine abstinence in both trials. Primary outcome measures will include abstinence, HIV-risk behavior, retention and cost-effectiveness. Overall, this research will contribute new empirical information about the efficacy of two approaches of providing CRA with CM. Such information may result in more cost-effective treatment and facilitate dissemination. Moreover, the computerization of substance-abuse treatment may positively impact the treatment field. Finally, this project will contribute positively to this region's public health by providing a substantial portion of all outpatient pharmacotherapy services for opioid dependence in the State of Vermont.