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Acceptance Therapy During Methadone Detoxification

美沙酮戒毒期间的接受治疗

基本信息

批准号：
7256279
负责人：
Angela L Stotts
金额：
$ 31.68万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-09-05 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7256279
关键词：
Abstinence Adaptive Behaviors Address Adherence Affect Agonist Anxiety Attention Behavior Therapy Behavioral Chronic Client Clinic Clinical Cognitive Therapy Collaborations Condition Counseling Data Disease Disease Management Distress Dose Drug Metabolic Detoxication Drug usage Effectiveness of Interventions Emotions Employment Enrollment Esthesia Failure Family Feeling Focus Groups Fright HIV Health Health Professional Health Sciences Hepatitis Hepatitis C Heroin Dependence Individual Intervention Knowledge Legal Life Literature Maintenance Measures Mediating Mediator of activation protein Memory Mental Depression Mental Health Methadone Methods Modeling Opiate Addiction Opiates Outcome Patients Pharmaceutical Preparations Phase Philosophy Phobic anxiety disorder Pilot Projects Procedures Protocols documentation Purpose Randomized Randomized Controlled Trials Rate Relapse Relative (related person)Research Research Personnel Resort Risk Behaviors Staging Substance Use Disorder Symptoms Testing Thinking Training Programs Treatment outcome Week Withdrawal Withdrawal Symptom Work base cost design experience follow-up innovation interest novel pilot trial programs psychologic psychosocial satisfaction size social success theories therapy development treatment effect

项目摘要

DESCRIPTION (provided by applicant): Opiate dependence is a severe and costly societal problem. While methadone maintenance (MM) is effective for managing this disorder, as many as 70% of MM clients are interested in detoxification in order to achieve a drug-free life. To date, however, success rates for opiate detoxification are very low, in part, due to physical and psychological symptoms and fears associated with opiate withdrawal. Few behavior therapies have been developed to promote abstinence during and subsequent to opiate dose reduction and even fewer treatment models have devoted sufficient attention to the distressing experiences specific to methadone withdrawal. A novel behavioral treatment, Acceptance and Commitment Therapy (ACT) is based on the idea that attempts to avoid private experience (thoughts, feelings, memories, bodily sensations) are ubiquitous yet often pathogenic. Given that opiate dependent individuals in detoxification often resort to opiate use to reduce, escape or avoid commonly experienced fear, anxiety, and physical symptoms, ACT seems uniquely applicable to the opiate detoxification experience. By decreasing experiential avoidance during dose reduction, ACT has the potential to significantly increase methadone detoxification success rates. The proposed Stage I research will develop and test an innovative ACT-based opiate detoxification behavioral therapy within the context of a long-term methadone dose reduction program. In Phase 1, investigators will develop the new therapy based on previous ACT protocols, focus groups, and expert knowledge. Phase 2 will consist of a pilot trial to evaluate the ACT-based opiate detoxification therapy. A randomized, controlled, between groups design will be used in which opiate dependent patients (N=70) motivated for detoxification are assigned to one of two treatment conditions: ACT or Drug Counseling. A 4-week stabilization period will precede a 5-month dose reduction period using an inverse exponential dosing strategy, with 1-month follow-up. Behavioral treatments will consist of 24 weekly sessions beginning in stabilization. Specific aims are to test the feasibility and acceptability of ACT for opiate detoxification, to assess patient improvement (e.g., drug use, HIV/Hepatitis C risk behavior, psychosocial functioning), to generate sufficient data to provide a basis for a power analysis, and to evaluate the active mechanisms of change in ACT: experiential avoidance as a mediator of treatment effects and a moderator of the impact of withdrawal symptoms, negative affect and detoxification fear. The work will be conducted using the rigorous procedures of our Treatment Research Clinic (SARC, UT-Health Science Center- Houston) in collaboration with experts in behavior therapy development and the originators of ACT. The research will contribute both theoretically and empirically to a rather sparse literature concerning effective behavior therapy for opiate detoxification. Effective treatment provided in conjunction with detoxification from agonist medication could result in significant decreases in the substantial health and social costs associated with chronic opiate dependence.

描述（由申请人提供）：阿片类药物依赖是一个严重和代价高昂的社会问题。虽然美沙酮维持（MM）是有效的管理这种疾病，多达70%的MM客户有兴趣戒毒，以实现无毒生活。然而，迄今为止，阿片剂戒毒的成功率很低，部分原因是身体和心理症状以及与阿片剂戒断有关的恐惧。很少有行为疗法被开发出来，以促进戒断期间和之后的阿片类药物剂量减少，甚至更少的治疗模式投入了足够的注意力，具体到美沙酮戒断的痛苦经历。一种新的行为治疗，接受和承诺疗法（ACT）是基于这样一种想法，即试图避免私人体验（思想，感觉，记忆，身体感觉）是普遍存在的，但往往是致病的。鉴于阿片类药物依赖者在戒毒过程中经常使用阿片类药物来减少、逃避或避免通常经历的恐惧、焦虑和身体症状，ACT似乎特别适用于阿片类药物戒毒经历。通过减少剂量减少期间的经验性回避，ACT有可能显着提高美沙酮脱毒成功率。拟议的第一阶段研究将在长期美沙酮剂量减少计划的背景下开发和测试一种创新的基于ACT的阿片类药物解毒行为疗法。在第一阶段，研究人员将根据以前的ACT方案，焦点小组和专家知识开发新的治疗方法。第二阶段将包括一项试点试验，以评估以青蒿素为基础的阿片类解毒疗法。将采用随机、对照、组间设计，其中将有戒毒动机的阿片类药物依赖患者（N=70）分配至两种治疗条件之一：ACT或药物咨询。4周的稳定期将在5个月的剂量降低期之前，使用逆指数给药策略，随访1个月。行为治疗将包括从稳定期开始的每周24次治疗。具体目标是测试ACT用于阿片类药物解毒的可行性和可接受性，评估患者的改善情况（例如，药物使用，艾滋病毒/丙型肝炎风险行为，心理社会功能），以产生足够的数据，为功率分析提供基础，并评估ACT变化的积极机制：经验回避作为治疗效果的中介和戒断症状，负面影响和脱毒恐惧的影响的调节器。这项工作将使用我们的治疗研究诊所（SARC，UT健康科学中心-休斯顿）的严格程序，与行为治疗开发专家和ACT的创始人合作进行。这项研究将有助于理论和经验，而稀疏的文献有关有效的行为治疗阿片类药物解毒。有效的治疗与激动剂药物解毒相结合，可大大减少与长期阿片剂依赖有关的大量健康和社会费用。