Acceptance Therapy During Methadone Detoxification

描述(由申请人提供)： 鸦片依赖是一个严重且代价高昂的社会问题。虽然美沙酮维持治疗(MM)对控制这种疾病是有效的，但多达70%的MM客户对戒毒感兴趣，以实现无毒品的生活。然而，到目前为止，阿片类药物戒毒的成功率非常低，部分原因是与阿片类药物戒断相关的身体和心理症状以及恐惧。几乎没有开发出行为疗法来促进阿片类药物剂量减少期间和之后的戒断，更少的治疗模型对美沙酮戒断特有的痛苦经历给予了足够的关注。一种新的行为治疗、接受和承诺疗法(ACT)基于这样的想法，即试图避免私人体验(思想、感觉、记忆、身体感觉)是无处不在的，但往往是致病的。鉴于阿片依赖者在戒毒中经常诉诸阿片类药物来减少、逃避或避免常见的恐惧、焦虑和身体症状，ACT似乎是唯一适用于阿片类戒毒体验的方法。通过减少剂量减少期间的经验回避，ACT有可能显著提高美沙酮脱毒成功率。 拟议的第一阶段研究将在美沙酮长期剂量减少计划的背景下开发和测试一种创新的基于ACT的阿片类药物戒毒行为疗法。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疗法。第二阶段将包括一项试点试验，以评估基于ACT的阿片类药物戒毒疗法。将使用随机、对照、组间设计，将有戒毒动机的阿片依赖患者(N=70)分配到两种治疗条件之一：ACT或药物咨询。4周的稳定期将先于5个月的剂量减少期，使用反向指数剂量策略，并进行1个月的随访。行为治疗将包括每周24次的治疗，从稳定开始。具体目的是测试ACT用于阿片类药物戒毒的可行性和可接受性，评估患者改善情况(例如，药物使用、艾滋病毒/丙型肝炎危险行为、心理社会功能)，产生足够的数据，为功率分析提供基础，并评估ACT的积极变化机制：经验回避是治疗效果的中介因素，也是戒断症状、负面情绪和戒毒恐惧影响的调节因素。 这项工作将使用我们的治疗研究诊所(SARC，德克萨斯大学健康科学中心-休斯顿)的严格程序，与行为治疗开发专家和ACT的发起人合作进行。这项研究将从理论和经验两个方面为有关阿片类药物戒毒的有效行为疗法的稀少文献做出贡献。有效的治疗结合兴奋剂药物的戒毒可大大降低与慢性阿片类药物依赖相关的大量健康和社会成本。

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.