Four Models of Telephone Support for Stimulant Recovery

描述（由申请人提供）： 继续发展和完善有经验支持的干预措施，以增加对治疗后善后护理的参与，促进持续戒除非法药物使用，是成瘾领域的一个优先事项。药物滥用干预的典型模式是密集的“治疗”期，然后是不太密集、定义不明确的“善后”期。参与强化治疗阶段的患者经常表现出减少或完全戒断目标药物和其他药物的使用。然而，当治疗强度降低在善后期间，复发和复吸是常见的。为了使药物滥用治疗达到长期戒断的预期效果，必须制定战略，提高疗后护理和（或）连续护理方法的有效性。此外，这种干预措施必须费用低廉，相对容易实施，以便能够移植到“真实的世界”的社区方案环境中。我们将开发和比较四种低成本的，电话支持协议的患者谁已经完成了结构化的，门诊兴奋剂滥用治疗协议的强化阶段的疗效。参与者将是500名成功完成4个月矩阵门诊模型的兴奋剂滥用治疗的患者。然后，他们将被随机分配到五种善后咨询条件之一（每个条件n=100）：（1）非结构化/非指示性，（2）非结构化/指示性，（3）结构化/非指示性，（4）结构化/指示性，或（5）标准转诊至善后护理，无需电话咨询（对照）。这两个结构化的条件是基于行为“提示”确定的Farabee等人。（2002年）与药物回避。在非指导性条件下，患者将陈述自己的目标以及他们打算如何实现这些目标。在指导条件中，辅导员将提供具体建议，以采取尽可能多的药物避免活动。某些患者的人格特质或风格也将进行评估，他们可能与电话咨询方面的相互作用。将在完成初级治疗后6个月和12个月跟踪结局，并将包括对药物回避活动（包括善后护理参与）参与情况的测量，以及对药物使用和相关亲社会行为变化的自我报告和客观测量。

DESCRIPTION (provided by applicant): The continuing development and refinement of empirically supported interventions to increase participation in post-treatment aftercare and promote sustained abstinence from illicit drug use is a priority for the addictions field. Typical models of drug abuse intervention have intensive periods of "treatment" followed by a less intensive, poorly defined "aftercare" period. Frequently, patients involved in the intensive phase of treatment show a reduction in, or complete abstinence from, the target and other drug use. However, when the treatment intensity is decreased during the aftercare period, relapse and readdiction are common. For drug abuse treatment to provide the desired result of long-term abstinence, it is important to develop strategies that will enhance the effectiveness of aftercare and/or continuity-of-care approaches. Moreover, such interventions must be inexpensive and relatively easy to implement to be portable to the "real world" setting of community-based programs. We will develop and compare the efficacy of four low-cost, telephone support protocols for patients who have completed the intensive phase of a structured, outpatient stimulant abuse treatment protocol. Participants will be 500 patients who have successfully completed the 4-month Matrix Outpatient Model of stimulant abuse treatment. They will then be randomly assigned to one of five aftercare-counseling conditions (each with n=100): (1) unstructured/non-directive, (2) unstructured/directive, (3) structured/non-directive, (4) structured/directive, or (5) standard referral to aftercare without telephone counseling (control). The two structured conditions are based on the behavioral "prompts" identified by Farabee et al. (2002) as being associated with drug avoidance. In the non-directive conditions, patients will state their own goals and how they intend to achieve them. In the directive conditions, the counselor will provide specific recommendations for the adoption of as many drug-avoidance activities as possible. Certain patient personality traits or styles will also be assessed for their possible interaction with the telephone counseling dimensions. Outcomes will be tracked at 6 and 12 months following completion of primary treatment and will include measurement of participation in drug-avoidance activities (including aftercare participation), as well as self-reported and objective measures of substance use and associated prosocial behavior change.