Behavior Therapy Development of Group CM in Methadone Tx

描述（由申请人提供）： 应急管理（CM）干预措施是在药物滥用治疗期间启动和维持药物戒断的最有效方法之一。不幸的是，社区治疗提供者认为这些程序与他们通常的做法不一致，过于昂贵，过于复杂。对治疗提供者的调查已经确定了CM干预的八个方面，他们认为这些干预是令人反感的或与常规护理不一致的：1）CM通常以个人与团体的形式提供; 2）它侧重于有形与社会激励; 3）它只奖励一种与多种行为; 4）当滥用不同药物的患者倾向于在异质组中接受治疗时，通常在其首选滥用药物方面同质的患者组中进行研究; 5）激励成本过高：6）它需要太多的工作人员时间; 7）它需要比诊所能够负担的更频繁的尿液分析; 8）它引起了人们对负面副作用的担忧，例如患者之间的争论。第一阶段研究的目标是确定这些问题中哪些可以合理解决，而不会严重影响干预的有效性。本项目将开发CM组干预措施，并进行3项小N逆转设计试点研究，将检查：a）一个与多个目标行为; B）减少尿液检测频率;以及c）将使用可卡因或苯二氮卓类药物的患者纳入同一组。它还将收集成本数据，以估计与CM干预相关的相对费用，召集当地治疗提供者咨询小组，并结合研究结果使用小组反馈，以指导关于纳入或排除特定CM程序的决策。最后，将收集初步数据，以建立ES，用于随后的应用，该应用将比较组CM治疗与个体CM和标准治疗。到该项目结束时，将完成第一阶段研究的所有产品，这些产品是开发更符合社区治疗提供者需求的集体CM干预所必需的。还将提供关于变革管理干预的重要具体方面的有趣的试点数据（即，目标行为的数量，尿检的频率）。虽然发展这种团体CM干预本身不会导致CM传播的改善，但它是朝着这个方向迈出的关键的第一步。

DESCRIPTION (provided by applicant): Contingency management (CM) interventions are among the most effective methods for initiating and maintaining drug abstinence during drug abuse treatment. Unfortunately, community treatment providers perceive these procedures as being inconsistent with their usual practices, too costly, and too complex. Surveys of treatment providers have identified eight aspects of CM interventions that they find objectionable or inconsistent with usual care: 1) CM has most often been delivered in individual vs. group formats; 2) It has focused on tangible vs. social incentives; 3) It rewards only one vs. multiple behaviors; 4) It often has been studied in groups of patients that are homogenous with respect to their preferred drugs of abuse when patients who are abusing different drugs tend to be treated in heterogeneous groups; 5) The incentive costs are excessive: 6) It requires too much staff time; 7) It requires more frequent urinalysis than clinics can afford; and 8) It raises concerns about negative side-effects such as arguing between patients. The goal of this Stage 1 research is to determine which of these concerns can be reasonably addressed without seriously compromising the efficacy of the intervention. This project will develop a Group CM intervention and conduct 3 small-N reversal design pilot studies that will examine: a) one vs. multiple target behaviors; b) reduced urine testing frequency; and c) including patients using cocaine or benzodiazepines in the same group. It also will collect cost data to estimate the relative expense associated with the CM interventions, convene an advisory panel of local treatment providers, and use panel feedback in combination with the results of studies to guide decision-making regarding the inclusion or exclusion of specific Group CM procedures. Finally, preliminary data will be collected to establish ESs for a subsequent application that will compare the Group CM treatment with Individual CM and standard treatment. By the end of this project, all the products of Stage I research necessary to develop a Group CM intervention that is more consistent with the needs of community treatment providers will have been completed. Interesting pilot data regarding important specific aspects of CM interventions will also be available (i.e., number of behaviors targeted, frequency of urine testing). While developing this Group CM intervention will not by itself result in improved dissemination of CM, it is a critical first step in this direction.