Enhanced & Attendance Based Prize Contingency Management in Community Setting

描述(由申请人提供)： 在我们的中心评估应急管理(CM)的研究中，我们注意到CM的疗效可能取决于患者在开始治疗时的状态。开始治疗时尿检呈可卡因阳性的患者往往会过早退出治疗，并在治疗期间继续使用。CM干预在减少这一亚组中的药物使用方面是有效的，并且效果是大小相关的。然而，到目前为止，我们只测试了最高250美元的奖金，更大的奖金可能会进一步改善结果。这项提议的目的之一是审查改进的CM程序的效力，在该程序中，在禁欲初期提供更多的获奖频率。从尿样可卡因阳性(N=120)开始治疗的可卡因依赖患者将随机分配到三组中的一组 条件：(A)标准、非CM治疗，(B)标准治疗加CM，预期 赢得约250美元奖金的可能性，或(C)标准治疗加上预期的CM 赢得约560美元奖金的可能性。我们还发现，接受可卡因阴性样本治疗的患者通常在整个治疗过程中都会转移阴性样本，无论他们是否接受了非CM或CM治疗，视戒断情况而定。因此，我们还将进行一项平行研究，以评估在这一亚组中，仅仅加强治疗的出勤率是否会增强保留率并改善长期结果。以尿液样本为阴性的可卡因依赖患者(N=330)将被随机分配到三种情况之一：(A)不含CM的标准治疗或(B)标准治疗加CM，预计可赢得价值约250美元的奖金，视戒毒情况而定；或(D)标准治疗加CM，预计赢得价值约250美元的奖金，取决于参加治疗的情况。总而言之，这些研究将解决低成本和高成本CM手术可能改善可卡因依赖患者预后的条件。

DESCRIPTION (provided by applicant): In our Center research evaluating contingency management (CM) that provides opportunities to win prizes with an average expense of under $250 per patient, we have noted that that the efficacy of CM may be dependent on the status of the individual as they initiate treatment. Patients who begin treatment with a cocaine-positive urinalysis result tend to drop out of treatment prematurely and to continue using while in treatment. CM interventions have been efficacious in reducing drug use in this subgroup, and the effects were magnitude dependent. However, we have thus far only tested up to a maximum of $250 in prizes, and larger magnitudes may further improve outcomes. One purpose of this proposal is to examine the efficacy of an enhanced CM procedure, in which increased frequencies of prize winnings are provided during initial periods of abstinence. Cocaine-dependent patients beginning treatment with a cocaine-positive urine sample (N=120) will be randomly assigned to one of three conditions: (a) standard, non-CM treatment, (b) standard treatment plus CM with an expected probability of winning about $250 in prizes, or (c) standard treatment plus CM with an expected probability of winning about $560 in prizes. We have also found that patients who present to treatment with cocaine-negative samples generally remit negative samples throughout their time in treatment, regardless of whether they received a non-CM or a CM treatment contingent upon abstinence. Thus, we will also conduct a parallel study that will assess whether simply reinforcing attendance at treatment enhances retention and improves long-term outcomes in this subgroup. Cocaine-dependent patients (N=330) initiating treatment with a cocaine-negative urine sample will be randomly assigned to one of three conditions: (a) standard treatment without CM or (b) standard treatment plus CM with an expected probability of winning about $250 worth of prizes contingent upon cocaine abstinence, or (d) standard treatment plus CM with an expected probability of winning about $250 worth of prizes contingent upon treatment attendance. Together, these studies will address the conditions under which lower and higher cost prize CM procedures may improve outcomes of cocaine-dependent patients.