Healthy Activities for Prize Incentives (HAPI)

描述（由申请人提供）：应急管理（CM）干预措施在加强治疗保留和减少药物使用方面非常有效。越来越多的证据表明，这些治疗方法可以改变各种行为，包括与健康有关的体育活动。体育活动对减少抑郁和改善健康有有益的作用。我们有试点数据表明，在CM治疗期间，与不进行锻炼的药物滥用患者相比，进行锻炼以获得强化的药物滥用结果有所改善。在这个第一阶段治疗开发项目中，我们计划开发、形式化并得出CM治疗的效应大小估计，该治疗的重点是改善健康，特别是与增加低强度体育活动（如散步、阻力训练和拉伸）有关。健康活动奖励（HAPI）干预措施将针对参加艾滋病毒救助中心的艾滋病毒阳性药物滥用者，并在他们中进行测试。在对9名患者进行了1a阶段的初步治疗后，将对治疗手册和材料进行调整和完善。在一项Ib期对照试验中，我们将招募并随机分配50名药物滥用hiv阳性患者(a) HAPI加12步促进治疗或(b) CM戒断加12步促进治疗。每项干预将包括每周一次的单独治疗，持续16周。所有参与者每周将提供两次尿液和呼吸样本，以检测阿片类药物、兴奋剂、大麻和酒精。两种情况下的患者都将有机会赢得提交药物阴性标本的奖品，而那些随机分配到HAPI条件的患者也将有机会赢得参与健康活动的奖品。将在治疗前、治疗后2个月和4个月（治疗后）测量身体活动水平、药物使用、心理症状和主观和客观健康指标（体重指数、腰围、血压、病毒载量），并在7个月（治疗后3个月）进行随访评估。与接受CM的12步促进戒毒相比，我们预计HAPI条件下的患者将参加更多的体育活动，更大程度上减少吸毒，抑郁症的减少，并显示出健康指数改善的趋势。如果在所有领域中至少注意到小到中等范围的效应量，我们将考虑在2期治疗开发研究中进一步评估该治疗。

DESCRIPTION (provided by applicant): Contingency management (CM) interventions are highly efficacious in enhancing retention in treatment and reducing drug use. Growing evidence suggests these treatments can be adapted to alter a variety of behaviors, including health-related physical activities. Physical activity has beneficial effects on reducing depression and improving health. We have pilot data suggesting that drug abusing patients who engage in exercise to earn reinforcement have improved drug abuse outcomes relative to those who do not engage in exercise during CM treatments. In this Stage 1 therapy development project, we plan to develop, formalize, and derive effect size estimates of a CM therapy that focuses on improving health, especially as related to increasing low intensity physical activities, such as walking, resistance training, and stretching. The Healthy Activities for Prize Incentives (HAPI) intervention will be targeted toward and tested within HIV-positive substance abusers who attend HIV drop-in centers. After initial therapy development in a Stage 1a pilot project with 9 patients, the therapy manuals and materials will be adapted and refined. In a Stage Ib controlled trial, we will recruit and randomize 50 substance abusing HIV-positive patients to (a) HAPI plus 12-step facilitation therapy or (b) CM for abstinence plus 12-step facilitation therapy. Each intervention will consist of one weekly individual therapy session for 16 weeks. All participants will provide urine and breathe specimens twice weekly that will be tested for opioids, stimulants, marijuana and alcohol. Patients in both conditions will earn the chance to win prizes for submitting drug-negative specimens, and those randomized to the HAPI condition will also earn the chance to win prizes for engaging in healthy activities. Physical activity levels, drug use, psychological symptoms, and subjective and objective indicators of health (body mass index, waist circumference, blood pressure, viral load) will be measured pre-treatment and at months 2 and 4 (post- treatment), as well as at a 7-month (3 months after treatment) follow-up evaluation. Compared to that receiving 12-step facilitation with CM for abstinence, we expect that those in the HAPI condition will participate in more physical activities, decrease drug use to a greater extent, evidence reduced depression, and show trends toward improvements in health indices. If effect sizes in at least the small to medium range are noted across all domains, we will consider the therapy appropriate for further evaluation in a Stage 2 therapy development study.