Abstinence Linked Money Management

描述（由申请人提供）：精神疾病残疾人经常使用可卡因，由于他们的脆弱性，受到伤害，但很少有基于证据的治疗方法。我们寻求更新和延长我们的第二阶段赠款，以测试一种以资金管理为基础的治疗方法的有效性，这种治疗方法针对可卡因的使用，称为顾问-出纳员资金管理器（首字母缩写为ATM）。ATM涉及将现金用于可卡因的倾向重新定向为用于基本需求和与禁欲有关的活动，方法是：1）储存客户资金; 2）围绕资金管理和实现禁欲进行培训; 3）为指定的计划和目标分配资金。在这项研究中，ATM治疗师将为客户提供两种额外的工具，以帮助他们防止将钱转移到毒品上首先，选择要求一个代表性的收款人来帮助限制滥用，其次，开发练习以帮助双重诊断的人避免复发。在我们迄今为止对使用可卡因和/或酒精的参与者的研究中，分配到ATM的参与者在可卡因使用的某些措施中表现出显着更大的减少，并且参加了比分配到控制干预的参与者更多的药物滥用治疗组。尽管早期的证据表明ATM的有效性，但ATM的传播受到了限制，因为要求提供ATM的站点具有处理客户支票和分配资金的会计专业知识-在拟议的研究中，将使用一种更可出口的ATM形式，其中一名中央会计师管理三个卫星站点的治疗师的账户。招募来自多个站点的近期可卡因使用者将解决先前针对双重诊断的ATM和其他干预措施的研究的另一个限制，即招募异质样本。在几个研究中心招募更同质的人群将提供足够的把握度来最终确定ATM对可卡因使用的疗效，并对中介和调节效应进行二次分析。在一项为期36周的三个地点的试验中，120名接受SSI或SSDI的人，在60天内使用过可卡因，并参加了门诊精神病治疗，他们将被随机分配到ATM或药物咨询，这是在Coastal合作研究中测试的标准化可卡因滥用治疗之一。将进行随访评估，直至第52周。主要药物滥用结局将是可卡因代谢物尿液毒理学试验阴性的周数比例，主要资金管理结局将是自我评定的资金管理不善。进一步的分析将确定可卡因使用的减少是否是通过节省的余额、参加门诊治疗的天数或指定代表性收款人来介导的。主持人分析将检查精神病诊断，网站和同时使用酒精和/或大麻的作用。ATM有可能成为这些难以治疗的客户的标准精神病护理的广泛应用的补充，更广泛地说，是一种基于资金管理的治疗，可以应用于其他情况，如代表性收款人安排。 公共卫生相关性：使用可卡因和患有致残性精神疾病的人可能会受益于一种治疗，这种治疗可以帮助他们更好地管理自己的钱，这样就不会把钱花在可卡因上。这项临床试验将确定基于金钱管理的治疗是否比标准药物咨询更有效地减少可卡因的使用。

DESCRIPTION (provided by applicant): People disabled by psychiatric illness often use cocaine and because of their vulnerability, are harmed by it, but there are few evidence-based treatments for them. We seek a renewal and extension of our Stage 2 grant to test the efficacy of a money management-based therapy targeting cocaine use called Advisor-Teller Money Manager (the acronym is ATM). ATM involves re-directing the tendency to spend cash on cocaine to spending on basic needs and abstinence-related activities by 1) storage of client funds; 2) training around money management and around achieving abstinence and; 3) allocating money for specified plans and goals. ATM therapists in the proposed study will offer clients two additional tools to help them prevent diversion of money to drugs-first, the option of requesting a representative payee to help restrain misspending and second, exercises developed to help dually diagnosed people avoid relapsing. In our studies to date of participants who used cocaine and/or alcohol, participants assigned to ATM showed significantly greater reductions in some measures of cocaine use and attended more substance abuse treatment groups than participants assigned to the control intervention. Despite early evidence of efficacy, ATM's dissemination has been limited by the requirement that sites offering ATM have the accounting expertise to handle client checks and dispense their funds -- in the proposed study, a more exportable form of ATM will be utilized in which a central accountant manages accounts for therapists at three satellite sites. Enrollment of recent cocaine users from multiple sites will address another limitation of previous studies of ATM and other interventions for the dually diagnosed, namely, the enrollment of heterogeneous samples. Enrollment of a more homogeneous population at several sites will provide sufficient power to conclusively determine ATM's efficacy for cocaine use and conduct secondary analyses of mediation and moderator effects. In a 36-week, three-site trial, 120 people who receive SSI or SSDI, have used cocaine within 60 days and are enrolled in outpatient psychiatric treatment will be randomly assigned to either ATM or Drug Counseling, one of the standardized cocaine abuse treatments tested in the Cocaine Collaborative Study. Follow-up assessments will be conducted until week 52. The primary sub- stance abuse outcome will be the proportion of weeks with urine toxicology tests negative for cocaine metabolite and the primary money management outcome will be self-rated money mismanagement. Further analyses will determine whether a reduction in cocaine use is mediated by balance saved, days attending outpatient treatment or assignment of a representative payee. Moderator analyses will examine the role of psychiatric diagnosis, site and concurrent use of alcohol and/or cannabis. ATM has the potential to be a widely-applied addition to standard psychiatric care for these hard-to-treat clients and is, more broadly, a money management-based therapy that can be applied to other situations such as representative payee arrangements. PUBLIC HEALTH RELEVANCE: People who use cocaine and have disabling mental illnesses may benefit from a therapy that helps them manage their money better so it is not spent for cocaine. This clinical trial will determine whether a money management-based therapy is more effective in reducing cocaine use than standard drug counseling.