Abstinence Linked Money Management

禁欲相关资金管理

• 批准号: 7898870
• 负责人: Marc I Rosen
• 金额: $ 48.66万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7898870
• 关键词: Abstinence; Accounting; Address; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Award; Budgets; Cannabis; Client; Clinic; Clinical Trials; Cocaine; Cocaine Abuse; Cocaine Users; Community Mental Health Centers; Complement; Contracts; Control Groups; Counseling; Cues; Deposition; Diagnosis; Disabled Persons; Enrollment; Equilibrium; Evidence based treatment; Exercise; Expenditure; Fostering; Funding; Goals; Grant; Individual; Intervention; Learning; Link; Measures; Mediating; Mediation; Mediator of activation protein; Mental disorders; Mentally Ill Persons; Motivation; Outcome; Outpatients; Paper; Participant; Patient Self-Report; Persons; Pharmaceutical Preparations; Population; Procedures; Psychiatric Diagnosis; Psychiatric therapeutic procedure; Publications; Randomized; Randomized Clinical Trials; Recruitment Activity; Relapse; Resources; Role; Sampling; Site; Specific qualifier value; Staging; Substance abuse problem; Symptoms; Testing; Therapeutic; Time; Toxicology; Training; Translating; Urine; Veterans; acronyms; alcohol abstinence; base; cocaine use; cost effectiveness; drug standard; efficacy testing; follow up assessment; high risk; improved; meetings; payment; prevent; public health relevance; substance abuse treatment; tool; treatment effect

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.

描述（由申请人提供）：因精神疾病而致残的人经常使用可卡因，并且由于他们的脆弱性，受到可卡因的伤害，但针对他们的循证治疗很少。我们寻求更新和延长第二阶段拨款，以测试针对可卡因使用的资金管理疗法（称为 Advisor-Teller Money Manager，缩写为 ATM）的疗效。 ATM 涉及通过 1) 储存客户资金，将现金花在可卡因上的倾向重新引导到花在基本需求和禁欲相关活动上的支出； 2) 围绕资金管理和实现节制进行培训； 3）为指定的计划和目标分配资金。在拟议的研究中，ATM 治疗师将为客户提供两种额外的工具，帮助他们防止资金被转移到毒品上——首先，可以选择请求代表收款人来帮助限制支出；其次，开发练习来帮助双重诊断的人避免旧病复发。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 的参与者与分配到对照干预的参与者相比，在某些可卡因使用指标上显示出显着更大的减少，并且参加了更多的药物滥用治疗组。尽管有早期证据证明其有效性，但 ATM 的传播仍受到限制，因为提供 ATM 的站点必须具备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为三个卫星站点的治疗师管理账户。从多个地点登记最近的可卡因使用者将解决先前 ATM 研究和双重诊断的其他干预措施的另一个限制，即异质样本的登记。在多个地点登记更同质的人群将提供足够的力量来最终确定 ATM 对可卡因使用的功效，并对中介和调节效应进行二次分析。在一项为期 36 周的三中心试验中，120 名接受 SSI 或 SSDI、在 60 天内使用过可卡因并参加门诊精神科治疗的患者将被随机分配到 ATM 或药物咨询，这是可卡因合作研究中测试的标准化可卡因滥用治疗之一。后续评估将持续到第 52 周。主要的药物滥用结果将是尿液毒理学测试可卡因代谢物呈阴性的周数比例，主要的资金管理结果将是自评资金管理不善。进一步的分析将确定可卡因使用量的减少是否是通过节省余额、参加门诊治疗的天数或指定受款人代表来调节的。主持人分析将检查精神科诊断、地点以及同时使用酒精和/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科护理的广泛应用的补充，更广泛地说，它是一种基于资金管理的疗法，可以应用于其他情况，例如代表收款人安排。 公共卫生相关性：使用可卡因并患有致残性精神疾病的人可能会受益于帮助他们更好地管理金钱的治疗，这样他们就不会把钱花在可卡因上。这项临床试验将确定基于资金管理的疗法是否比标准药物咨询更有效地减少可卡因使用。