Behavioral Activation and HIV Risk Reduction for MSM with Crystal Meth Abuse

滥用冰毒的 MSM 的行为激活和 HIV 风险降低

• 批准号: 8069443
• 负责人: Matthew James Mimiaga
• 金额: $ 34.07万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8069443
• 关键词: Amphetamine Abuse; Anal Sex; Anhedonia; Attention; Behavior; Behavior Therapy; Behavioral; Clinic; Complex; Counseling; DSM-IV; Data; Dependence; Depressed mood; Diagnosis; Distress; Drug abuse; Drug usage; Event; Evidence based treatment; Feeling; Funding; Goals; Grant; HIV; HIV Infections; HIV therapy; HIV/STD; Hobbies; Individual; Intervention; Learning; Life; Mediator of activation protein; Mental Depression; Mental Health; Methamphetamine; Modeling; Moods; Motivation; National Institute of Drug Abuse; Outcome; Participant; Pharmaceutical Preparations; Professional counselor; Psychological reinforcement; Randomized; Randomized Controlled Trials; Refractory; Reporting; Research; Resistance; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Safety; Severities; Sex Behavior; Testing; Training; Treatment Efficacy; Unsafe Sex; Work; arm; base; depressive symptoms; evidence base; experience; follow-up; improved; innovation; interest; intervention effect; meetings; men who have sex with men; non-drug; novel; pleasure; primary outcome; programs; secondary outcome; sex; sex risk; skills; therapy design

DESCRIPTION (provided by applicant): Problematic crystal methamphetamine ("meth") use is a prevalent and treatment refractory problem in MSM, and highly associated with HIV sexual risk behavior. This is an application to conduct a pilot randomized controlled trial (RCT) of a behavioral intervention to reduce high risk sex in MSM with meth abuse/dependence who are at risk for HIV acquisition. The intervention incorporates state of the art behavioral risk reduction counseling with behavioral activation therapy (BAT) to help participants re-engage in enjoyable and meaningful life activities not involving drugs. Behavioral activation is an evidence-based treatment for depression that focuses on helping individuals reengage in activities that generate feelings of mastery and pleasure. We chose this strategy for MSM who abuse meth because our formative work revealed that MSM who abuse meth report becoming unable to enjoy activities that they previously enjoyed as a result of ongoing meth use. This lack of enjoyment (anhedonia) in activities that do not involve meth use or sex contributes to the continued use of meth and potentially unsafe sex. The intervention approach was developed and piloted through a NIDA-funded R03, and the proposed pilot RCT is the next logical step in testing this approach. Overview: Building on our prior R03, this is a two-arm pilot RCT of BAT and HIV risk reduction counseling for MSM with meth abuse/dependence. Conceptual Model: The conceptual model focuses on anhedonia (a loss of interest in previously enjoyed activities) as a consequence of continued meth use. Accordingly, for individuals who abuse meth, drug use becomes the central means for (or the only means for) obtaining enjoyment. We hypothesize that an intervention targeting both sexual risk reduction and increasing safe, pleasurable goal-directed activities via BAT will contribute to increased intervention efficacy and, thus, reductions in unprotected sex and meth use. The hypothesized mechanism of action is that behavioral activation will re-engage participants in pleasurable non-drug use activities (e.g., interests or hobbies that were enjoyable before meth use) that will serve as a natural reinforcement for functional behavior, improve depressed mood when not on meth by experiencing increases in pleasure and mastery, and decrease overall distress so that MSM who abuse meth can better benefit from HIV risk reduction counseling. Research Plan Overview: MSM who are HIV-uninfected and meet DSM-IV criteria for a diagnosis of meth (amphetamine) abuse/dependence will be randomized. The two arms include (1) "BAT-RR", behavioral activation therapy and risk reduction counseling which lasts 10 sessions; and (2) the comparison condition, the equivalent risk reduction counseling only for 2 sessions. Participants will be followed for 6 months post-randomization. Main outcomes include sexual risk (primary) and meth use (secondary). Additional secondary outcomes include increases in pleasurable (but safe) activities, increases in HIV information, motivation re: sexual safety, and behavioral skills, decreases in depressive symptoms severity, and decreases in polysubstance use. PUBLIC HEALTH RELEVANCE: Problematic crystal meth use is a prevalent and treatment resistant-problem in men who have sex with men (MSM) domestically, and is highly associated with HIV risk behavior and HIV infection. The present study aims to test a novel treatment for crystal meth use in MSM, incorporating behavioral activation therapy with HIV risk reduction counseling. This approach may be more potent than traditional drug abuse counseling as our preliminary data suggest that MSM who abuse crystal have stopped receiving pleasure from previously enjoyed activities, and behavioral activation therapy involves re-engaging participants in functional and enjoyable activities. If the current RCT pilot is effective at reducing HIV acquisition risk behavior and crystal meth use, in the next grant (NIDA R01) we will work on a combined dissemination and efficacy study- conducting the intervention in drug abuse treatment clinics for MSM, and delivered by drug abuse counselors.

描述（由申请人提供）：甲基苯丙胺（“冰毒”）使用问题是MSM中普遍存在的难治性问题，与HIV性风险行为高度相关。这是一项申请，旨在进行一项行为干预的试点随机对照试验（RCT），以减少有HIV感染风险的甲基苯丙胺滥用/依赖的MSM的高风险性行为。该干预措施将最先进的行为风险降低咨询与行为激活疗法（BAT）相结合，以帮助参与者重新参与不涉及药物的愉快和有意义的生活活动。行为激活是一种基于证据的抑郁症治疗方法，专注于帮助个人重新参与产生掌控感和快乐感的活动。我们选择这种策略的男男性接触者滥用冰毒，因为我们的形成性工作显示，男男性接触者滥用冰毒的报告成为无法享受活动，他们以前享受的结果是持续使用冰毒。在不涉及使用冰毒或性的活动中缺乏享受（快感缺失）导致继续使用冰毒和潜在的不安全性行为。干预方法是通过NIDA资助的R 03开发和试点的，拟议的试点RCT是测试这种方法的下一个合乎逻辑的步骤。概述：在我们之前的R 03的基础上，这是一项针对甲基苯丙胺滥用/依赖的MSM的BAT和HIV风险降低咨询的双臂试点RCT。概念模型：概念模型侧重于快感缺乏（对以前喜欢的活动失去兴趣）作为持续使用冰毒的结果。因此，对于滥用冰毒的人来说，吸毒成为获得享受的主要手段（或唯一手段）。我们假设，通过BAT针对性风险降低和增加安全，愉快的目标导向活动的干预措施将有助于提高干预效果，从而减少无保护性行为和冰毒的使用。假设的作用机制是，行为激活将使参与者重新参与愉快的非药物使用活动（例如，兴趣或爱好是令人愉快的前甲基使用），这将作为一个自然的功能性行为的强化，改善抑郁情绪时，不对甲基通过体验增加快乐和掌握，并减少整体的痛苦，使男男性接触者滥用甲基可以更好地受益于艾滋病毒风险降低咨询。研究计划概述：未感染艾滋病毒且符合DSM-IV冰毒（安非他明）滥用/依赖诊断标准的MSM将被随机分组。两组包括（1）“BAT-RR”，行为激活疗法和风险降低咨询，持续10次;（2）对照条件，等效风险降低咨询仅持续2次。将在随机化后对受试者进行6个月的随访。主要结果包括性风险（主要）和冰毒使用（次要）。其他次要结果包括增加愉快（但安全）的活动，增加艾滋病毒信息，动机重新：性安全和行为技能，抑郁症状严重程度降低，并减少多种物质的使用。 公共卫生关系：冰毒使用问题是国内男男性行为者（MSM）中普遍存在的治疗抵抗问题，并且与HIV风险行为和HIV感染高度相关。本研究的目的是测试一种新的治疗MSM使用冰毒，将行为激活疗法与艾滋病毒风险降低咨询。这种方法可能比传统的药物滥用咨询更有效，因为我们的初步数据表明，滥用水晶的MSM已经停止从以前喜欢的活动中获得快乐，行为激活疗法涉及重新参与功能和愉快的活动。如果目前的随机对照试验在减少艾滋病毒感染风险行为和冰毒使用方面是有效的，在下一次拨款（NIDA R 01）中，我们将进行一项联合传播和疗效研究-在药物滥用治疗诊所对MSM进行干预，并由药物滥用咨询师提供。