Abstinence Linked Money Management

描述（由申请人提供）：因精神疾病致残的人经常使用可卡因，由于他们的脆弱性，因此受到伤害，但很少有针对他们的循证治疗方法。我们寻求第二阶段拨款的续期和延期，以测试一种针对可卡因使用的基于资金管理的疗法的疗效，这种疗法被称为Advisor-Teller money Manager（缩写为ATM）。自动取款机通过将客户资金储存起来，将把现金花在可卡因上的倾向重新导向基本需求和与禁欲有关的活动；2)关于金钱管理和禁欲的培训；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，以帮助他们防止资金被转移到毒品上——第一，要求有代表性的收款人的选择，以帮助限制滥用；第二，开发练习，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，与分配到控制干预组的参与者相比，分配到ATM组的参与者在某些措施上明显更大幅度地减少了可卡因的使用，并且参加了更多的药物滥用治疗组。尽管早期的有效性证据，ATM的传播一直受到限制，要求提供ATM的网站具有会计专业知识来处理客户支票和分配他们的资金——在提议的研究中，一种更可出口的ATM形式将被利用，其中中央会计师为三个卫星站点的治疗师管理账户。纳入来自多个地点的近期可卡因使用者将解决先前对双重诊断的ATM和其他干预研究的另一个限制，即纳入异质样本。在几个地点登记一个更均匀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，并对调解和调节效应进行二次分析。在一项为期36周的三地点试验中，120名接受SSI或SSDI治疗的人，在60天内使用过可卡因，并在门诊精神病治疗中登记，他们将被随机分配到ATM或药物咨询组，这是可卡因合作研究中测试的标准化可卡因滥用治疗方法之一。后续评估将进行到第52周。药物滥用的主要结果是尿液毒理学检测可卡因代谢物呈阴性的周数所占的比例，而主要的金钱管理结果将是自我评定的金钱管理不善。进一步的分析将确定减少可卡因使用是否通过节省余额、参加门诊治疗的天数或指定有代表性的收款人来调解。调节分析将检查精神病诊断、酒精和/或大麻的使用地点和同时使用的作用。ATM有可能成为标准精神护理的一种广泛应用的补充，用于这些难以治疗的客户，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，如代表性的收款人安排。

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.