Contingency Management for the Treatment of Co-Occurring Alcohol and Opiate Use

处方阿片类药物滥用与酒精依赖密切相关，这两种情况都会对美国印第安人(Al)社区造成不成比例的伤害。应急管理(CM)是一种旨在增加药物戒断的行为干预措施，在许多研究中，这与减少阿片类药物的使用有关。CM在治疗1)酒精使用障碍；2)多物质使用障碍；以及3)土著人口方面尚未得到充分研究。之前对CM酒精依赖的研究使用了酒精呼气测试，这种测试只能在12小时内检测到使用情况。由于呼吸测试不能检测临床评估之间的使用情况，它们的使用导致干预措施的交付不一致。我们提出了一项研究，将通过使用基于高级酒精测量的CM范式来解决这一关键的方法障碍，即乙基葡萄糖醛酸苷尿检，它可以在酒精使用发生后2天或更多天检测到。 这项研究的目标是进行一项随机对照试验，以评估针对文化定制的CM干预在2个保留地的Al部落成员中增加酒精和阿片类药物戒断的能力。蒙大拿州的佩克堡和华盛顿州的奎诺。有酒精依赖和处方阿片滥用的寻求治疗的个人将被随机分成4组中的1组，这些组将复发： (1)酒精为CM，(2)鸦片为CM。(3)两种物质均为CM，或(4)两种物质均不使用CM。我们的目标是确定(1)随机进入CM条件的参与者是否比非偶然(NC)对照组的参与者使用更少的酒精和阿片类药物，(2)与单一物质CM组或NC对照组的参与者相比，对于同时接受CM戒酒和阿片类药物戒断的参与者，干预是否更有效。(3)二次成瘾相关结局和酒精和阿片类药物相关健康损害行为的组间差异。这项拟议的研究具有创新性，具有改善公共卫生的潜力。通过与部落社区合作来适应、实施和评估这项试验，我们将增加我们的部落合作伙伴对循证成瘾治疗和研究的知识，同时改善他们对Al社区成瘾干预的信任。

Prescription opiate drug misuse is strongly associated with alcohol dependence, and both conditions cause disproportionate harm to American Indian (Al) communities. Contingency management (CM) is a behavioral intervention designed to increase drug abstinence that has been associated with reduced opiate use in a number of studies. CM is understudied in the treatment of 1) alcohol use disorders; 2) polysubstance use disorders; and 3) Native populations. Previous studies of CM for alcohol dependence have used alcohol breath tests that are capable of detecting use for only 12 hours. Because breath tests cannot detect use between clinical assessments, their use leads to inconsistent delivery of interventions. We propose a study that will address this critical methodological barrier by using a CM paradigm based on a superior alcohol measure, ethyl glucuronide urine tests, which can detect alcohol use 2 or more days after it has occurred. The goal of this study is to perform a randomized, controlled trial to evaluate the ability of a culturally-tailored CM intervention to increase alcohol and opiate abstinence among Al tribal members from 2 reservations. Fort Peck in Montana and Quinault in Washington State. Treatment-seeking individuals with alcohol dependence and prescription opiate misuse will be randomized into to 1 of 4 groups that will recelive: (1) CM for alcohol, (2) CM for opiates. (3) CM for both substances, or (4) no CM for either substance. We aim to determine (1) whether participants randomized to CM conditions use less alcohol and opiates than those in the noncontingent (NC) control group, (2) whether the intervention is more effective for participants receiving CM for both alcohol and opiate abstinence, compared to participants in the single-substance CM groups or the NC control group. (3) group differences in secondary addiction-related outcomes and alcoholand opiate-associated health-Impairing behaviors. The proposed research Is innovative and has the potential to improve public health. By partnering with tribal communities to adapt, implement, and evaluate this trial, we will increase our tribal partners' knowledge of evidence-based addiction treatments and research, while improving their trust for addiction interventions in Al communities.