The Therapeutic Workplace Intervention in Community Settings.

社区环境中的工作场所治疗干预。

• 批准号: 8443693
• 负责人: Sigurdur Oli Sigurdsson
• 金额: $ 11.16万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE COUNTY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8443693
• 关键词: AIDS/HIV problem; Abstinence; Address; Adult; Aftercare; Alcohols; American; Amphetamines; Businesses; Cessation of life; Chronic; Chronic Disease; Clinical Trials; Cocaine; Cocaine Dependence; Collection; Communities; Conceptions; Control Groups; Crack Cocaine; Data; Development; Disease; Drug Addiction; Drug abuse; Drug usage; Effectiveness; Employee; Employment; Employment Terminations; Enrollment; Evaluation; Exposure to; Feedback; Future; Grant; Guidelines; HIV; HIV risk; Heroin Dependence; Housing; Income; Individual; Injection of therapeutic agent; Intervention; Laboratories; Manuals; Marijuana; Measures; Methadone; Methods; Modeling; Monitor; Nature; Occupations; Opiates; Participant; Pathway interactions; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Procedures; Provider; Psychological reinforcement; Randomized; Relapse; Research; Research Infrastructure; Resistance; Risk; Risk Behaviors; Safety; Sampling; Schedule; Secure; Series; Services; Sex Behavior; Societies; Staging; Substance abuse problem; System; Testing; Therapeutic; Therapeutic community technique; Time; Training Support; Transportation; United States; Urine; Work; Workplace; alcohol testing; base; cocaine use; community intervention; community setting; contingency management; cost; drug abstinence; drug abuser; drug testing; effective therapy; hazard; novel; public health relevance; response; skills; treatment as usual; voucher

DESCRIPTION (provided by applicant): Drug addiction is a chronic disorder characterized by excessive drug use that persists over years and often until death. We propose to evaluate a novel method for implementing a highly effective and potentially practical intervention for cocaine addiction to maintain long-term drug abstinence. Our application focuses on methadone patients who use injection or crack cocaine because of their increased risk of acquiring or transmitting HIV through injection or drug-related sexual behavior. Methadone is effective for heroin addiction, but many methadone patients continue to use cocaine. High magnitude and long-duration voucher-based abstinence reinforcement is one of the most effective treatments for drug addiction and can maintain cocaine abstinence over extended periods of time, but practical methods of implementing this intervention are needed. Our research on a model Therapeutic Workplace has shown that employment-based abstinence reinforcement, in which participants must provide drug-free urine samples to access the workplace and maintain maximum pay, can maintain cocaine abstinence and reduce drug-related HIV risk behaviors over extended time periods. Our next challenge is to disseminate employment-based reinforcement for the treatment of drug addiction. We propose to develop, manualize, and pilot test a community-friendly Therapeutic Workplace intervention that can be implemented widely throughout the US and elsewhere. To test the Community Therapeutic Workplace intervention, we will conduct a randomized pilot study. Methadone patients who use injection or crack cocaine during methadone treatment will be invited to participate (N = 58) and randomly assigned to one of two groups: Usual Care (control) group or Community Therapeutic Workplace group. As in our prior implementations of the Therapeutic Workplace intervention, Community Therapeutic Workplace participants will enroll in Phase 1 to initiate drug abstinence and acquire job skills. Participants who initiate abstinence and acquire job skills in Phase 1 will be hired into community workplaces with collaborating employers in Phase 2. During Phase 2, employment-based abstinence reinforcement contingencies will be implemented using existing infrastructure and procedures for workplace drug and alcohol testing overseen by the US Department of Transportation. Using this system, a national provider of Drug-Free Workplace Services will arrange random drug testing and employment-based abstinence reinforcement contingencies in which employees will be required to remain drug-free to maintain employment. We will pilot-test the manual and revise in response to feedback from staff, participants, and employers. The study will provide vital information on the acceptability of the intervention to participants and employers, and provide preliminary data on the effectiveness of our procedures to maintain abstinence and promote employment. The data we collect in this study will be crucial to inform future larger-scale studies on the effectiveness of the Community Therapeutic Workplace intervention to maintain long-term drug abstinence and to reduce drug-related HIV risk behaviors.]

描述（由申请人提供）：药物成瘾是一种慢性疾病，其特征是过度使用药物，持续多年，通常直至死亡。我们建议评估一种新的方法，用于实施一种高效且潜在实用的可卡因成瘾干预措施，以维持长期的药物戒断。我们的应用程序的重点是美沙酮患者谁使用注射或快克可卡因，因为他们获得或通过注射或与毒品有关的性行为传播艾滋病毒的风险增加。美沙酮对海洛因成瘾有效，但许多美沙酮患者继续使用可卡因。高强度和长时间的基于凭证的戒断强化是最有效的药物成瘾治疗方法之一，可以在较长的时间内维持可卡因戒断，但需要实施这种干预的实用方法。我们对一个治疗工作场所模型的研究表明，基于就业的禁欲强化，其中参与者必须提供无毒品的尿液样本才能进入工作场所并保持最高工资，可以保持可卡因禁欲并在较长时间内减少与毒品相关的艾滋病毒风险行为。我们的下一个挑战是传播以就业为基础的戒毒治疗强化措施。我们建议开发，手册化和试点测试社区友好的治疗工作场所干预，可以在美国和其他地方广泛实施。为了测试社区治疗工作场所干预，我们将进行一项随机试点研究。在美沙酮治疗期间使用注射或快克可卡因的美沙酮患者将被邀请参加（N = 58），并随机分配到两组之一：社区护理（对照）组或社区治疗工作场所组。正如我们之前实施的治疗工作场所干预一样，社区治疗工作场所参与者将参加第1阶段，开始戒毒并获得工作技能。在第一阶段开始禁欲并获得工作技能的参与者将 在第二阶段与合作雇主一起被雇用到社区工作场所。在第二阶段，将利用美国交通部监督的现有基础设施和工作场所毒品和酒精测试程序，实施基于就业的禁欲强化应急措施。利用这一系统，一个全国性的无毒品工作场所服务提供者将安排随机药物测试和基于就业的禁欲强化应急措施，要求雇员保持无毒品以维持就业。我们将对手册进行试点测试，并根据员工、参与者和雇主的反馈意见进行修订。这项研究将为参与者和雇主提供关于干预措施可接受性的重要信息，并提供关于我们维持禁欲和促进就业的程序的有效性的初步数据。我们在这项研究中收集的数据将是至关重要的，为未来更大规模的研究提供信息，以了解社区治疗工作场所干预措施的有效性，以保持长期的药物戒断和减少与药物相关的艾滋病毒风险行为。