Evaluation Of Treatments Of Opioid And Cocaine Dependence

治疗科继续其长期项目，通过行为、药理学以及行为和药理学相结合的干预措施改善对物质依赖的治疗。 我们完成了一项临床试验，研究了100至190毫克/天的个体化美沙酮剂量的有效性，并在随机双盲设计中与100毫克/天的固定剂量进行比较。 令人惊讶的是，个体化高剂量组的多种药物使用（效应量h = 0.30）和海洛因渴望（效应量d = 0.87）显著高于固定剂量组，个体化高剂量组没有降低海洛因使用的趋势。 这一违反直觉的发现需要重复，但支持需要额外的高剂量美沙酮对照研究。 我们还完成了普萘洛尔对线索诱导的可卡因渴望的双盲干预研究，其中普萘洛尔的单次给药旨在阻断可卡因相关情绪反应的再巩固，从而导致线索诱导的渴望的持久减少。 结果再次出乎意料。 通过渴求量表和生理反应评估，普萘洛尔组的提示反应出乎意料地高于安慰剂组。 普萘洛尔给药后和随后的试验期间均存在这种反向假设的组间差异。我们的研究结果不支持普萘洛尔用于阿片类药物维持患者的线索诱导的可卡因渴望。 我们还开发并部署了基于视频的智能手机交付的移动的艾滋病毒风险降低（mHIVRR）干预措施。 我们开发了3个视频模块，包括一个10分钟的HIVRR视频，11个可接受性问题，和3个知识问题，并部署它们作为一个更大的研究生态瞬时和地理瞬时评估的次要研究。 所有24名留在主研究中足够长时间的个体都完成了mHIVRR次要研究。所有3个视频都符合我们在人群中的先验可接受性标准：他们在5分制李克特量表上的中位数得分为2.5; 20%的人在量表上给予他们最负面的评级;大多数人表示他们不喜欢其他格式而不是基于视频的智能手机（所有p <0.05）。&#8804;&#8804;此外，我们所有的视频模块都符合我们的先验可行性标准：20%的数据因参与者不依从而缺失，20%的数据因技术故障而缺失。&#8804;&#8804; 我们的结论是，基于视频的mHIVRR教育通过智能手机是可以接受的和可行的，并可能增加艾滋病毒/性病风险降低知识。 未来的研究，与干预前的知识和随机分配的评估，需要证实这些发现。 最后，我们继续开发地理瞬时评估（GMA），一种描述性的方法，以更好地衡量和理解情绪，药物使用和环境暴露之间的关系，以心理社会压力。我们仍然致力于将描述转化为干预。例如，我们已经证明，电子日记研究可以提供对药物滥用者在治疗期间的日常生活的惊人洞察，以及对即使是短暂禁欲期间的行为变化敏感的数据。使我们能够在现场收集药物使用，渴望和压力数据的技术也可以用于现场治疗，也许是为了响应患者自己的自我报告行为或先前确定的触发因素。

The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. We completed a clinical trial examining the effectiveness of individualized methadone dosages of 100 to 190 mg/day, compared in a randomized, double-blind design with fixed dosages of 100 mg/day. Surprisingly, polydrug use (effect-size h = .30) and heroin craving (effect-size d = .87) were significantly greater in the individualized high-dose group than in the fixed-dose group, with no trend toward lower heroin use in the individualized high-dose group. This counterintuitive finding requires replication, but supports the need for additional controlled studies of high-dose methadone. We also completed a double-blind interventional study of propranolol on cue-induced cocaine craving, in which a single administration of propranolol was intended to block reconsolidation of cocaine-associated emotional responses, thereby leading to an enduring reduction in cue-induced craving. Again, the results were unexpected. Cue reactivity, as assessed by craving scales and physiological responses, was unexpectedly greater in the propranolol group than in the placebo group. This counter-hypothesized group difference was present both acutely after propranolol administration and during the subsequent test sessions. Our results do not support the use of propranolol for cue-induced cocaine craving in opioid-maintained patients. We also developed and deployed a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessment. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability as is in the population: they achieved median scores of &#8804;2.5 on a 5-point Likert scale; &#8804;20% of individuals gave them the most negative rating on the scale; and a majority of individuals stated they would not prefer other formats over video-based smartphone-delivered (all p<0.05). Additionally, all of our video modules met our a priori criteria for feasibilty: &#8804;20% of data were missing due to participant noncompliance and &#8804;20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable and feasible, and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings. Finally we continue to develop Geographical Momentary Assessment (GMA), a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.