Evaluation Of Treatments Of Opioid And Cocaine Dependenc

该科继续调查药物滥用的药理和行为治疗方法，并探索治疗方法的组合。我们已经证明了行为干预(加强可卡因阴性尿样)在市中心静脉注射多药滥用者的大样本中的有效性，我们正在继续评估应用这种治疗的最佳方法。我们目前正在完成一项研究的积极治疗阶段，以解决假设的美沙酮维持诊所如何最好地分配其资源(药理学和非药理学)来减少海洛因和可卡因滥用的问题，如果该诊所要实施基于凭单的应急管理的话。通过将一项主要旨在通过行为强化(应急管理)减少可卡因使用的干预措施与另一项侧重于通过药物治疗(大剂量美沙酮维持)减少非法阿片类药物使用的干预措施相结合，我们假设，与单独应用这两种方法时相比，我们将看到更大的可卡因和非法阿片类药物戒断。为了控制成本和技术转让，我们已经开始了一项试点研究，其中增强剂是抽奖而不是代金券，因为其他人的工作表明，基于彩票的增援程序可以由社区制造商和商人的捐款来资助。如果抽奖程序在我们手中奏效，我们计划将其纳入一项更雄心勃勃的研究中，在这项研究中，各种低成本或零成本的激励措施针对的是广泛的行为改变，而不仅仅是减少药物使用。我们目前研究的另一个焦点来自我们的同事？实验室动物数据表明，阿尔法肾上腺素能激动剂洛非西定可以防止应激诱导的寻求可卡因和/或海洛因的恢复。我们正在进行一项剂量范围的研究，以确定洛非西定如何与美沙酮在人类身上联合使用最安全；我们计划在此之后进行一项临床试验，在此基础上，在凭证启动戒断之后，继续服用洛非西定(或安慰剂)，以防止应激诱导的复发。我们还在继续一项研究，在这项研究中，长期存在注意力缺陷/多动障碍(ADHD)症状的成年可卡因滥用者接受安非他酮(或安慰剂)和认知行为疗法的治疗，前提是他们的可卡因滥用可能在一定程度上代表了他们试图自我用药。使用安非他酮的理由是它在治疗ADHD方面有一定的疗效，而且不容易被滥用。这项研究包括治疗前和治疗后的神经心理测试和反复的电脑注意力评估。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. We have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine-negative urine samples) in large inner-city samples of intravenous polydrug abusers, and we continue to evaluate the best ways to apply the treatment. We are currently concluding the active-treatment phase of a study to address the question of how a hypothetical methadone-maintenance clinic could best allocate its resources (both pharmacological and nonpharmacological) to reduce both heroin and cocaine abuse, if the clinic were to institute voucher-based contingency management. By combining an intervention primarily aimed at decreasing cocaine use through behavioral reinforcement (contingency management) with another intervention focused on decreasing illicit-opiate use through pharmacological treatment (high-dose methadone maintenance), we hypothesize that we will see greater abstinence from cocaine and illicit opiates than has been seen when either approach was applied separately. In the interest of cost containment and technology transfer, we have begun a pilot study in which the reinforcers are lottery draws rather than vouchers, since work by others has shown that a lottery-based reinforcement procedure can be funded by donations from community manufacturers and merchants. If the lottery procedure works in our hands, we plan to incorporate it into a more ambitious study in which a variety of low- or no-cost incentives are targeted toward a broad range of behavioral changes beyond reductions in drug use. Another current focus of our research derives from our colleagues? laboratory-animal data showing that stress-induced reinstatement of cocaine-seeking and/or heroin-seeking can be prevented with the alpha-adrenergic agonist lofexidine. We are conducting a dose-ranging study to determine how lofexidine can most safely be coadministered with methadone in humans; we plan to follow this with a clinical trial in which voucher-initiated abstinence is followed by maintenance on lofexidine (or placebo) for prevention of stress-induced relapse. We are also continuing a study in which adult cocaine abusers with longstanding symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are treated with bupropion (or placebo) and cognitive-behavioral therapy, on the premise that their cocaine abuse may partly represent an attempt at self-medication. The rationale for using bupropion is that it has some efficacy in treating ADHD and is not prone to abuse. The study incorporates pre- and posttreatment neuropsychological testing and repeated computerized assessments of attention.