ADAPTIVE TREATMENT FOR COCAINE ADDICTION

虽然一些可卡因依赖的治疗方法是有效的，但仍存在一些重大挑战。 社区环境中治疗的有效性，包括对传统专业护理缺乏兴趣 模型，早期脱落率高，以及最初参与治疗的患者的反应存在相当大的差异。 在治疗中。我们小组和其他人最近的工作表明，适应性治疗模型可以适应- 服装的许多问题，干扰了成功交付的有效此外治疗.这些 这些模式旨在通过提供随时间变化的灵活护理来提高治疗参与率 基于患者对治疗的反应以及患者的选择或偏好。该项目的目标是 进一步发展对寻求治疗的可卡因依赖者的适应性护理模式 在以社区为基础的专业护理项目中。完成强化治疗的患者（N = 300） 门诊计划（1OP）将随机分为两种情况，使用基于电话的激励 访谈（MI）以增加标准IOP（MI-IOP）或三种IOP之一的参与率 患者选择的治疗方案（MI-PC）。如果患者未能接受这些干预， 在第1 - 2周定期参加IOP（"非参与"组），如果他们达到初始参与（"非参与"组）， 组），但随后在第3 - 12周期间的某个时间点停止治疗IOP。的治疗选择 在MI-PC中，IOP、基于电话的分级护理或莫达非尼和药物管理的组合 在非参与组;和IOP，基于电话的阶梯式护理，或认知行为治疗 (CBT)在这群人中。未参与和未参与群体的选择略有不同， 因为我们想提供一种非专业护理替代方案（例如，莫达非尼）， 最初参与IOP，而将IOP患者的选择限制为基于IOP的干预似乎 临床上合适的。主要分析将比较MI-IOP和MI-PC的参与率/保留率， 前12周和可卡因使用结果在第1 - 24周，并确定是否预测的优势 MI-PC相对于MI-IOP的比值随着处于非参与组或非参与组中而变化。进一步 分析将检查次要结局，MI-PC非参与性研究中每种治疗方案的选择率 以及每种治疗方案的结果。

Although a number of treatments for cocaine dependence are efficacious, there are several major challenges to the effectiveness of treatment in community settings, including lack of interest in traditional specialty care models, high rates of early dropout, and considerable variability of response in patients who initially engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can ad- Dress many of the problems that interfere with the successful delivery of effective addition treatment. These models are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment, and patient choice or preference. The goal of this project is the further development of an adaptive model of care for individuals with cocaine dependence who seek treatment in community-based, specialty care programs. Patients (N=300) who complete an intake at an Intensive Outpatient Program (1OP) will be randomized into two conditions, which use telephone-based Motivational Interviewing (Ml) to increase rates of engagement in either standard IOP (MI-IOP), or in one of three treatment options selected by the patient (MI-PC). Patients are eligible for these interventions if they fail to attend IOP regularly in weeks 1-2 (the "Non-engaged" group), of if they achieve initial engagement (the "Engaged" group) but subsequently stop attending IOP at some point during weeks 3-12. The treatment options in MI-PC are IOP, telephone-based stepped care, or the combination of modafinil and medication management in the Non-engaged group; and IOP, telephone-based stepped care, or Cognitive-Behavioral Treatment (CBT) in the Engaged group. The options for the Non-engaged and the Engaged groups differ slightly, because we wanted to offer a non-specialty care alternative (e.g., modafinil) to patients who failed to achieve initial engagement in IOP, whereas limiting options in Engaged patients to lOP-based interventions seemed clinically appropriate. Primary analyses will compare MI-IOP and MI-PC on rates engagement/retention over the first 12 Weeks and cocaine use outcomes over weeks 1-24, and determine whether the predicted advantage of MI-PC over MI-IOP varies as a function of being in the Non-engaged or the Engaged groups. Further analyses will examine secondary outcomes, rates of selection of each treatment option in the MI-PC Nonengaged and Engaged groups, and outcomes within each of these treatment options.