ENHANCED AND ATTENDANCE-BASED PRIZE

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 中心，不一定是研究者的机构。 在我们的研究评估应急管理（CM），提供机会赢得奖品，我们已经注意到，CM的疗效可能取决于个人的状态，因为他们开始治疗。开始治疗时尿分析结果呈可卡因阳性的患者往往会过早退出治疗，并在治疗期间继续使用。 CM干预在减少该亚组的药物使用方面是有效的，并且效果是幅度依赖性的。 然而，到目前为止，我们只测试了最高250美元的奖金，更大的幅度可能会进一步改善结果。 本提案的目的之一是检查增强的CM程序的有效性，在该程序中，在禁欲的最初阶段提供了更高频率的奖金。 用可卡因阳性尿样开始治疗的可卡因依赖患者（N=120）将被随机分配到三种情况之一：（a）标准、非CM治疗，（B）标准治疗加CM，预期有可能赢得约250美元的奖品，或（c）标准治疗加CM，预期有可能赢得约560美元的奖品。 我们还发现，接受可卡因阴性样本治疗的患者在整个治疗期间通常会释放阴性样本，无论他们是否接受了非CM或依赖于禁欲的CM治疗。因此，我们还将进行一项平行研究，以评估是否简单地加强治疗的出勤率提高保留和改善该亚组的长期结果。使用可卡因阴性尿样开始治疗的可卡因依赖患者（N=330）将被随机分配至以下三种情况之一：（a）没有CM的标准治疗，或（B）标准治疗加CM，其具有取决于可卡因戒断的赢得价值约250美元的奖品的预期概率，或（d）标准治疗加CM，预期有可能赢得价值约$250的奖品，视乎治疗出席情况而定。总之，这些研究将解决的条件下，较低和较高的成本奖励CM程序可能会改善可卡因依赖患者的结果

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In our research evaluating contingency management (CM) that provides opportunities to win prizes, we have noted that the efficacy of CM may be dependent on the status of the individual as they initiate treatment. Patients who begin treatment with a cocaine-positive urinalysis result tend to drop out of treatment prematurely and to continue using while in treatment. CM interventions have been efficacious in reducing drug use in this subgroup, and the effects were magnitude dependent. However, we have thus far only tested up to a maximum of $250 in prizes, and larger magnitudes may further improve outcomes. One purpose of this proposal is to examine the efficacy of an enhanced CM procedure, in which increased frequencies of prize winnings are provided during initial periods of abstinence. Cocaine-dependent patients beginning treatment with a cocaine-positive urine sample (N=120) will be randomly assigned to one of three conditions: (a) standard, non-CM treatment, (b) standard treatment plus CM with an expected probability of winning about $250 in prizes, or (c) standard treatment plus CM with an expected probability of winning about $560 in prizes. We have also found that patients who present to treatment with cocaine-negative samples generally remit negative samples throughout their time in treatment, regardless of whether they received a non-CM or a CM treatment contingent upon abstinence. Thus, we will also conduct a parallel study that will assess whether simply reinforcing attendance at treatment enhances retention and improves long-term outcomes in this subgroup. Cocaine-dependent patients (N=330) initiating treatment with a cocaine-negative urine sample will be randomly assigned to one of three conditions: (a) standard treatment without CM or (b) standard treatment plus CM with an expected probability of winning about $250 worth of prizes contingent upon cocaine abstinence, or (d) standard treatment plus CM with an expected probability of winning about $250 worth of prizes contingent upon treatment attendance. Together, these studies will address the conditions under which lower and higher cost prize CM procedures may improve outcomes of cocaine-dependent patients