Diversion to treatment for injection drug users arrested for possession of heroin

因持有海洛因而被捕的注射吸毒者被转移到治疗

• 批准号: 8281781
• 负责人: Anthony DeFulio
• 金额: $ 34.32万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8281781
• 关键词: Abstinence; Address; Adult; American; Baltimore; Behavior Therapy; Budgets; Charge; Cocaine; Cognitive; Communities; Costs and Benefits; Crime; Criminal Justice; Data; Drug abuse; Drug usage; Eligibility Determination; Employment; Enrollment; Foundations; Funding; Government; Government Officials; HIV; HIV Infections; Health; Heroin; Heroin Dependence; Imprisonment; Indium; Individual; Injecting drug user; Injection of therapeutic agent; Intervention; Lawyers; Letters; Literature; Methadone; Methods; Modeling; National Institute of Drug Abuse; Occupations; Opiates; Participant; Patients; Pharmaceutical Preparations; Pilot Projects; Plant Roots; Population; Randomized; Randomized Controlled Trials; Refractory; Relapse; Risk; Risk Behaviors; Sampling; Services; Societies; Staging; Study Section; System; Testing; Therapeutic; Training; Treatment Efficacy; Unemployment; Urine; Work; Workplace; adjudication; base; cocaine use; contingency management; cost; cost effective; design; drug abstinence; drug testing; effective intervention; effective therapy; high risk; interest; methadone maintenance; motivational intervention; novel; offender; recidivism; therapeutic effectiveness; therapy development; transmission process; treatment as usual; voucher

DESCRIPTION (provided by applicant): More Americans are arrested for drug offenses than for any other crime. In 2009, over 294,000 arrests were made for possession of cocaine or heroin. Incarceration does not address the root problems and is frequently followed by relapse and re-arrest after release. In the case of opiate-dependent adults arrested for possession of heroin, one potentially effective alternative is to divert offenders to methadone maintenance treatment (MMT) as an alternative to adjudication of their case. MMT is an effective treatment for heroin dependence, and appears very effective for criminal offenders. However, cocaine use is common in MMT patients, including those with recent criminal justice involvement, and MMT alone is ineffective in addressing cocaine use. Continued cocaine use carries a substantial health burden and necessarily entails continued criminal activity. Thus, treatment for diverted opiate-dependent offenders should be designed to address cocaine use as well as opiate use. A Stage 1 Behavior Therapy Development project is planned over 2 years to adapt, manualize and pilot test the Therapeutic Workplace intervention for adults charged with heroin possession and offered diversion to methadone maintenance treatment as an alternative to adjudication of their case. The Therapeutic Workplace is a novel, employment-based contingency management intervention that has been very effective in promoting cocaine abstinence in adults who use cocaine persistently during methadone treatment. In the Therapeutic Workplace, participants are hired in a model workplace and required to provide drug-free urine samples to work and to earn maximum pay. Once we develop and manualize the adapted version of the Therapeutic Workplace for adults arrested for heroin possession, a pilot test will be conducted. Individuals identified by the State Attorney's office as candidates for diversion will be assessed for study eligibility. Given the high rates of injection drug use and injection-related transmission of HIV i Baltimore, this study will be restricted to injection drug users to evaluate the potential utility f this intervention in reducing HIV risk. Eligible individuals will be offered methadone maintenance in lieu of prosecution and will be required to remain in methadone treatment for 90 days. All participants will receive standard MMT, independent of whether they decide to participate in the pilot study. After beginning MMT, participants will be invited to enroll in the pilot study and randomly assigned to two study groups. Participants assigned to the Usual Care Diversion group will receive the standard MMT. Participants assigned to the Therapeutic Workplace Enhanced Diversion group will receive the standard MMT and the Therapeutic Workplace intervention. The data from this pilot study will serve as the foundation for a full-scaled randomized controlled trial. Overall, the Therapeutic Workplace could serve as a novel and ideal intervention for many heroin dependent adults involved in the criminal justice system. The use of MMT in lieu of adjudication in combination with the Therapeutic Workplace could increase drug abstinence and employment and decrease HIV risk and criminal activity in this refractory high-risk population. PUBLIC HEALTH RELEVANCE: We propose to conduct a stage 1 behavior therapy development project to evaluate the efficacy of the Therapeutic Workplace as the central element in a drug abuse treatment for unemployed injection drug users who have been arrested for possession of heroin and diverted from prosecution to treatment. The Therapeutic Workplace is a motivational intervention of proven efficacy that uses routine drug testing and contingent access to stipend-supported job training or employment to promote drug abstinence. The Therapeutic Workplace could serve as a novel and ideal intervention for diverted drug dependent arrestees, which could increase abstinence and employment, and reduce HIV risk and recidivism.

描述（由申请人提供）：更多的美国人因毒品犯罪而被捕，而不是任何其他犯罪。2009年，有294 000多人因持有可卡因或海洛因而被捕。监禁并不能解决根本问题，释放后往往又复发和再次被捕。至于因藏有海洛英而被拘捕的依赖鸦片类药物的成年人，其中一个可能有效的替代方法是将罪犯转介接受美沙酮维持治疗，以代替对他们的个案作出裁决。MMT是一种有效的海洛因依赖治疗方法，对犯罪分子也非常有效。然而，可卡因的使用在MMT患者中很常见，包括那些最近参与刑事司法的患者，并且单独使用MMT在解决可卡因使用方面无效。继续使用可卡因会带来巨大的健康负担，必然导致犯罪活动的继续。因此，对转移用途的阿片剂依赖罪犯的治疗应当既针对阿片剂使用，也针对可卡因使用。第一阶段行为治疗发展项目计划在2年内适应，手册化和试点测试治疗工作场所干预的成年人被控持有海洛因，并提供美沙酮维持治疗的替代裁定他们的情况。治疗工作场所是一种新颖的，以就业为基础的应急管理干预措施，在促进美沙酮治疗期间持续使用可卡因的成年人的可卡因戒断方面非常有效。在治疗工作场所，参与者被雇用在一个示范工作场所，并要求提供无毒品尿样工作，并赚取最高工资。一旦我们为因持有海洛因而被捕的成年人开发和手册化了治疗工作场所的改编版本，将进行试点测试。由国家检察官办公室确定为分流候选人的个人将被评估为研究资格。鉴于巴尔的摩注射吸毒和注射相关HIV传播的高发生率，本研究将仅限于注射吸毒者，以评价这种干预措施在降低HIV风险方面的潜在效用。符合条件的个人将获得美沙酮维持治疗，以代替起诉，并将被要求继续接受美沙酮治疗90天。所有参与者都将接受标准MMT，无论他们是否决定参加试点研究。开始MMT后，参与者将被邀请参加试点研究，并随机分配到两个研究组。分配到精神护理转移组的受试者将接受标准MMT。分配到治疗性工作场所增强转移组的受试者将接受标准MMT和治疗性工作场所干预。这项初步研究的数据将作为全面随机对照试验的基础。总的来说，治疗工作场所可以作为一个新的和理想的干预许多海洛因依赖的成年人参与刑事司法系统。使用MMT代替裁定与治疗工作场所相结合，可以增加药物戒断和就业，并减少艾滋病毒的风险和犯罪活动，在这个难治性高风险人群。 公共卫生关系：我们建议进行第一阶段的行为治疗发展项目，以评估疗效的治疗工作场所的中心元素，在药物滥用治疗的失业注射吸毒者谁已被逮捕持有海洛因和转移从起诉到治疗。治疗工作场所是一种经证明有效的激励性干预措施，它使用常规药物测试和有条件获得津贴支持的职业培训或就业机会，以促进戒毒。治疗工作场所可以作为一个新的和理想的干预转向药物依赖被捕者，这可以增加禁欲和就业，并减少艾滋病毒的风险和累犯。