Behavioral Activation and HIV Risk Reduction for MSM with Crystal Meth Abuse

滥用冰毒的 MSM 的行为激活和 HIV 风险降低

• 批准号: 8235848
• 负责人: Matthew James Mimiaga
• 金额: $ 27.95万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-03-15 至 2014-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8235848
• 关键词: Amphetamine Abuse; Anal Sex; Anhedonia; Attention; Behavior; Behavior Therapy; Behavioral; Clinic; Complex; Counseling; DSM-IV; Data; Dependence; Depressed mood; Diagnosis; Distress; Drug abuse; Drug usage; Event; Evidence based treatment; Feeling; Funding; Goals; Grant; HIV; HIV Infections; HIV therapy; HIV/STD; Hobbies; Individual; Intervention; Learning; Life; Mediator of activation protein; Mental Depression; Mental Health; Methamphetamine; Modeling; Moods; Motivation; National Institute of Drug Abuse; Outcome; Participant; Pharmaceutical Preparations; Professional counselor; Psychological reinforcement; Randomized; Randomized Controlled Trials; Refractory; Reporting; Research; Resistance; Risk; Risk Behaviors; Risk Reduction; Risk-Taking; Safety; Severities; Sex Behavior; Testing; Training; Treatment Efficacy; Unsafe Sex; Work; arm; base; depressive symptoms; evidence base; experience; follow-up; improved; innovation; interest; intervention effect; meetings; men who have sex with men; non-drug; novel; pleasure; primary outcome; programs; public health relevance; secondary outcome; sex; sex risk; skills; therapy design

DESCRIPTION (provided by applicant): Problematic crystal methamphetamine ("meth") use is a prevalent and treatment refractory problem in MSM, and highly associated with HIV sexual risk behavior. This is an application to conduct a pilot randomized controlled trial (RCT) of a behavioral intervention to reduce high risk sex in MSM with meth abuse/dependence who are at risk for HIV acquisition. The intervention incorporates state of the art behavioral risk reduction counseling with behavioral activation therapy (BAT) to help participants re-engage in enjoyable and meaningful life activities not involving drugs. Behavioral activation is an evidence-based treatment for depression that focuses on helping individuals reengage in activities that generate feelings of mastery and pleasure. We chose this strategy for MSM who abuse meth because our formative work revealed that MSM who abuse meth report becoming unable to enjoy activities that they previously enjoyed as a result of ongoing meth use. This lack of enjoyment (anhedonia) in activities that do not involve meth use or sex contributes to the continued use of meth and potentially unsafe sex. The intervention approach was developed and piloted through a NIDA-funded R03, and the proposed pilot RCT is the next logical step in testing this approach. Overview: Building on our prior R03, this is a two-arm pilot RCT of BAT and HIV risk reduction counseling for MSM with meth abuse/dependence. Conceptual Model: The conceptual model focuses on anhedonia (a loss of interest in previously enjoyed activities) as a consequence of continued meth use. Accordingly, for individuals who abuse meth, drug use becomes the central means for (or the only means for) obtaining enjoyment. We hypothesize that an intervention targeting both sexual risk reduction and increasing safe, pleasurable goal-directed activities via BAT will contribute to increased intervention efficacy and, thus, reductions in unprotected sex and meth use. The hypothesized mechanism of action is that behavioral activation will re-engage participants in pleasurable non-drug use activities (e.g., interests or hobbies that were enjoyable before meth use) that will serve as a natural reinforcement for functional behavior, improve depressed mood when not on meth by experiencing increases in pleasure and mastery, and decrease overall distress so that MSM who abuse meth can better benefit from HIV risk reduction counseling. Research Plan Overview: MSM who are HIV-uninfected and meet DSM-IV criteria for a diagnosis of meth (amphetamine) abuse/dependence will be randomized. The two arms include (1) "BAT-RR", behavioral activation therapy and risk reduction counseling which lasts 10 sessions; and (2) the comparison condition, the equivalent risk reduction counseling only for 2 sessions. Participants will be followed for 6 months post-randomization. Main outcomes include sexual risk (primary) and meth use (secondary). Additional secondary outcomes include increases in pleasurable (but safe) activities, increases in HIV information, motivation re: sexual safety, and behavioral skills, decreases in depressive symptoms severity, and decreases in polysubstance use. PUBLIC HEALTH RELEVANCE: Problematic crystal meth use is a prevalent and treatment resistant-problem in men who have sex with men (MSM) domestically, and is highly associated with HIV risk behavior and HIV infection. The present study aims to test a novel treatment for crystal meth use in MSM, incorporating behavioral activation therapy with HIV risk reduction counseling. This approach may be more potent than traditional drug abuse counseling as our preliminary data suggest that MSM who abuse crystal have stopped receiving pleasure from previously enjoyed activities, and behavioral activation therapy involves re-engaging participants in functional and enjoyable activities. If the current RCT pilot is effective at reducing HIV acquisition risk behavior and crystal meth use, in the next grant (NIDA R01) we will work on a combined dissemination and efficacy study- conducting the intervention in drug abuse treatment clinics for MSM, and delivered by drug abuse counselors.

描述(由申请人提供)：问题晶体甲基苯丙胺(“冰毒”)的使用是男男性接触者中普遍存在的一个难以治疗的问题，与HIV的性行为高度相关。这是一个应用程序，用于进行行为干预的试点随机对照试验(RCT)，以减少有艾滋病毒感染风险的滥用冰毒/依赖的MSM的高危性行为。这项干预将最先进的行为风险降低咨询与行为激活疗法(BAT)结合在一起，帮助参与者重新参与到不涉及毒品的愉快和有意义的生活活动中。行为激活是一种以证据为基础的抑郁症治疗方法，其重点是帮助个人重新参与产生主控感和快乐感的活动。我们为滥用冰毒的男男性接触者选择这一策略是因为我们的形成工作显示，滥用冰毒的男男性接触者报告说，由于持续使用冰毒，他们变得不能享受他们以前喜欢的活动。在不涉及冰毒使用或性行为的活动中缺乏快感(快感缺乏)，助长了冰毒的持续使用和潜在的不安全性行为。干预方法是通过NIDA资助的R03开发和试点的，拟议的试点RCT是测试这一方法的下一个合乎逻辑的步骤。概述：在我们之前的R03的基础上，这是一个针对有冰毒滥用/依赖的MSM的BAT和HIV风险降低咨询的双臂试点RCT。概念模型：概念模型侧重于由于持续使用冰毒而导致的快感丧失(对以前享受过的活动失去兴趣)。因此，对于滥用冰毒的个人来说，吸毒成为获得享受的主要手段(或唯一手段)。我们假设，通过BAT同时降低性风险和增加安全、愉快的目标导向活动的干预将有助于提高干预效果，从而减少无保护措施的性行为和冰毒使用。假设的作用机制是，行为激活将使参与者重新参与到愉快的非药物使用活动中(例如，在使用冰毒之前可以享受的兴趣或爱好)，这些活动将作为功能性行为的自然强化，通过体验快乐和掌握的增加来改善不服用冰毒时的抑郁情绪，并减少总体痛苦，以便滥用冰毒的MSM能够更好地从艾滋病毒风险降低咨询中受益。研究计划概述：未感染艾滋病毒并且符合DSM-IV诊断冰毒(苯丙胺)滥用/依赖的标准的MSM将被随机分组。两组包括(1)“BAT-RR”，即行为激活治疗和风险降低咨询，共10次；(2)对照条件，相当于减少风险咨询，只进行2次。参与者将在随机化后接受为期6个月的跟踪。主要结果包括性风险(主要)和冰毒使用(次要)。其他次要结果包括愉快(但安全)活动的增加，艾滋病毒信息的增加，动机：性安全和行为技能，抑郁症状严重程度的降低，以及多种物质使用的减少。 公共卫生相关性：在国内男男性行为者(MSM)中，有问题的冰毒使用是一个普遍存在的治疗耐药问题，与艾滋病毒危险行为和艾滋病毒感染高度相关。本研究旨在测试一种新的治疗MSM中冰毒使用的方法，将行为激活疗法与HIV风险降低咨询相结合。这种方法可能比传统的药物滥用咨询更有效，因为我们的初步数据表明，滥用水晶的MSM已经不再从以前享受的活动中获得快乐，而行为激活疗法包括重新让参与者参与到功能性和愉快的活动中。如果目前的随机对照试验在减少艾滋病毒感染风险行为和冰毒使用方面是有效的，在下一笔赠款(NIDA R01)中，我们将致力于一项传播和疗效相结合的研究-在MSM药物滥用治疗诊所进行干预，并由药物滥用顾问提供。