Intensive Motivational Interviewing for Methamphetamine Dependence

描述(由申请人提供)：一项第二阶段随机临床试验(RCT)被提出，以测试一个有前景的9阶段动机访谈(MI)模式对甲基苯丙胺(MA)依赖的有效性。阶段1试点测试表明，干预措施可以很容易地学习和准确地实施。30名MA依赖者的样本在9周内显示出MA使用量的大幅减少、良好的保留率和持续的出勤率。量身定制的治疗方法借鉴了我们之前关于心肌梗死的概念性论文以及我们对各种心肌梗死方案的经验，包括两项关于心肌梗死的临床试验网络(CTN)研究。《高剂量激励强化疗法》手册的一个创新特点是，它全面解决了已实现持续戒酒的客户以及仍在使用药物的客户的问题。因此，它的目的是促进治疗进入和参与以及维持在治疗方面取得的成果。我们假设，一个更密集的MI模型对于解决MA依赖的个体是必要的，因为他们经常比有其他物质依赖的个体出现更严重的问题，并且更容易失去他们在治疗中取得的成果。MA依赖客户(N=220)将从加利福尼亚州拉斐特的New Leaf门诊部招募。该网站有很长的研究历史，包括参与了一项评估MA依赖治疗结果的多点研究。研究参与者将被随机分配到1)一次动机访谈(MI)加上8小时的健康/营养教育，或2)9次强化MI干预。除了研究干预外，这两组人都将在New Leaf接受标准的门诊治疗服务。参与者将在治疗的前9周每周接受MA使用评估。更广泛的评估将在治疗开始时以及2、4和6个月的随访中进行。两名治疗师将被“交叉”，并治疗这两种情况下的客户。主要的结果指标将是MA使用的时间线随访(TLFB)、MA尿液分析结果和治疗中的滞留。次要结果将包括酒精和其他药物的ASI和TLFB。探索性分析将检查艾滋病毒危险行为、动机和服务利用情况。调解模型将建立在Moyers等人的MI研究基础上。(2005)和我们构建的“支持性对抗”(Polcin等人，2006)，通过测试关于使用MA的潜在危害的警告增强的反馈是否促进了治疗联盟，以及这是否反过来促进了更好的结果。最近的一项荟萃分析突显了这项研究的重要性，该分析发现，较高剂量的心肌梗死与较好的结果相关(Burke等人，2003年)。相反，最近对药物依赖客户的标准单次心肌梗死的几项研究质疑其有效性。患有MA依赖的患者很适合接受更大剂量的MI，因为他们有严重的医疗和心理社会问题。因此，现在是时候测试这一有希望的干预措施，将其作为对患有MA依赖的客户的标准MI的有用扩展。公共卫生相关性：该提案响应了美国国家药物滥用研究所宣布的“行为与综合治疗发展计划”(PA-07-111)。这项研究测试了一份新的9节“动机访谈”咨询手册在治疗甲基苯丙胺依赖方面是否比最常用的标准单节辅导更有效。找到有效的治疗甲基苯丙胺依赖的方法很重要，因为甲基苯丙胺的使用正在迅速增加，在一些地区，如美国西部，正在达到流行的比例。

DESCRIPTION (provided by applicant): A Stage 2 randomized clinical trial (RCT) is proposed to test the efficacy of a promising 9-session model of motivational interviewing (MI) for methamphetamine (MA) dependence. Stage 1 pilot testing indicated the intervention could be easily learned and implemented with fidelity. The sample of 30 MA dependent individuals over 9 weeks showed large reductions in MA use, good retention and consistent attendance. The tailored treatment approach draws upon our previous conceptual papers on MI as well as our experience with a variety of MI protocols, including two Clinical Trials Network (CTN) studies of MI. An innovative feature of the "Higher Dose Motivational Enhancement Therapy" manual is that it comprehensively addresses the issues of clients who have achieved sustained sobriety as well as those still using substances. Thus, it is designed to facilitate treatment entry and engagement as well as maintenance of the gains made in treatment. We posit that a more intensive MI model is necessary to address MA dependent individuals because they frequently present more serious problems than individuals with other substance dependencies and are more prone to lose the gains they make in treatment. MA dependent clients (N=220) will be recruited from New Leaf outpatient treatment in Lafayette, California. This site has a long history of conducting research, including participation in a multi-site study assessing treatment outcome of MA dependence. Study participants will be randomly assigned to 1) a single session of Motivational Interviewing (MI) plus 8 hours of health/nutrition education, or 2) the intensive 9-session MI intervention. In addition to the study interventions, both groups will receive standard outpatient treatment services at New Leaf. Participants will be assessed weekly during the first 9 weeks of treatment for MA use. More extensive assessments will be conducted at treatment entry and 2-, 4-and 6-month follow-ups. Two therapists will be "crossed" and treat clients in both conditions. Primary outcome measures will be the Timeline Follow Back (TLFB) for MA use, MA urinalysis results, and retention in treatment. Secondary outcomes will include the ASI and the TLFB for alcohol and other drugs. Exploratory analyses will examine HIV risk behaviors, motivation, and service utilization. A mediation model will build upon MI research by Moyers et al. (2005) and our construct of "supportive confrontation" (Polcin, et al., 2006) by testing whether feedback enhanced with warnings about the potential harm of MA use facilitates the therapeutic alliance, and whether this in turn facilitates better outcome. The significance of the study is highlighted by a recent meta-analysis finding higher doses of MI were associated with better outcomes (Burke et al., 2003). Conversely, several recent studies of standard single session MI with drug dependent clients questioned its effectiveness. Clients with MA dependence are good candidates for a more intensive dose of MI because of their severe medical and psychosocial problems. Thus, it is time to test this promising intervention as a useful extension of standard MI for clients with MA dependence. PUBLIC HEALTH RELEVANCE: This proposal responds to the National Institute on Drug Abuse Program Announcement, "Behavioral & Integrative Treatment Development Program" (PA-07-111). The study tests whether a new 9- session manual of "Motivational Interviewing" counseling is more effective for treating methamphetamine dependence than the standard single session that is used most commonly. Finding effective treatments for methamphetamine dependence is important because methamphetamine use is rapidly increasing and in some areas, such as the Western U.S, is reaching epidemic proportions.