Novel Intervention for Drug Use and HIV Risk among Anxiety Sensitive Heroin Users

针对焦虑敏感海洛因使用者吸毒和艾滋病毒风险的新干预措施

• 批准号: 7554085
• 负责人: Carl W Lejuez
• 金额: $ 37.11万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7554085
• 关键词: Abstinence; Accounting; Acquired Immunodeficiency Syndrome; Address; Alcohol or Other Drugs use; American; Anxiety; Area; Arousal; Attitude; Basic Science; Behavior; Belief; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Cognitive; Combined Modality Therapy; Comorbidity; Contracts; Data; Dropout; Drops; Drug usage; Educational process of instructing; Effectiveness; Esthesia; Event; Exercise; Fright; Goals; HIV; HIV Infections; Heroin; Heroin Users; Hypersensitivity; Individual; Individual Differences; Injection of therapeutic agent; Intervention; Knowledge; Life; Link; Mediator of activation protein; Minority; Modeling; Moods; Needles; Nondirective Therapy; Outcome; Outcome Measure; Patients; Pattern; Population; Poverty; Prevalence; Process; Protocols documentation; Psychological Models; Public Health; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Relapse; Relative (related person); Reliance; Research; Residential Treatment; Risk; Risk Behaviors; Safety; Sex Behavior; Staging; Structure; Symptoms; Testing; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Work; active control; base; bodily sensation; brief intervention; coping; craving; high risk sexual behavior; improved; inner city; novel; prevent; psychologic; sex risk; skills; social; therapy design; therapy development; transmission process; treatment center

More than 850,000 Americans are currently living with AIDS and an estimated 40,000 continue to contract HIV each year (CDC, 2004). Minority individuals living in urban and poverty-stricken areas who engage in injection heroin use are particularly at risk for HIV infection (Chitwood et aI., 2000; De Rossi et aI., 1988; SAMHSA, 2003). These findings suggest the importance of developing treatments focused on helping individuals achieve abstinence from injection heroin use, especially within inner-city minority popUlations. However, inner-city minorities are less likely to have access to longer-term substance use treatment (Bernstein et aI., 2005), and within residential treatment centers, the likelihood of drop-out and relapse to substance use among injection heroin users is strikingly high (Manu et aI., 1994). Therefore, there is a need for targeted, brief interventions that can be conducted as an adjunct to substance use treatment to reduce vulnerability for treatment drop-out and relapse to substance use, reducing risk for further injection drug use and HIV infection or transmission. Building from contemporary models of psychological vulnerability (Barlow, 2002), there is conceptual and robust empirical reason to explore cognitive factors reflecting a hypersensitivity to aversive events in order to better understand the factors that contribute to treatment dropout and relapse to substance use among heroin users (Brown et aI., 2005). One such cognitive vulnerability that holds promise is anxiety sensitivity (AS). AS, a relative stable individual difference characteristic representing the tendency to fear anxiety-related symptoms due to the belief that these symptoms will have negative consequences (Reiss, 1991), has recently been linked to heroin use (Lejuez et aI., 2006) and has been found to significantly and uniquely predict treatment drop-out among heroin users (Lejuez et aI., 2007). Our group has subsequently developed an exposure-based individual intervention specifically tailored to inner-city heroin users with heightened AS - the Anxiety Sensitivity Treatment for Heroin Users (ASTH; Tull et aI., 2007). Pilot data indicate the feasibility of the treatment with patients evidencing reduced AS and heroin cravings. Additionally, if the treatment is successful, there is a counterintuitive potential for increased HIV risk through sexual contact resulting from a reduction in heroin use and/or anxiety. Therefore, we propose to utilize an integrated treatment combining ASTH with Healthy Relationships (HR; Kalichman et aI., 2001), a targeted intervention designed to prevent high risk sexual behavior. The combined intervention (ASTH+HR) is now structured to reduce risk for HIV infection/transmission by (a) promoting heroin abstinence by reducing AS, and (b) preventing engagement in risky sexual behaviors using a social cognitive approach aimed at increasing one's understanding of interpersonal/intimate relationships and potential for risky sexual behaviors in those relationships, combined with skill building to help the individual more effectively cope and remain sexually safe in those situations. We also collected pilot data to establish the safety, feasibility, and acceptability of this combined intervention. The objective of the present proposal is to provide a two year Stage 1b randomized control trial of 60 patients receiving standard residential substance use treatment comparing ASTH combined with modules from a modified Healthy Relationships (HR; a brief intervention designed to reduce risky sex behaviors; Kalichman et aI., 2001) to nondirective therapy (NT+HR), with a focus on the substance use outcomes of treatment drop-out from the residential treatment and relapse following the residential treatment across 3 months, as well as engagement in HIV-risk behaviors including injection drug use and risky sexual behavior across this period.

目前有超过 850,000 名美国人患有艾滋病，估计还有 40,000 人继续感染艾滋病毒 每年（CDC，2004）。居住在城市和贫困地区从事注射的少数民族人员 使用海洛因特别容易感染艾滋病毒（Chitwood 等人，2000 年；De Rossi 等人，1988 年；SAMHSA， 2003）。这些发现表明开发专注于帮助个人实现目标的治疗方法的重要性 戒除注射海洛因的使用，特别是在市中心的少数民族人口中。然而，市中心 少数群体获得长期药物滥用治疗的可能性较小（Bernstein 等人，2005 年），并且 在住院治疗中心内，注射期间退出和再次吸毒的可能性 海洛因吸食者数量惊人（Manu 等人，1994 年）。因此，需要采取有针对性的、简短的干预措施 可以作为药物滥用治疗的辅助手段进行，以减少治疗中断的可能性 再次吸毒，降低进一步注射吸毒和艾滋病毒感染或传播的风险。 根据当代心理脆弱性模型（Barlow，2002），有概念和 探索反映对厌恶事件过敏的认知因素的强有力的实证理由，以便 更好地了解导致海洛因戒断治疗和药物滥用复发的因素 用户（Brown 等人，2005）。其中一种有望实现的认知脆弱性是焦虑敏感性（AS）。作为，一个 相对稳定的个体差异特征代表对焦虑相关症状的恐惧倾向 由于相信这些症状会产生负面后果（Reiss，1991），最近被联系起来 与海洛因使用相关（Lejuez 等人，2006 年），并被发现可以显着且独特地预测治疗退出 海洛因吸食者（Lejuez 等人，2007 年）。我们小组随后开发了基于曝光的 专门针对患有高度 AS（焦虑症）的市中心海洛因吸食者量身定制的个人干预措施 海洛因使用者的敏感性治疗（ASTH；Tull 等人，2007 年）。试点数据表明了该方案的可行性 对显示 AS 和海洛因渴望减少的患者进行治疗。另外，如果治疗成功的话， 由于性接触减少而导致艾滋病毒风险增加，这可能是违反直觉的。 海洛因使用和/或焦虑。因此，我们建议采用 ASTH 与 ASTH 相结合的综合治疗方法。 健康关系（HR；Kalichman 等，2001），旨在预防高风险的有针对性的干预措施 性行为。联合干预措施（ASTH+HR）现在旨在降低艾滋病毒风险 通过以下方式感染/传播：(a) 通过减少 AS 来促进海洛因戒断，以及 (b) 预防参与 使用社会认知方法进行危险的性行为，旨在增加人们对危险的性行为的理解 人际关系/亲密关系以及这些关系中危险性行为的可能性，综合起来 培养技能，帮助个人更有效地应对这些情况并保持性安全。我们 还收集了试点数据，以确定这种联合干预措施的安全性、可行性和可接受性。这 本提案的目标是提供一项有 60 名患者参加的为期两年的 1b 期随机对照试验 接受标准住宅物质使用治疗，将 ASTH 与模块相结合 改良的健康关系（HR；旨在减少危险性行为的简短干预；Kalichman 等 aI., 2001) 到非指导性治疗 (NT+HR)，重点关注退出治疗后的物质使用结果 从住院治疗到住院治疗后 3 个月内复发，以及 在此期间参与艾滋病毒风险行为，包括注射吸毒和危险性行为。