Effectiveness of Extended Treatments for Drug Dependence

描述（由申请人提供）：本申请是对以下通知的回应：NIH宣布为竞争性修订申请提供恢复法案资金（NOT-OD-09-058）。有相当多的证据表明，对吸毒疾患的治疗可大大改善吸毒和心理社会问题的严重程度。然而，相当大比例的患者相对较快地退出，复发率很高，并且持续的护理往往不足或不可用。在我们的NIDA母基金中，我们正在测试两种延长的持续护理模式，旨在管理长达两年的患者。这些模式结合了联合收割机低水平的电话监测和咨询，与适应性的组成部分，以加强护理水平时，需要的。其中一种模式还包括对已完成的持续护理联系人的小额奖励。来自前250名参与者的数据表明，与没有激励措施的相同干预措施相比，这些激励措施产生了非常高的持续护理联系率（74%对52%的所有可能的持续护理联系完成）。对3个月、6个月、9个月和12个月时可卡因尿液毒理学样本的初步分析表明，两种延长护理干预措施都比常规门诊治疗产生了更好的结果。在母公司研究中，我们正在从公共资助的社区项目中招募有保险的患者。扩展的持续护理干预措施由一群训练有素且受到密切监督的辅导员提供。对于补充，我们建议将这种持续护理模式扩展到新的高风险人群，没有任何保险的内城居民，他们通过费城行为健康部门的特殊计划寻求可卡因依赖治疗。我们将培训城市电话护理管理人员，为进入该计划的患者提供我们的电话持续护理干预，提供12个月的定期监测，简短的咨询，病例管理和与社区支持的联系，并根据需要进一步转介治疗服务。我们将随机选择200名参与者接受这种干预或常规护理，并随访12个月。这一补充将提供一个更直接的测试，我们的持续护理模式是否可以成功地实施“真实的世界”公共资助的计划及其工作人员的辅助专业人员和辅导员，并将促进城市的转变为一个恢复为导向的，持续的成瘾治疗护理模式。宾夕法尼亚大学医学院为当地经济做出了巨大贡献。2008年，该校创造了37，000个就业机会和54亿美元的区域经济活动，该地区训练有素的劳动力为840个开放的宾夕法尼亚大学员工研究职位提供了24，600多份申请。目前的提案将创造或保留16个工作岗位。 公共卫生相关性：物质使用障碍的治疗通常包括相对短暂的护理，不能适当地解决这些障碍的慢性复发性。在父母补助金和其他先前的工作中，我们已经开发了一种基于电话的持续护理模式，该模式提供了扩展护理，并在几项精心控制的研究中证明了其有效性。拟议的补充将确定是否可以有效地使用这种持续护理协议的12个月版本在弱势可卡因依赖个人寻求治疗的公共资助，内城计划。

DESCRIPTION (provided by applicant): This application is in response to the following notice: NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (NOT-OD-09-058). There is considerable evidence that treatment for drug use disorders can lead to substantial improvements in substance use and psychosocial problem severity. However, a significant percentage of patients drop out relatively quickly, rates of relapse are high, and continuing care is often inadequate or unavailable. In our NIDA parent grant, we are testing two extended continuing care models designed to manage patients for up to two years. These models combine low-level telephone-based monitoring and counseling, with an adaptive component to step up level of care when needed. One of these models also includes small incentives for completed continuing care contacts. Data from the first 250 participants indicates these incentives produce very high rates of continuing care contact, compared to the same intervention without incentives (74% vs. 52% of all possible continuing care contacts completed). Preliminary analyses of cocaine urine toxicology samples at 3, 6, 9, and 12 months indicated that both extended care interventions are producing better outcomes than outpatient treatment as usual. In the parent study, we are recruiting insured patients out of publicly funded community programs. The extended continuing care interventions are provided by a group of highly trained and closely supervised counselors. For the supplement, we propose to extend this continuing care model into a new population of high risk individuals, inner city residents without any kind of insurance who seek treatment for cocaine dependence through a special program run by the City of Philadelphia's Behavioral Health Department. We will train city telephone care managers to deliver our telephone continuing care intervention to patients who enter this program, to provide 12 months of regular monitoring, brief counseling, case management and linkage to community supports, and further referral to treatment services as needed. We will randomize 200 participants to receive this intervention or usual care, and follow them up for 12 months. This supplement will provide a more direct test of whether our continuing care model can be implemented successfully by "real world" publicly funded programs and their staff of paraprofessionals and counselors, and will facilitate the City's transformation into a recovery-oriented, continuing care model of addiction treatment. The University of Pennsylvania School of Medicine contributes substantially to the local economy. In 2008, the School created 37,000 jobs and $5.4 billion in regional economic activity, with the area's highly trained workforce producing more than 24,600 applications for just 840 open Penn staff research positions. The current proposal will create or retain 16 jobs. PUBLIC HEALTH RELEVANCE: Treatment for substance use disorders generally consists of relatively brief episodes of care that do not properly address the chronic, relapsing nature of these disorders. In the parent grant and other prior work, we have developed a telephone-based continuing care model that provides extended care and has proved efficacious in several carefully controlled studies. The proposed supplement will determine whether a 12 month version of this continuing care protocol can be used effectively in disadvantaged cocaine dependent individuals seeking treatment in publicly funded, inner-city programs.