Contingency Management for the Treatment of Co-Occurring Alcohol and Opiate Use

处方阿片类药物滥用与酒精依赖密切相关，这两种情况对美国印第安人（Al）社区造成不成比例的伤害。应急管理（CM）是一种行为干预，旨在增加药物戒断，已与减少阿片类药物的使用在一些研究。CM在治疗1）酒精使用障碍; 2）多种物质使用障碍;和3）土著人群方面研究不足。以前对酒精依赖的CM研究使用了酒精呼吸测试，这些测试只能检测12小时的使用情况。由于呼吸测试无法检测临床评估之间的使用，因此其使用导致干预措施的不一致。我们提出了一项研究，通过使用基于上级酒精测量的CM范式（乙基葡萄糖醛酸苷尿液测试）来解决这一关键方法障碍，该测试可以在发生后2天或更长时间检测酒精使用情况。 本研究的目的是进行一项随机对照试验，以评估文化定制的CM干预的能力，以增加来自2个保留地的Al部落成员的酒精和阿片类药物戒断。蒙大拿州的派克堡和华盛顿州的奎诺特。酒精依赖和处方阿片类药物滥用的寻求治疗的个体将被随机分配到4组中的1组，接受以下治疗： (1)CM代表酒精，（2）CM代表阿片类药物。(3)两种物质的CM，或（4）两种物质均无CM。我们的目的是确定（1）随机分配到CM条件的参与者是否比非偶然（NC）对照组使用更少的酒精和阿片类药物，（2）与单一物质CM组或NC对照组的参与者相比，干预是否对接受CM的参与者更有效。(3)二次成瘾相关结果和酒精和阿片类药物相关健康损害行为的组间差异。这项研究具有创新性，有可能改善公众健康。通过与部落社区合作适应，实施和评估这项试验，我们将增加我们的部落伙伴对循证成瘾治疗和研究的了解，同时提高他们对Al社区成瘾干预措施的信任。

Prescription opiate drug misuse is strongly associated with alcohol dependence, and both conditions cause disproportionate harm to American Indian (Al) communities. Contingency management (CM) is a behavioral intervention designed to increase drug abstinence that has been associated with reduced opiate use in a number of studies. CM is understudied in the treatment of 1) alcohol use disorders; 2) polysubstance use disorders; and 3) Native populations. Previous studies of CM for alcohol dependence have used alcohol breath tests that are capable of detecting use for only 12 hours. Because breath tests cannot detect use between clinical assessments, their use leads to inconsistent delivery of interventions. We propose a study that will address this critical methodological barrier by using a CM paradigm based on a superior alcohol measure, ethyl glucuronide urine tests, which can detect alcohol use 2 or more days after it has occurred. The goal of this study is to perform a randomized, controlled trial to evaluate the ability of a culturally-tailored CM intervention to increase alcohol and opiate abstinence among Al tribal members from 2 reservations. Fort Peck in Montana and Quinault in Washington State. Treatment-seeking individuals with alcohol dependence and prescription opiate misuse will be randomized into to 1 of 4 groups that will recelive: (1) CM for alcohol, (2) CM for opiates. (3) CM for both substances, or (4) no CM for either substance. We aim to determine (1) whether participants randomized to CM conditions use less alcohol and opiates than those in the noncontingent (NC) control group, (2) whether the intervention is more effective for participants receiving CM for both alcohol and opiate abstinence, compared to participants in the single-substance CM groups or the NC control group. (3) group differences in secondary addiction-related outcomes and alcoholand opiate-associated health-Impairing behaviors. The proposed research Is innovative and has the potential to improve public health. By partnering with tribal communities to adapt, implement, and evaluate this trial, we will increase our tribal partners' knowledge of evidence-based addiction treatments and research, while improving their trust for addiction interventions in Al communities.