TREATING COCAINE ABUSE--A BEHAVIORAL APPROACH

可卡因依赖可能仍然是美国严重的公共卫生问题

Cocaine dependence is likely to remain a serious U.S. public-health problem throughout the 1990's. In an effort to address that problem, we have been researching the efficacy of a multicomponent, outpatient treatment for cocaine dependence that is based on the principles of behavior analysis and behavioral pharmacology. This treatment effectively retains cocaine-dependent adults in outpatient treatment and engenders clinically-significant periods of continuous cocaine abstinence. The purpose of the studies proposed in this application is to analyze further which components of this multicomponent treatment contribute to the positive outcomes observed with it. Such dismantling studies are essential to the development of empirically-based and effective treatments for drug dependence, and are consistent with the research objectives outlined in RFA #DA-94-02 "Behavioral Therapies Development Program", which is the RFA to which we are responding. One of our prior trials demonstrated that an incentive program wherein patients earned vouchers exchangeable for retail items contingent on submitting cocaine-free urine specimens was an active component of this treatment. However, that study did not determine whether the incentives directly increased cocaine abstinence via reinforcement or acted indirectly by increasing treatment retention and the amount of services received and in that manner improved outcome. Study 1 of this application will systematically replicate our prior findings and extend them by dissociating effects on retention and cocaine abstinence. Study 2 will assess whether a disulfiram-therapy component used to treat alcohol abuse in this multiple-drug abusing population contributes to positive outcomes, and, if so, whether the medication-compliance procedures we use in implementing this therapy are an effective feature. Preliminary results from our clinic and others indicate that treating alcohol abuse in this cocaine-dependent population via disulfiram therapy and medication- compliance procedures significantly reduces drinking and cocaine use. Study 3 will assess whether including significant others in the treatment process improves outcome, and , if so, whether the behavioral-contracting procedures we use in this component are an effective feature. Preliminary results from our clinic indicate that including significant others in treatment and teaching them to use behavioral contracts significantly increases the probability of patients achieving clinically-significant periods of continuous cocaine abstinence. Each of the proposed trials will contribute important new information on the efficacy of specific components of this promising behavioral treatment for cocaine dependence. This information will permit us to empirically streamline this intervention down to its necessary components. Moreover, these studies will contribute to our longer-term goal of producing both a comprehensive treatment package and specific treatment components for dissemination as manual-guided and effective interventions for outpatient treatment of cocaine dependence.