EVALUATION OF TREATMENTS OF DRUG DEPENDENCE IN HIV INFECTED PATIENTS

该科继续调查药理学和行为学。 药物滥用的治疗以及这两种形式之间的互动 接受治疗的机会。这些研究的一个主要目标是消除毒品 使用可卡因和/或减少艾滋病毒传播的可能性 海洛因依赖者。几乎所有研究的人群都注射了 毒品，感染和传播艾滋病毒感染的风险很高。 药物滥用的两种主要非药物治疗，应急 管理和认知/行为疗法，正在评估中。 我们实验室的早期研究表明，节欲 增援应急有效地产生了显著的 在市中心戒除可卡因和鸦片类药物的时期， 静脉注射、多药滥用者接受标准美沙酮维持治疗 治疗。药物滥用的认知/行为咨询方法 我们实验室开发的治疗方法正在整合到 行为应急管理计划，以增加持续时间 仅通过鼓励的行为治疗产生的戒断 药物使用和其他艾滋病毒危险行为的长期变化。在过去 一年来我们扩大了应急管理的应用范围 提高纳曲酮维持治疗依从性的技术。 非身体依赖阿片类药物滥用者在一名门诊患者中登记 治疗研究计划，随机分成3组，分别接受 服用纳曲酮的代金券奖励(特遣队组)，代金券 不依赖纳曲酮摄入(非应急组)，或不使用代金券 (对照组)。这些代金券可以兑换成商品和服务。 结果显示，给出的凭单取决于纳曲酮 选择性摄取增加对纳曲酮的依从性 给药方案。在医学监督下戒除阿片类药物 是一种常用的治疗方法，但在建立 长期禁欲。启动纳曲酮维持程序 戒断期间的治疗已经被开发出来，以提供更多 有效的戒断后治疗，包括药物治疗 使用阿片类拮抗剂治疗。纳曲酮开始给药 在为期四天的丁丙诺啡戒毒方案的第二天 与仅丁丙诺啡相比，仅产生适度的阿片类药物戒断 在完成四天后启动纳曲酮维护的组 丁丙诺啡疗法。未来的努力将指向 丁丙诺啡-纳曲酮停药方案与门诊患者的联系 加强应急管理的非药物或纳曲酮治疗 维持治疗依从性和禁欲，降低艾滋病毒风险 行为。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and interactions between these two forms of treatments. A primary objective of these studies is to eliminate drug use and decrease the probability of HIV transmission in cocaine- and/or heroin-dependent patients. Nearly all of the population studied inject drugs and are at high risk for contracting and spreading HIV infection. Two major non-pharmacological treatments of substance abuse, contingency management and cognitive/behavioral therapy, are under evaluation. Earlier research in our laboratory has shown that abstinence reinforcement contingencies are effective in producing significant periods of abstinence from cocaine and opiates in inner-city, intravenous, polydrug abusers receiving standard methadone maintenance treatment. A Cognitive/Behavioral counseling approach to substance abuse treatment developed in our laboratory is being integrated into the behavioral contingency management program to increase the duration of abstinence produced by the behavioral treatment alone by encouraging long-term changes in drug use and other HIV risk behaviors. In the past year we have extended the application of the contingency management technique to improving compliance with naltrexone maintenance treatment. Non-physically dependent opioid abusers were enrolled in an outpatient treatment research program and randomized to 3 groups who received either voucher incentives for ingesting naltrexone (Contingent Group), vouchers independent of naltrexone ingestion (NonContingent Group), or no vouchers (Control Group). The vouchers were exchangeable for goods and services. The results showed that the vouchers given contingent on naltrexone ingestion selectively increased adherence to the naltrexone administration regimen. Medically supervised withdrawal from opioids is a commonly used treatment but is usually not effective in establishing long-term abstinence. A procedure for initiating naltrexone maintenance during withdrawal treatment has been developed to provide a more effective post-withdrawal treatment that includes pharmacological treatment with opioid antagonists. Naltrexone administration initiated on Day 2 of a four-day buprenorphine regimen for heroin detoxification produced only moderate opiate withdrawal compared to a buprenorphine-only group that initiated naltrexone maintenance four days after completion of the buprenorphine regimen. Future efforts will be directed toward linking the buprenorphine-naltrexone withdrawal regimen with outpatient drug-free or naltrexone treatment enhanced with contingency management to maintain treatment compliance and abstinence and decrease HIV risk behaviors.