COMPARING COMPLEMENTARY BEHAVIOR THERAPIES

描述：(申请人摘要) 接受治疗的患者持续使用可卡因和其他物质 美沙酮替代疗法大大降低了这种疗法的疗效。 干预。基于社区的治疗方案需要新的和 提高美沙酮疗效的有效策略 通过减少可卡因和其他药物的使用进行治疗 伴随着海洛因的使用。两种类型的禁欲导向行为 加固程序在实现以下目标方面显示出相当大的希望 节欲比率的提高无疑会转化为节欲的改善 这一人群中的治疗滞留。第一种是或有凭证 激励(CVI)，提供基于货币的凭证，视情况而定 提交不含药物的尿样。第二种方法是 行为条件药物疗法(BCP)，在这种疗法中，继续获得 对表现不佳的患者进行美沙酮维持取决于 参加强化的每周咨询并随后提交 不含药物的尿样。该项目将比较两种方法的效率 这两种疗法，并将评估它们在多大程度上互补和 相互促进。拟议的为期6个月的随机临床试验(包括 3个月的随访期)采用2x2析因设计 评估这些行为的独立和综合效果 关于治疗结果的强化干预措施(例如，治疗 药物使用和艾滋病毒药物使用的保留、客观和自我报告指数 和性危险行为)新入院的美沙酮替代品 在以社区为基础的诊所进行计划。这项研究的具体目的是 要：1)比较仅使用CVI和仅使用BCP的相对有效性 改善新入院患者治疗结果的方法；2) 确定结合使用这些方法(CVI和BCP)是否更有效 而不是仅使用CVI、仅使用BCP或标准治疗干预；3)确定 3个月随访期间这些干预措施结果的稳定性 期间；以及4)确定个体差异之间的关联 变量(反社会人格和其他精神障碍、指数 毒品使用严重程度、性别和其他人口统计特征)和 治疗结果。这项研究将有意义地扩展过去的研究，通过 经验性地评价这两者的联合和互补效果 通过直接比较它们的独立疗效来测试干预措施。它 还针对更广泛的药物滥用和评估结果 持续时间比以前的研究更长。由于该项目将是 在以社区为基础的治疗计划中进行，它也有可能 增强研究结果对其他国家患者的普适性 基于社区的计划。

DESCRIPTION: (Applicant's Abstract) The persistent use of cocaine and other substances by patients receiving methadone substitution therapy is greatly reducing the efficacy of this intervention. Community-based treatment programs are in need of new and effective strategies to enhance the therapeutic potency of methadone treatment by reducing the use of cocaine and other drugs that typically accompany heroin use. Two types of abstinence-oriented behavioral reinforcement procedures have shown considerable promise in achieving increased abstinence rates that will undoubtedly translate into improved treatment retention in this population. The first is contingent voucher incentives (CVI), which offers monetary-based vouchers contingent on submission of drug-free urine specimens. The second approach is behaviorally contingent pharmacotherapy (BCP), in which continued access to methadone maintenance among poorly performing patients is contingent on attending intensified weekly counseling and subsequent submission of drug-free urine specimens. This project will compare the efficacies of these two treatments and will assess the extent to which they complement and enhance one another. The proposed 6-month randomized clinical trial (with a 3-month follow-up) utilizes a 2 x 2 factorial design to systematically evaluate the independent and combined efficacy of these behavioral reinforcement interventions on treatment outcomes (e.g., treatment retention, objective and self-report indexes of drug use, and HIV drug use and sexual risk behaviors) of new admissions to a methadone substitution program in a community-based clinic. The specific aims of this study are to: 1) compare the relative effectiveness of CVI-only and BCP-only approaches for improving the treatment outcome of new admissions; 2) determine whether combining these approaches (CVI and BCP) is more effective than CVI-only, BCP-only, or a standard treatment intervention; 3) determine the stability of outcome for these interventions during a 3-month follow up period; and 4) determine the associations between individual difference variables (antisocial personality and other psychiatric disorders, indexes of drug use severity, gender and other demographic characteristics) and treatment outcomes. The study will meaningfully extend past research by evaluating the combined and complementary efficacy of these two empirically tested interventions by directly comparing their independent efficacy. It also targets a wider spectrum of drugs of abuse and assesses outcome over a longer duration of time than in previous studies. Since the project will be conducted in a community-based treatment program it also has the potential to enhance the generalizability of study findings to patients in other community-based programs.