OUTPATIENT TREATMENT FOR IV DRUG ABUSERS

门诊无毒（非美沙酮）治疗是最广泛使用的 现有的药物滥用治疗方式。然而， 对研究和开发工作的关注不成比例。 一个特别需要门诊治疗的群体最近已经戒毒 静脉注射吸毒者。这些人已经利用了大量的 住院期间的治疗资源，但仍有风险， 艾滋病毒感染者，如果他们在出院后立即恢复吸毒。 预后将通过登记继续护理得到改善。然而， 从戒毒计划转介后开始门诊治疗 在门诊治疗中的保留率非常低， 扶贫这项服务研究补助金计划的目的是 调查l）海洛因静脉注射吸毒者的过渡方法，或 海洛因和可卡因从戒毒到门诊善后治疗 服务，2）将这些患者留在康复治疗中的方法 一旦他们进行了项目接触，以及3）预防复发的方法， 在短暂的住院戒毒期后的药物使用。研究1将 记录静脉注射队列（N = 150）6个月内的自然结局 戒毒者在三天医学监督下戒毒后出院 计划，以确定其戒毒后治疗的程度和持续时间 入学率以及吸毒、社会适应和艾滋病毒风险 结果。研究2将确定四种治疗过渡的影响 干预措施（承诺合同、应急合同、陪同 转介及日常护理转介），以了解病人在戒毒后曾接触及 随后继续门诊戒毒治疗。研究3将 评估两种药物单独和联合治疗对治疗保留的影响 实际干预措施-交通服务和奖励性付款- 旨在促进门诊治疗的保留，这通常是 很穷。最后，研究4将a）评估对治疗的影响 保留和药物使用的禁欲激励程序先前显示 对可卡因滥用者门诊治疗有效，B）评价效果 社区强化模式的强化行为咨询 以前的方法对酗酒者的门诊治疗有效 和可卡因滥用者和c）确定行为的程度 咨询增强禁欲激励程序的好处 旨在直接影响药物滥用者实现所需的 成果目标。总的来说，这个赠款项目将提供有价值的新的 关于吸引和留住人才的方法的有效性的信息iv 门诊戒毒治疗和实现复吸 预防目标。从患者中获得的治疗结果数据， 从医学监督戒毒治疗过渡到 门诊善后，将有更广泛的应用，以改善任何 门诊免费药物治疗服务。生成的数据将具有 对关于最有效支出方式的政策辩论的影响 有限的资源，以产生最好的结果，从门诊 药物滥用治疗服务。

Outpatient drug-free (non methadone) treatment is the most widely utilized of available drug abuse treatment modalities. Yet it has received disproportionately little attention in research and development efforts. One group particularly in need of outpatient care are recently detoxified i.v. drug abusers. These individuals have already utilized significant treatment resources during their inpatient stay, but remain at risk for HIV infection if they return immediately to drug use upon discharge. Prognosis would be improved by enrollment in continuing care. Yet rates of initiating outpatient treatment after being referred from a detox program are surprising low and retention in outpatient treatment is extremely poor. The purpose of this services research grant project is to investigate l) methods for transitioning iv drug abusers of heroin or heroin and cocaine from detoxification to outpatient aftercare treatment services, 2) methods for retaining these patients in aftercare treatment once they make a program contact and 3) methods for preventing relapse to drug use after the brief inpatient period of abstinence. Study 1 will document naturalistic outcomes over 6-months in a cohort (N = 150) of iv drug abusers discharged from a 3-day medically supervised detoxification program to determine the extent and duration of their post-detox treatment enrollment as well as drug use, social adjustment and HIV risk exposure outcomes. Study 2 will determine the impact of four treatment transition interventions (commitment contracting, contingency contracting, escorted referral and usual care referral) on patients' post-detox contact with and subsequent retention in outpatient drug-free treatment. Study 3 will evaluate separate and combined effects on treatment retention of two practical interventions- transportation service and incentive payment- designed to promote retention in outpatient treatment, which is typically very poor. Finally, Study 4 will a) evaluate effects on treatment retention and drug use of abstinence incentive procedures previously shown effective for outpatient treatment of cocaine abusers, b) evaluate effects of intensive behavioral counseling modeled on the Community Reinforcement Approach previously shown effective for outpatient treatment of alcoholics and cocaine abusers and c) determine the extent to which behavioral counseling enhances the benefits of abstinence incentive procedures designed to directly influence drug abusers toward achieving desired outcome goals. Overall, this grant project will provide valuable new information about the effectiveness of methods to attract and retain iv drug abusers in outpatient drug-free treatment and to achieve relapse prevention goals. The treatment outcome data obtained from patients making the transition from medically supervised detoxification treatment to outpatient aftercare, will have broader application for improving any outpatient drug-free treatment service. The data generated will have implications for policy debates about the most effective way to spend limited resources in order to produce the best results from outpatient drug abuse treatment services.