EVALUATION OF NON-PHARMACOLOGICAL TREATMENTS OF SUBSTANCE ABUSE

该科继续调查两个主要的非药理学 药物滥用的治疗。去年，一个项目完成，展示了 一种行为干预，即应急管理，在 减少一组美沙酮维持患者的可卡因使用。 应急管理组的患者基本上实现了 持续戒除可卡因的时间比 一组戴着轭的对照组。后续研究正在进行中，以完善 加强协议，以提高启动和维护率 禁欲。最初的增援计划被设计为升级 在价值上，激励随着患者时间的长短而增长 节欲在增长。因此，有强烈的动机留下来 节欲。然而，凭单的初始价值很小，而且 许多受试者从未达到最初的禁欲。在当前 研究发现，对于头几个可卡因阴性的尿液，增加了奖励 然后淡出，以增加科目达到的比例 节制；不断升级的激励价值被保留下来 禁欲。 应急管理程序也在第二个月开始实施 提高纳曲酮治疗依从性的研究。临床 经验表明，纳曲酮治疗的依从性往往 非常差，严重影响了它的临床应用。目的 这项研究的目的是测试应急管理的有效性 改善患者纳曲酮治疗的依从性。 咨询是几乎所有药物滥用治疗的重要因素； 因此，需要对咨询程序进行标准化和评估 要建立有效的治疗，咨询是否是唯一的 治疗或与药物治疗相结合。为期12周的 完成了一项研究，在这项研究中，标准化个人的功效 实施认知/行为/人际咨询计划 根据指定的治疗手册，每周给药两次，一次 每周或每两周进行一次比较。结果衡量标准包括 可卡因和其他药物使用(通过自我报告和尿毒学)，可卡因 渴望、心理状态和心理社会功能。初步 分析表明，在两次考试中，最初的辍学人数较少 一周治疗组，但用药情况无明显差异 治疗12周后两组间的结果测量。这个 目前正在对手册进行改编，以便在团体治疗形式中使用。

The section has continued to investigate two major non-pharmacological treatments of substance abuse. Last year a project was completed showing that a behavioral intervention, contingency management, was effective in decreasing cocaine use among a group of methadone maintenance patients. Patients in the contingency management group achieved substantially longer periods of sustained abstinence from cocaine use than persons in a yoked control group. A follow-up study is underway to refine the reinforcement protocol to improve rates of initiation and maintenance of abstinence. The original reinforcement schedule was designed to escalate in value so that the incentive grew as the length of time that patients were abstinent grew. Thus, there was a strong incentive to remain abstinent. The initial value of the vouchers, however, was small, and a number of subjects never achieved initial abstinence. In the current study, a bonus was added for the first few cocaine-negative urines and then faded out in order increase the proportion of subjects achieving abstinence; the escalating incentive value was retained to maintain abstinence. The contingency management procedure is also being applied in a second study to improve compliance with naltrexone treatment. Clinical experience has shown that compliance with naltrexone treatment tends to be very poor, seriously compromising its clinical utility. The purpose of the study is to test the efficacy of contingency management for improving patient compliance with naltrexone treatment. Counseling is an important element of virtually all drug abuse treatment; thus standardization and evaluation of counseling procedures is needed to establish effective treatment, whether counseling is the sole treatment or is given in combination with pharmacotherapy. A 12-week study was completed in which the efficacy of a standardized individual Cognitive/Behavioral/Interpersonal counseling program administered according to a specified therapy manual, given either twice weekly, once weekly, or every two weeks, were compared. Outcome measures included cocaine and other drug use (by self-report and urine toxicology), cocaine craving, psychological state, and psychosocial functioning. Preliminary analysis indicated that there were fewer initial drop-outs in the twice a week treatment group, but no significant differences in drug use outcome measures between groups after twelve weeks of treatment. The manual is currently being adapted for use in a group treatment format.