CONTINGENCY MANAGEMENT FOR REAL-LIFE DRUG TREATMENT

尽管研究证明了基于凭证的应急管理（CM）干预措施对减少药物使用的有效性和患者可接受性，但社区提供者采用这些程序的速度很慢。采用管理管理程序的一个障碍是支持此类程序的高成本。然而，利用社区或用户支持的服务来加强戒毒或其他目标行为的新方法可能为CM项目的融资提供解决方案。该提案的具体目的是评估或有费用回扣和社区赞助的代金券计划，这是两种用于社区药物治疗计划的创新且具有潜在成本效益的CM策略。该项目的目标是使基于凭证的应急管理研究所揭示的强大成功具有足够的实用性，以便社区从业者进行广泛的测试和采用。这些策略将在科罗拉多州丹佛市一个大型城市门诊药物滥用服务中心的三个公共资助诊所进行检查。四项对照研究将评估这些技术在一系列药物滥用者中的使用，包括双重诊断，孕妇，艾滋病毒阳性人群和儿童，以增加我们研究结果的普遍性。研究1-3将提供对改善美沙酮和laam维持的门诊患者治疗结果的或有费用回扣的检查。研究4将评估一个社区赞助的代金券计划，该计划利用社区和制造商捐赠的奖励商店来减少怀孕药物滥用者的吸烟和其他药物使用。建立社区赞助的代金券计划加强了社区在药物滥用治疗中的作用。拟议的研究将使用不同的CM策略来阐明最实用和有效的强化计划（固定与可变）和最佳目标行为（药物使用与咨询出席）。研究将整合到现有的临床项目结构中，以证明将CM程序转移到现有社区项目的可行性。行为干预将与每个地点可用的药理学辅助手段一起提供。我们还将评估我们的干预措施对减少艾滋病风险行为的影响。最后，在该计划实施的五年时间里，我们将培训新的从业人员如何使用这些策略，并与NIDA合作制作培训材料，如手册、软件、视频和详细的筹款策略，以便向临床医生和政策制定者传播。总的来说，这些研究将指导从业者在现实生活中使用CM进行药物滥用治疗。

Despite research demonstrating the efficacy and patient acceptability of voucher-based contingency management (CM) interventions for reducing drug use, community providers have been slow to adopt these procedures. One barrier to adoption of CM procedures is the high cost of supporting such programs. However, novel approaches using community- or user-supported services to reinforce drug abstinence or other target behaviors may offer a solution for financing CM programs. The specific aims of this proposal are to evaluate Contingent Fee Rebates and a Community-Sponsored Voucher Program, two innovative and potentially cost-effective CM strategies for use in community-based drug treatment programs. This project's goal is to make the robust success revealed by voucher-based contingency-management research practical enough for widespread testing and adoption by community-based practitioners. These strategies will be examined in three publicly-funded clinics within a large, urban, outpatient substance abuse service in Denver, CO. Four controlled studies will evaluate the use of these techniques with a range of substance abusers, including dually-diagnosed, pregnant, HIV-positive populations and children to increase the generality of our findings. Studies 1-3 will provide an examination of Contingent Fee Rebates for improving treatment outcomes among methadone-and LAAM-maintained outpatients. Study 4 will evaluate a community-sponsored voucher program for reducing smoking and other drug use among pregnant substance abusers using an incentive store stocked by community and manufacturer donations. Establishing a community-sponsored voucher program reinforces the role of the community in substance abuse treatment. The proposed research will use different CM strategies to elucidate the most practical and effective reinforcement schedules (fixed vs. variable) and the optimal target behaviors to reinforce (drug use vs. counseling attendance). Studies will be integrated into the existing structure of clinical programs to demonstrate the feasibility of transferring the CM procedures to existing community-based programing. Behavioral interventions will be delivered in conjunction with pharmacological adjuncts available at each site. The impact of our interventions on reducing AIDS risk behaviors will also be assessed. Finally, throughout the five years of this proposal, we will train new practitioners in the use of these strategies and work with NIDA to create training materials such as manuals, software, videos and detailed fundraising strategies for dissemination to clinicians and policy makers. Overall, these studies will guide practitioners in the use of CM for real-life drug abuse treatment.