COMPARING COMPLEMENTARY BEHAVIOR THERAPIES

描述：（申请人摘要） 长期使用可卡因和其他物质的病人接受 美沙酮替代疗法大大降低了这种治疗的效果。 干预 以社区为基础的治疗方案需要新的和 加强美沙酮治疗效能的有效策略 通过减少可卡因和其他通常 伴随着海洛因的使用 两种类型的禁欲导向行为 强化程序在实现 提高禁欲率，无疑将转化为改善 在这一人群中的治疗保留。 一是或有凭证 激励措施（CVI），提供基于货币的代金券， 提交无毒品尿液标本。 第二种方法是 行为权变药物治疗（BCP），其中继续获得 在表现不佳的患者中维持美沙酮治疗取决于 参加每周一次的强化咨询， 无药物尿液样本。 本项目将比较 这两种治疗方法，并将评估它们的互补程度， 互相促进。 拟议的6个月随机临床试验（ 3-随访1个月）采用2 x 2析因设计， 评估这些行为的独立和综合疗效 对治疗结果的强化干预（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）的新入院美沙酮替代品 在一个社区诊所里。 本研究的具体目的是 目的：1）比较仅CVI和仅BCP的相对有效性 改善新入院患者治疗结果的方法; 2） 确定结合这些方法（CVI和BCP）是否更有效 比仅CVI、仅BCP或标准治疗干预更有效; 3）确定 在3个月随访期间，这些干预措施结果的稳定性 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 吸毒严重程度、性别和其他人口统计学特征）， 治疗结果。 这项研究将有意义地扩展过去的研究， 经验性地评估这两种方法的组合和互补功效 通过直接比较其独立功效来测试干预措施。 它 还针对更广泛的滥用药物，并评估 比以前的研究更长的时间。 由于该项目将 在以社区为基础的治疗计划中进行， 提高研究结果对其他国家患者的普遍性， 基于社区的方案。

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.