EVALUATION OF TREATMENTS OF DRUG DEPENDENCE IN HIV INFECTED PATIENTS

该项目评估了药理学和 艾滋病毒感染者阿片类药物依赖的行为治疗， 在降低高风险HIV传播行为的方法中， 药物滥用者 艾滋病的流行已迅速扩展到注射 吸毒者，其中许多人依赖阿片类药物;这些患者代表 对医疗保健系统的挑战，因为他们需要医疗保健， 因慢性疾病住院治疗。 戒断症状 代表可能对结果产生负面影响的额外压力， 对病情恶化的病人进行治疗 我们目前正在 进行一项研究，比较可乐定的有效性， 美沙酮和丁丙诺啡用于短期阿片类药物解毒， 制定阿片依赖者阿片解毒指南 因急性艾滋病相关疾病住院的患者。 主观 记录客观测量，包括戒断和疼痛 变量 假设接受丁丙诺啡的患者 会表现出较低的戒断和疼痛评分， 行为。 本研究设计为双盲、双模拟， 口服可乐定、口服美沙酮和父母的随机试验 丁丙诺啡（IM）用于短期阿片类药物解毒。 第二项研究正在进行中，以检查持续的艾滋病毒保护是否 行为可以通过增加认知行为应对技能来实现 和复吸预防干预，以凭单为基础的应急 管理 在一项随机临床试验中使用了市中心的美沙酮- 维持可卡因依赖的受试者，患者将被教导自我， 控制技巧：1）增加非药物强化源， 与药物使用的强化作用竞争; 2）发展 以问题为中心和以情绪为中心的适应性应对反应， 与吸毒和艾滋病毒有关的特定毒品和一般生活压力因素 风险传递。

This project assesses the safety and efficacy of pharmacological and behavioral treatments of opioid dependence in HIV-infected patients and in methods for decreasing high risk HIV transmission behaviors in substance abusers. The AIDS epidemic has rapidly extended to injection drug users, many of them dependent on opioids; these patients represent a challenge to the health care system, as they require medical care and hospitalization for chronic medical disorders. Withdrawal syndromes represent added stresses that may negatively affect the outcome of medical treatments in compromised patients. We are currently conducting a study to compare the effectiveness of clonidine, methadone, and buprenorphine for short opioid detoxification and to develop guidelines for opioid detoxification in opioid-dependent patients, hospitalized for acute AIDS-related illnesses. Subjective and objective measures are recorded, including withdrawal and pain variables. The hypothesis is that patients receiving buprenorphine will show lower withdrawal and pain scores and fewer disruptive behaviors. The study is designed as a double-blind, double-dummy, randomized trial of oral clonidine, oral methadone and parental buprenorphine (IM) for short opioid detoxification. A second study is under way to examine whether sustained HIV protective behavior can be achieved by adding a cognitive-behavioral coping skills and relapse prevention intervention to voucher-based contingency management. In a randomized clinical trial with inner city methadone- maintained cocaine-dependent subjects, patients will be taught self- control skills: 1) to increase non-drug sources of reinforcement to compete with reinforcing effects of drug use; and 2) to develop adaptive problem-focused and emotion-focused coping responses to manage drug specific and general life stressors related to drug use and HIV risk transmission.