OUTPATIENT TREATMENT FOR IV DRUG ABUSERS

门诊非药物(非美沙酮)治疗是使用最广泛的 现有的药物滥用治疗方式。然而，它已经收到了 对研究和开发工作的关注少得不成比例。 特别需要门诊护理的一群人最近戒毒了 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，但仍面临 如果他们出院后立即重新吸毒，就会感染艾滋病毒。 参加继续护理将会改善预后。然而，利率 从戒毒计划转诊后开始门诊治疗 出人意料的低，在门诊治疗中的保留率非常低 可怜。这项服务研究资助计划的目的是 L)海洛因静脉吸毒者转业办法 海洛因和可卡因从戒毒到门诊善后治疗 服务，2)留住这些病人进行善后治疗的方法 一旦他们与程序联系，以及3)防止复发的方法 在短暂的住院戒毒期之后的药物使用。研究1将 在静脉注射队列(N=150)中记录超过6个月的自然主义结果 吸毒者在医学监督下戒毒3天后出院 计划以确定他们戒毒后治疗的范围和持续时间 入学以及药物使用、社会适应和艾滋病毒风险暴露 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、护送 转诊和日常护理转诊)患者戒毒后接触和 随后留存在门诊的非药物治疗。研究3将 评估两种药物对治疗保留的单独和联合影响 实际干预--交通服务和奖励支付-- 旨在促进门诊治疗中的留存，这通常是 非常穷。最后，研究4将a)评估治疗效果。 先前显示的戒酒激励程序的保留和使用 对可卡因滥用者的门诊治疗有效，b)评估效果 以社区强化为蓝本的密集行为咨询 先前证明对酗酒者的门诊治疗有效的方法 和可卡因滥用者，以及c)决定行为的程度 咨询增强了禁欲激励程序的好处 旨在直接影响吸毒者实现预期目标 结果目标。总体而言，这一赠款项目将提供有价值的新 关于吸引和留住IV的方法的有效性的信息 吸毒者在门诊戒毒治疗中实现复吸 预防目标。从患者获得的治疗结果数据 从医学监督戒毒治疗过渡到 门诊后护理，将有更广泛的应用来改善任何 门诊无毒救治服务。生成的数据将具有 对关于最有效的消费方式的政策辩论的影响 有限的资源，以实现门诊患者的最佳效果 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.