BEHAVIORALLY-CONTINGENT PHARMACOTHERAPY FOR OPIOID DEPENDENCE

已经进行了大量的研究来改善 接受美沙酮替代治疗的患者的治疗反应。 由于艾滋病毒的高感染率，这项工作变得至关重要 与药物滥用有关的传播和越来越多的 对标准美沙酮治疗反应差的患者。这个趋势 与美沙酮替代计划相似的是更差的结果 严重可卡因的流行和治疗中的其他药物使用问题 寻找阿片类药物滥用者。 尽管现在的研究表明，许多形式的心理社会治疗可以 增强对美沙酮药物治疗的反应，他们也揭示了有限的 当向患者提供这些服务时，患者的兴趣和就诊率较低。 这个问题说明了对更新的服务交付模式的需求 确保参与必要的心理社会治疗，以最大限度地 对药物治疗的反应。为了有效，这些新的模式 治疗也必须在不损害治疗的情况下取得成功。 留存。 左旋乙酰美沙醇(LAAM)用于阿片类药物维持的批准 治疗提出了另一个需要评估的重要问题--是否 用一种药物(即美沙酮)进行有效的心理社会治疗 将在其他药物疗法中保持其疗效。我们之前 展示了一种新的治疗提供模式的有效性 阿片类药物滥用者通过使阿片类药物 美沙酮的持续使用最终取决于咨询 出席和短暂的禁欲。在建议的研究中，我们 将评估这种治疗在一组新的阿片类药物中的疗效 施虐者在LAAM上被诱导和维护，这有非常不同的 临床用药报告时间表可能与 行为干预驱赶治疗方法。 总共220名患者将被随机分配到我们的专科 治疗或标准护理对照组，评估在10分以上 一个月的期限，包括一个月的基线和三个月的后续。 主要结果衡量标准包括咨询出勤率、自我评价 报告和客观衡量的药物使用、艾滋病毒危险行为比率 改变，和治疗保留。这项研究还将提供信息 关于个体差异的影响(例如，精神病患者-- 发病率、个性、变化阶段)对LAAM替代的反应 当它与或独立于以下物质一起或单独使用时 定期的咨询服务。

An impressive number of studies have been conducted to improve the treatment response of patients receiving methadone substitution therapy. This work has become critically important because of the high rate of HIV transmission associated with drug abuse and the increasing number of patients responding poorly to standard methadone treatment. The trend toward poorer outcomes across methadone substitution programs parallels the epidemic of severe cocaine and other drug use problems in treatment seeking opioid abusers. Although studies now show that many forms of psychosocial treatments can enhance response to methadone pharmacotherapy, they also reveal limited interest and poor attendance when patients are offered these services. This problem illustrates the need for newer service delivery models that ensure participation in the psychosocial treatments necessary to maximize response to the pharmacotherapies. To be effective, these new models of treatment must also achieve success without doing harm to treatment retention. The approval of levo alpha acetyl methadol (LAAM) for opioid maintenance therapy raises yet another question that is important to evaluate- whether effective psychosocial treatments with one medication (i.e., methadone) will retain their efficacy across other pharmacotherapies. We previously demonstrated the effectiveness of a new treatment delivery model for opioid abusers that produced excellent clinical outcomes by making the continued availability of methadone ultimately contingent on counseling attendance and brief episodes of abstinence. In the proposed study, we will evaluate the efficacy of this treatment in a new group of opioid abusers inducted and maintained on LAAM, which has a very different clinical medication reporting schedule that might interact with the behavioral interventions driving out treatment approach. A total of 220 patients will be randomly assigned to our specialized treatment or a standard care comparison group and evaluated over a 10 month period, including a month baseline and a three month follow-up. Major outcome measures include rates of counseling attendance, self- reported and objectively measured drug use, rates of HIV risk behavior change, and treatment retention. The study will also provide information about the influence of individual differences (e.g., psychiatric co- morbidity, personality, stages of change) on response to LAAM substitution when it is administered either contingently with, or independently of, scheduled counseling services.