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。 由于艾滋病毒感染率很高， 与药物滥用有关的传染以及 对标准美沙酮治疗反应不佳的患者。趋势 在美沙酮替代方案中， 治疗中严重可卡因和其他药物使用问题的流行 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 病人对这些服务不感兴趣和出勤率低。 这个问题说明了需要更新的服务交付模式， 确保参与必要的心理社会治疗， 对药物治疗的反应。为了有效，这些新的模型 治疗还必须在不损害治疗的情况下取得成功 潴留 批准左旋α乙酰美沙酮（LAAM）用于阿片类药物维持治疗 治疗提出了另一个重要的问题，以评估-是否 用一种药物进行有效的心理社会治疗（即，美沙酮） 将在其他药物治疗中保持其疗效。我们之前 证明了一种新的治疗模式的有效性， 阿片类药物滥用者，通过使 美沙酮的持续供应最终取决于咨询 出席和短暂的禁欲。在这项研究中，我们 将评估这种治疗在一组新的阿片类药物中的疗效。 滥用者在LAAM上导入和维护，这有一个非常不同的 临床用药报告时间表可能与 行为干预驱逐治疗方法。 共有220名患者将被随机分配到我们的专业 治疗组或标准治疗对照组，并在10 一个月的时间，包括一个月的基线和三个月的随访。 主要的结果指标包括咨询出席率，自我， 报告和客观衡量的药物使用率，艾滋病毒风险行为率 改变和治疗保留。该研究还将提供信息， 关于个体差异的影响（例如，精神科合 发病率、个性、变化阶段）对LAAM替代反应的影响 当其与以下药物一起或独立给药时， 定期咨询服务。

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.