EVALUATION OF TREATMENTS OF OPIOID AND COCAINE DEPENDENCE

该科继续调查药物滥用的药理和行为治疗方法，并探索治疗方法的组合。NIDA/IRP治疗研究已经证明，行为干预(加强可卡因阴性尿样)在市中心静脉注射多药滥用者的大样本中是有效的。最近完成的一项研究评估了行为干预是否可以通过最初加强戒酒的中间步骤(降低尿液中可卡因代谢物浓度)来变得更有效。在整个研究过程中，所有患者都接受了每日口服美沙酮维持(50毫克/天)和每周咨询。在为期5周的基线治疗后，继续使用可卡因的患者被随机分配到两个为期8周的干预措施中的一个：1)根据可卡因阴性尿样的代金券(戒毒组)；或2)根据可卡因代谢物浓度与之前的样本相比至少下降50%的代金券，持续3周，然后只对可卡因阴性的尿样进行5周的干预(逐步组)。收集观察的尿液样本，进行尿液定性和定量分析。代金券具有货币价值，可以兑换商品和服务。在为期8周的干预期间，两组的可卡因戒断率(可卡因阴性尿样的百分比)都有所增加。虽然循序渐进的计划是有效的，但强化计划似乎在产生可卡因戒断方面同样有效。在过渡到禁欲时间表时，逐步治疗组显示出在禁欲组中没有看到的显著额外改善。因此，循序渐进的时间表可能已经让患者为禁欲做好了准备。(Preston KL，Umbricht A，Wong C和Epstein D.药物依赖问题学院第61届年度科学会议，1999。)另一项NIDA/IRP研究证明了丁丙诺啡与纳曲酮缩短的阿片类药物脱毒的安全性、有效性和患者的可接受性。(Umbricht A，Montoya ID，Hoover DR，Demuth KL，Chiang CT，Preston KL.毒品和酒精依赖56(3)：181-190,1999。一项即将完成的研究将应急管理方法(加强可卡因阴性尿液)与我们诊所开发的认知行为复发预防疗法相结合；研究人员假设，应急管理将创造一个禁欲的时间窗口，在此期间可以引入复发预防疗法，以促进更持久的行为改变。-药物滥用、药物滥用治疗、海洛因、鸦片、可卡因、美沙酮、应急管理、丁丙诺啡、纳曲酮-人类受试者

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. NIDA/IRP treatment studies have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine- negative urine samples) in large inner-city samples of intravenous polydrug abusers. One recently completed study evaluated whether a behavioral intervention could be made more effective by initial reinforcement of an intermediate step toward abstinence (decreases in urine cocaine metabolite concentration). Throughout the study, all patients received daily oral methadone maintenance (50 mg/day) and weekly counseling. Following a 5-week baseline treatment, patients who continued to use cocaine were randomly assigned to one of two 8-week interventions: 1) vouchers contingent on cocaine-negative urine specimens (abstinence group); or 2) vouchers contingent on at least a 50% decrease in cocaine metabolite concentration compared to the previous specimen for 3 weeks, then only for cocaine-negative urine specimens for 5 weeks (stepwise group). Observed urine specimens were collected MWF; qualitative and quantitative urinalysis was performed. Vouchers had monetary value and were exchangeable for goods and services. Cocaine abstinence (% cocaine-negative urine specimens) increased during the 8-week intervention in both groups. While the stepwise schedule was in effect, the reinforcement schedules appeared equally effective in producing cocaine abstinence. At the transition to the abstinence schedule, the stepwise-treatment group showed significant additional improvement not seen in the abstinence group. Thus, the stepwise schedule may have prepared patients for abstinence. (Preston KL, Umbricht A, Wong C, and Epstein D. 61st Annual Scientific Meeting of the College of Problems on Drug Dependence, 1999.) Another NIDA/IRP study demonstrated the safety, efficacy, and patient acceptability of naltrexone-shortened opioid detoxification with buprenorphine. (Umbricht A, Montoya ID, Hoover DR, Demuth KL, Chiang CT, and Preston KL. Drug & Alcohol Dependence 56(3): 181-190, 1999.) A study nearing completion combines the contingency-management approach (reinforcement of cocaine-negative urines) with a cognitive-behavioral relapse-prevention therapy developed at our clinic; the investigators hypothesize that contingency management will create a temporal window of abstinence during which relapse-prevention therapy can be introduced to foster more durable changes in behavior. - substance abuse, substance abuse treatment, heroin, opiates, cocaine, methadone, contingency management, buprenorphine, naltrexone - Human Subjects