Effectiveness and Costs of Enhanced Cocaine Treatments

描述：（申请人摘要） 虽然有证据表明标准的门诊治疗可以有效 对于一些可卡因依赖患者，早期治疗退出率和 复发率仍然相对较高。最近的研究表明， 为同时存在的精神、人际和就业问题提供服务 可以改善患者的物质使用结果，特别是如果他们有 这些领域的问题更加严重。这种方法的前提是 这些领域专业提供的服务有助于“消除 障碍”，以恢复患者的共同发生的疾病。一个独立 一系列的研究已经产生了大量的证据， 以代金券形式加强，视提供无毒尿液而定 可以兑换商品和服务的样品也可以改善 物质使用的结果。这些发现表明， 概念上和理论上不同的，基于行为的途径， 改善药物滥用者的治疗效果。我们建议评估 这两种方法对可卡因依赖患者谁也将接受 在门诊社区治疗计划中“照常治疗”。因为 不同的所谓机制的变化，在服务匹配， 问题和代金券条件，研究将采用2X2设计， 评估两种干预措施的潜在叠加效应。治疗 研究中的条件如下：a）常规治疗（TAU）：B） 强化（TAU+V）：c）针对问题提供服务（TAU+S）d）服务 匹配问题加凭证（TAU+SV）研究的治疗阶段 将持续六个月，患者将被随访一年。 将进行有效性和效益-成本分析。关于 有效性，一个主要的影响凭证期间预测， 治疗期内。在治疗后随访期间， 假设与问题和凭证条件相匹配的服务， 沿着交互作用。具体来说，TAU+V和TAU+S条件 假设比TAU产生更好的可卡因使用结果， 两种干预措施的组合（TAU+SV）预计将产生更好的 与TAU+V或TAU+ S相比，在成本效益方面， 假设TAU+S和TAU+V干预措施具有成本效益，因为 与常规治疗相比，预计TAU+SV具有成本效益 与TAU+S和TAU+ V进行比较。分析还将比较 专业服务与凭证强化。其他分析将 确定对TAU+V和TAU+S条件响应的预测因子，并测试 预测可能的作用机制。

DESCRIPTION: (Applicant's Abstract) Although there is evidence that standard outpatient treatment can be effective for some patients with cocaine dependence, rates of early treatment dropout and relapse remain relatively high. Recent studies have indicated that the addition of services for concurrent psychiatric, interpersonal, and employment problems can improve substance use outcomes for patients, particularly if they have greater problem severity in these areas. This approach is predicated on the idea that professionally-delivered services in these areas help "remove the barriers" to recovery in patients with co-occurring disorders. An independent line of research has generated considerable evidence that providing reinforcement in the form of vouchers, contingent on providing drug-free urine samples that can be redeemed for goods and services can also lead to improved substance use outcomes. These findings suggest that there may be two conceptually and theoretically different, behaviorally-based avenues for improving treatment outcomes for substance abusers. We propose to evaluate these two approaches for cocaine dependent patients who will also receive "treatment as usual" in an outpatient community treatment program. Because of the different purported mechanisms of change in the services matched to problems and voucher conditions, the study will feature a 2 X 2 design to evaluate the potential additive effects of the two interventions. The treatment conditions in the study are as follows: a) Treatment as usual (TAU): b) Voucher reinforcement (TAU+V): c) Services matched to problems (TAU+S) d) Services matched to problems plus vouchers (TAU+SV) The treatment phase of the study will last six months, and patients will be followed up for another year. Both effectiveness and benefit-cost analyses will be conducted. With regard to effectiveness, a main effect for vouchers is predicted during the within-treatment phase. During the post-treatment follow-up, main effects for both the services matched to problems and voucher conditions are hypothesized, along with an interaction effect. Specifically, the TAU+V and TAU+S conditions are hypothesized to produce better cocaine use outcomes than TAU, and the combination of both interventions (TAU+SV) is expected to generate better outcomes than either TAU+V or TAU+ S. With regard to benefit-cost, both the TAU+S and TAU+V interventions are hypothesized to be cost-beneficial, as compared to treatment as usual, and TAU+SV is predicted to be cost-beneficial compare to TAU+S and TAU+V. Analyses will also compare the benefit-cost of professional services vs. voucher reinforcement. Additional analyses will identify predictors of response to the TAU+V and TAU+S conditions, and test predictions regarding possible mechanisms of action.