CONTINGENCY MANAGEMENT FOR REAL-LIFE DRUG TREATMENT

尽管研究证明了基于凭证的应急管理（CM）干预措施减少药物使用的有效性和患者的可接受性，但社区提供者采用这些程序的速度很慢。 采用CM程序的一个障碍是支持这些程序的高成本。然而，使用社区或用户支持的服务，以加强药物戒断或其他目标行为的新方法可能会提供一个解决方案，为CM计划的融资。 本提案的具体目标是评估应急费用回扣和社区赞助的药物治疗计划，这两个创新的和潜在的成本效益的CM策略用于以社区为基础的药物治疗计划。 该项目的目标是使基于凭证的应急管理研究所揭示的强大成功足够实用，以供社区从业者广泛测试和采用。 这些策略将在三个公共资助的诊所内的一个大型，城市，门诊药物滥用服务在丹佛，CO四个对照研究将评估使用这些技术与一系列的药物滥用者，包括双重诊断，怀孕，HIV阳性人群和儿童，以增加我们的研究结果的一般性。 研究1-3将提供一个检查或有费用回扣，以改善美沙酮和LAAM维持门诊患者的治疗结果。 研究4将评估一项社区赞助的代金券计划，该计划使用社区和制造商捐赠的激励商店减少怀孕药物滥用者的吸烟和其他药物使用。 建立社区赞助的代金券计划加强了社区在药物滥用治疗中的作用。 拟议的研究将使用不同的CM策略，以阐明最实用和有效的强化时间表（固定与可变）和最佳的目标行为，以加强（药物使用与咨询出席）。 研究将被整合到现有的临床项目结构中，以证明将CM程序转移到现有的社区规划的可行性。行为干预将与每个研究中心提供的药理学药物一起提供。 还将评估我们的干预措施对减少艾滋病危险行为的影响。 最后，在这项提案的五年中，我们将培训新的从业人员使用这些策略，并与NIDA合作，制作培训材料，如手册，软件，视频和详细的筹款策略，以传播给临床医生和政策制定者。 总体而言，这些研究将指导从业人员使用CM进行现实生活中的药物滥用治疗。

Despite research demonstrating the efficacy and patient acceptability of voucher-based contingency management (CM) interventions for reducing drug use, community providers have been slow to adopt these procedures. One barrier to adoption of CM procedures is the high cost of supporting such programs. However, novel approaches using community- or user-supported services to reinforce drug abstinence or other target behaviors may offer a solution for financing CM programs. The specific aims of this proposal are to evaluate Contingent Fee Rebates and a Community-Sponsored Voucher Program, two innovative and potentially cost-effective CM strategies for use in community-based drug treatment programs. This project's goal is to make the robust success revealed by voucher-based contingency-management research practical enough for widespread testing and adoption by community-based practitioners. These strategies will be examined in three publicly-funded clinics within a large, urban, outpatient substance abuse service in Denver, CO. Four controlled studies will evaluate the use of these techniques with a range of substance abusers, including dually-diagnosed, pregnant, HIV-positive populations and children to increase the generality of our findings. Studies 1-3 will provide an examination of Contingent Fee Rebates for improving treatment outcomes among methadone-and LAAM-maintained outpatients. Study 4 will evaluate a community-sponsored voucher program for reducing smoking and other drug use among pregnant substance abusers using an incentive store stocked by community and manufacturer donations. Establishing a community-sponsored voucher program reinforces the role of the community in substance abuse treatment. The proposed research will use different CM strategies to elucidate the most practical and effective reinforcement schedules (fixed vs. variable) and the optimal target behaviors to reinforce (drug use vs. counseling attendance). Studies will be integrated into the existing structure of clinical programs to demonstrate the feasibility of transferring the CM procedures to existing community-based programing. Behavioral interventions will be delivered in conjunction with pharmacological adjuncts available at each site. The impact of our interventions on reducing AIDS risk behaviors will also be assessed. Finally, throughout the five years of this proposal, we will train new practitioners in the use of these strategies and work with NIDA to create training materials such as manuals, software, videos and detailed fundraising strategies for dissemination to clinicians and policy makers. Overall, these studies will guide practitioners in the use of CM for real-life drug abuse treatment.