EVALUATION OF TREATMENTS OF OPIOID AND COCAINE DEPENDENCE

本节继续研究药理学 以及药物滥用和互动的行为治疗 这两种治疗方式之间的区别。的主要目的 这些研究是为了消除药物使用，降低 可卡因和/或海洛因依赖患者的艾滋病毒传播。 禁欲强化，一种行为治疗方法， 哪些患者接受药物戒断奖励，以及 美沙酮维持治疗是药物治疗的有效方法， 虐待我们进行了一项研究， 强化，美沙酮剂量增加，以及它们的组合 与未增加剂量的标准治疗相比。患者 在美沙酮的前5周内继续使用阿片类药物的人 维持组（50 mg/天PO）随机分配至4组之一 实验组：阿片类药物阴性尿液的应急凭证 标本加20 mg美沙酮剂量增加;视情况而定 代金券加不增加美沙酮剂量; 20 mg美沙酮剂量 增加额加非或有凭单和非或有凭单 加无剂量增加对照组。阿片类药物使用减少， 在所有三组中， 或有代金券或剂量增加或两组，但不包括 对照组然而，只有那些接受特遣队的团体， 代金券大大增加了持续的 禁欲因此，戒断强化和美沙酮剂量 增加对减少类阿片使用同样有效， 禁欲强化选择性地增加持续禁欲。 然而，联合剂量增加和戒断强化 并不比单独治疗更有效。早期研究 在我们的实验室里， 或有事项在产生重大期间有效， 市中心静脉注射多种药物滥用者的可卡因戒断率。的 然而，这种治疗的效果往往是短暂的， 患者认知/行为复发预防咨询 我们实验室开发的药物滥用治疗方法 被整合到行为应急管理中 计划，以增加禁欲的持续时间产生的 通过鼓励长期的改变， 吸毒和其他艾滋病毒危险行为。一项研究评估了 加强戒断和预防复发相结合 心理咨询正在进行中

The section continues to investigate pharmacological and behavioral treatments of substance abuse and interactions between these two forms of treatments. A primary objective of these studies is to eliminate drug use and decrease the probability of HIV transmission in cocaine- and/or heroin-dependent patients. Abstinence reinforcement, a behavioral treatment approach in which patients receive incentives for drug abstinence, and methadone maintenance are both effective treatments for drug abuse. We have conducted a study evaluating abstinence reinforcement, methadone dose increase, and their combination compared to standard treatment without dose increase. Patients who continued to use opiates during the first 5 weeks of methadone maintenance (50 mg/day PO) were randomly assigned to one of 4 experimental groups: contingent vouchers for opiate-negative urine specimens plus a 20 mg methadone dose increase; contingent vouchers plus no methadone dose increase; 20 mg methadone dose increase plus noncontingent vouchers; and noncontingent vouchers plus no dose increase control group. Opiate use decreased during the intervention period in all three groups receiving either contingent vouchers or dose increase or both group, but not in the control group. However, only those groups receiving contingent vouchers had significantly increased periods of sustained abstinence. Thus, abstinence reinforcement and methadone dose increase were equally effective in decreasing opioid use, and abstinence reinforcement selectively increased sustained abstinence. However, combined dose increase and abstinence reinforcement was not more effective than either treatment alone. Earlier research in our laboratory showed that abstinence reinforcement contingencies are effective in producing significant periods of cocaine abstinence in inner-city, intravenous, polydrug abusers. The effects of this treatment, however, tend to be short lived in many patients. A cognitive/behavioral relapse prevention counseling approach to substance abuse treatment developed in our laboratory is being integrated into the behavioral contingency management program to increase the duration of abstinence produced by the behavioral treatment alone by encouraging long-term changes in drug use and other HIV risk behaviors. A study evaluating the combination of abstinence reinforcement and relapse prevention counseling is underway.