BOSTON UNIVERSITY CRU FOR ALCOHOLISM TREATMENT

描述：该提案结合了两项研究，以评估合并 酒精依赖的行为和药物治疗。这个 初步研究旨在检查氨基己酸酯对小鼠的影响 结合简短的干预(激励增强疗法 [Met])对渴求、线索诱导的反应性以及 饮酒行为开始后的酒精含量与 安慰剂--只接受治疗的对照组。美国以实验室为基础的研究 已经为我们提供了纳曲酮减少线索诱导的证据 反应性和渴求，可能还有酒精的回报价值，但 氨基己酸酯的类似作用机制还没有被探索过。这个 初步研究的目的是确定渴求的变化 而心理生理反应介导了氨基己酸酯的作用。 喝酒。为此，受试者将被分配到无菌素或 安慰剂组12周。基于实验室的线索反应性的测量 方案将在药物试验前后进行评估。这个 初步研究的第二阶段将为所有无反应者提供 确定测序效果的替代药物 干预措施。在12周的治疗后，对氨基己酸酯或 安慰剂将接受阿卡米松加安慰剂、阿卡米松加安慰剂 纳曲酮、纳曲酮加安慰剂或安慰剂。这一阶段将允许我们 评估联合用药是否比用药更有效 无论是单独用药维持戒酒还是连续用药 对无反应者的治疗有助于降低复发率。这个 主要研究(11)旨在检查两种方法的相对有效性 强度不同的行为治疗(MET和认知行为 治疗[CBT])与下列组合之一相结合 药物(阿卡米松加安慰剂、纳曲酮加安慰剂、阿卡米松 加纳曲酮，或安慰剂加安慰剂)。受试者将被招募参加 6个月的治疗试验，然后是12个月的随访期， 为我们提供了评估行为治疗是否 不同强度的药物在治疗酒精方面的效果也不同 依赖。这项研究还将允许我们检查是否 两种已知能有效减少饮酒的药物联合使用 比单独使用每种药物都有好处，以及是否有 预测治疗结果的个体患者特征。最后， 拟议的初步研究将使我们能够评估 两个层次的心理治疗与不同的组合 提供药物。这将是第一项研究提供长期的 关于纳曲酮与行为疗法相结合的结果数据， 不止一种药物与行为疗法的结合，以及 短期干预结合药物治疗慢性阻塞性肺疾病 酒精依赖。

DESCRIPTION: This proposal incorporates two studies to assess combined behavioral and pharmacological treatments of alcohol dependence. The preliminary study is designed to examine the effect of acamprosate in combination with a brief intervention (motivational enhancement therapy [MET]) on craving, cue-induced reactivity, and the subjective effects of alcohol following the initiation of drinking behavior compared to placebo-controls receiving only MET. Laboratory-based studies in the US have provided us with evidence that naltrexone decreases cue-induced reactivity and craving, and possibly the rewarding value of alcohol, but similar mechanisms of action for acamprosate have not been explored. The purpose of the preliminary study is to determine whether changes in craving and psychophysiological reactivity mediate the effects of acamprosate on drinking. To this end, subjects will be assigned to the acamprosate or placebo group for 12 weeks. Measures from a laboratory based cue reactivity protocol will be evaluated before and after the medication trial. The second phase of the preliminary study will provide all nonresponders with alternative medications to determine the effects of sequencing interventions. After 12 weeks of treatment, nonresponders to acamprosate or placebo will receive either acamprosate plus placebo, acamprosate plus naltrexone, naltrexone plus placebo, or placebo. This phase will allow us to assess whether a combination of medications offers more benefits than either medication alone in sustaining abstinence and whether sequential treatment for nonresponders is helpful in reducing relapse rates. The primary study (11) is designed to examine the relative effectiveness of two behavioral treatments that vary in intensity (MET and cognitive-behavioral treatment [CBT]) combined with one of the following combinations of medications (acamprosate plus placebo, naltrexone plus placebo, acamprosate plus naltrexone, or placebo plus placebo). Subjects will be recruited for a six month treatment trial followed by a 12 month follow-up period that will provide us with the opportunity to evaluate whether behavioral treatments varying in intensity also vary in their effectiveness in treating alcohol dependence. This study will also permit us to examine whether the combination of two medications known to be effective in reducing drinking has benefits over using each medication alone, and whether there are individual patient characteristics that predict treatment outcome. Finally, the proposed primary study will permit an evaluation of the interaction of the two levels of psychological treatment with the varying combination of medications provided. This will be the first study that provides long-term outcome data on the combination of naltrexone with behavior therapy, the combination of more than one medication with behavior therapy, and the combination of a brief intervention with medication in the treatment of alcohol dependence.