Effectiveness and Costs of Enhanced Cocaine Treatments

描述：(申请人摘要) 尽管有证据表明标准的门诊治疗是有效的 对于一些可卡因依赖的患者，早期治疗的中途辍学率和 复发率仍然相对较高。最近的研究表明，添加 针对同时存在的精神病、人际关系和就业问题的服务 可以改善患者的物质使用结果，特别是如果他们有 这些领域的问题严重程度更高。这种方法的前提是 认为在这些领域由专业人员提供的服务有助于“消除 共病患者的康复障碍。独立研究 一系列研究已经产生了相当多的证据表明 以凭单的形式加强，条件是提供无毒尿液 可以兑换商品和服务的样品也可以带来改善 物质使用结果。这些发现表明，可能有两个 概念和理论上不同的、基于行为的途径 改善药物滥用者的治疗结果。我们建议评估 这两种方法适用于可卡因依赖患者，他们也将获得 在一个门诊社区治疗项目中“照常治疗”。因为. 与以下服务相匹配的不同声称的服务变化机制 问题和凭单条件，研究将采用2X2设计 评估这两种干预措施的潜在相加效应。治疗方法 研究中的条件如下：A)照常治疗(TAU)：B)代金券 加固(TAU+V)：c)服务匹配问题(TAU+S)d)服务 与问题匹配加优惠券(TAU+SV)研究的治疗阶段 将持续六个月，患者将再接受一年的随访。 将进行有效性和效益-成本分析。关于…… 有效性，凭证的一个主要影响被预测在 治疗内阶段。在治疗后的随访中，主要疗效为 与问题和凭证条件匹配的服务都是假设的， 以及相互作用的影响。具体地说，TAU+V和TAU+S条件 假设比TAU产生更好的可卡因使用结果，并且 这两种干预措施的组合(TAU+SV)预计会产生更好的效果 结果比TAU+V或TAU+S都要好。在收益-成本方面， 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，TAU+SV预计具有成本效益 与TAU+S和TAU+V的比较分析还将比较 专业服务VS代金券强化。其他分析将 确定对TAU+V和TAU+S条件的反应的预测因素，并进行测试 关于可能的行动机制的预测。

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.