CONTINGENCY MANAGEMENT FOR REAL-LIFE DRUG TREATMENT

尽管研究证明了基于凭证的应急管理(CM)干预措施在减少药物使用方面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一直很慢。采用CM程序的一个障碍是支持此类程序的高成本。然而，使用社区或用户支持的服务来加强药物戒除或其他目标行为的新方法可能为资助CM项目提供一种解决方案。这项提案的具体目的是评估或有费用回扣和社区赞助的代金券计划，这是两种用于社区药物治疗计划的创新且可能具有成本效益的CM战略。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。这些策略将在科罗拉多州丹佛市一家大型城市门诊药物滥用服务机构内的三家公共资助诊所进行研究。四项对照研究将评估这些技术在一系列药物滥用者中的使用情况，包括双重诊断、怀孕、艾滋病毒阳性人群和儿童，以增加我们研究结果的普遍性。研究1-3将审查或有费用回扣，以改善美沙酮和LAAM维持的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，该计划旨在利用社区和制造商捐赠的奖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治疗药物滥用方面的作用。这项拟议的研究将使用不同的CM策略来阐明最实用和有效的强化计划(固定与可变)和最佳目标行为强化(药物使用与咨询出勤)。研究将被整合到现有的临床方案结构中，以证明将中医程序转移到现有的以社区为基础的方案的可行性。行为干预将与每个地点提供的药理辅助药物一起提供。我们还将评估我们的干预措施在减少艾滋病危险行为方面的影响。最后，在这项提案的整个五年中，我们将培训新的从业者使用这些战略，并与NIDA合作创建培训材料，如手册、软件、视频和详细的筹款战略，以分发给临床医生和政策制定者。总体而言，这些研究将指导从业者在现实生活中使用中药进行药物滥用治疗。

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.