Evaluation Of Treatments Of Opioid And Cocaine Dependenc

本节继续调查药物滥用的药理学和行为治疗，并探索治疗的组合。我们已经在市内大量静脉注射多种药物滥用者的样本中证明了行为干预（加强可卡因阴性尿样）的有效性，我们将继续评估应用这种治疗的最佳方法。在过去的一年里，我们完成了一项研究的积极治疗阶段，该研究解决了一个假设的美沙酮维持诊所如何最好地分配其资源（药理学和非药理学）来减少海洛因和可卡因滥用的问题，如果诊所要建立基于凭证的应急管理。通过将一种主要旨在通过行为强化（应急管理）减少可卡因使用的干预措施与另一种通过药物治疗（高剂量美沙酮维持）减少非法阿片类药物使用的干预措施相结合，我们假设我们将看到可卡因和非法阿片类药物的戒断程度比单独应用任何一种方法时都要高。分析正在进行中。为了控制成本和技术转让，我们正在进行试点研究，其中强化剂是彩票抽奖而不是代金券，因为其他人的工作表明，基于彩票的强化程序可以由社区制造商和商人的捐赠提供资金。最初的试点研究表明，抽签程序在研究参与者中产生了极大的热情，在技术上比代金券计划更容易。在进一步进行的试点研究中，我们比较了两种不同的抽签程序和两种不同的强化密度。我们计划将抽签程序纳入一项更雄心勃勃的研究中，在这项研究中，各种低成本或无成本的激励措施旨在减少药物使用以外的广泛行为改变。我们目前研究的另一个重点来自实验动物数据，这些数据表明，压力诱导的可卡因寻求和/或海洛因寻求的恢复可以用α -肾上腺素能激动剂洛非昔定来预防。在过去的一年里，我们完成了一项剂量范围的研究，以确定洛非昔定如何与美沙酮在人类中最安全地联合使用。我们计划在此基础上进行一项临床试验，在凭证倡导的戒断之后，继续服用洛非昔定（或安慰剂），以预防压力引起的复发。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. We have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine-negative urine samples) in large inner-city samples of intravenous polydrug abusers, and we continue to evaluate the best ways to apply the treatment. In the past year we completed the active-treatment phase of a study to address the question of how a hypothetical methadone-maintenance clinic could best allocate its resources (both pharmacological and nonpharmacological) to reduce both heroin and cocaine abuse, if the clinic were to institute voucher-based contingency management. By combining an intervention primarily aimed at decreasing cocaine use through behavioral reinforcement (contingency management) with another intervention focused on decreasing illicit-opiate use through pharmacological treatment (high-dose methadone maintenance), we hypothesize that we will see greater abstinence from cocaine and illicit opiates than has been seen when either approach was applied separately. Analyses are ongoing. In the interest of cost containment and technology transfer, we are conducting pilot studies in which the reinforcers are lottery draws rather than vouchers, since work by others has shown that a lottery-based reinforcement procedure can be funded by donations from community manufacturers and merchants. The initial pilot study indicated that the lottery procedure generated substantial enthusiasm among study participants and is technically easier than the voucher program. In a further ongoing pilot study we are comparing two different lottery procedures and two different densities of reinforcement. We plan to incorporate the lottery procedure into a more ambitious study in which a variety of low- or no-cost incentives are targeted toward a broad range of behavioral changes beyond reductions in drug use. Another current focus of our research derives from laboratory-animal data showing that stress-induced reinstatement of cocaine-seeking and/or heroin-seeking can be prevented with the alpha-adrenergic agonist lofexidine. In the past year we completed a dose-ranging study to determine how lofexidine can most safely be co-administered with methadone in humans. We plan to follow this with a clinical trial in which voucher-initiated abstinence is followed by maintenance on lofexidine (or placebo) for prevention of stress-induced relapse.