Employment-Based Addiction Pharmacotherapy

描述(由申请者提供)：海洛因成瘾可造成破坏性的社会、医疗和经济后果。美沙酮维持是治疗海洛因成瘾的一种有效方法，但只有大约20%的阿片依赖者接受这种治疗。纳曲酮是一种阿片类拮抗剂，可以为许多人提供非常有效的替代药物。然而，它的效用一直受到限制，因为大多数人拒绝它。计划在5年内进行一项随机研究，以评估治疗工作场所在促进失业阿片依赖注射吸毒者纳曲酮摄取和戒断方面的有效性。治疗工作场所是一种新型的以就业为基础的干预措施，它使用工作工资来加强临床上重要的行为改变。在这个模范工作场所，药物滥用患者被雇佣并支付工资。为了促进临床上重要的行为，工资是根据工作和这些行为的表现来安排的。参与者将接受阿片类药物戒毒和纳曲酮诱导。完成纳曲酮诱导的参与者将被随机分配到三组之一。所有小组都将被邀请在治疗工作场所工作，并开出26周的纳曲酮处方药。这两个群体在工作和赚取工资的应急措施上会有所不同。“工作加纳曲酮应急”参与者将被要求服用纳曲酮来工作，并将因错过一剂而获得短暂的减薪。“工作加纳曲酮和禁欲应急”参与者将被要求服用纳曲酮上班，并将因错过一剂纳曲酮或提供鸦片或可卡因阳性尿样而获得短暂的减薪。“工作加纳曲酮处方”参与者将得到纳曲酮处方药，但不会被要求服用纳曲酮来工作。将评估鸦片和可卡因使用以及艾滋病毒危险行为的关键措施。这项研究将对一种新的以就业为基础的干预措施--治疗工作场所--进行严格的评估，以促进注射吸毒者中纳曲酮的摄入和戒毒，这些注射吸毒者有很大的传播或感染艾滋病毒感染的风险。

DESCRIPTION (provided by applicant): Heroin addiction can have devastating social, medical and economic consequences. Methadone maintenance is an effective treatment for heroin addiction, but only about 20 percent of opiate dependent individuals receive it. Naltrexone is an opiate antagonist that could provide an extraordinarily effective alternative for many individuals. However, its utility has been limited because most individuals refuse it. A randomized study is planned over 5 years to evaluate the effectiveness of the Therapeutic Workplace in promoting naltrexone ingestion and abstinence in unemployed opiate-dependent injection drug users. The Therapeutic Workplace is a novel employment-based intervention that uses salary for work to reinforce clinically important behavior change. Drug abuse patients are hired and paid in this model workplace. To promote clinically important behaviors, salary is arranged contingent both on work and on the emission of those behaviors. Participants will be offered an opioid detoxification and naltrexone induction. Participants who complete the naltrexone induction will be randomly assigned to one of three groups. All groups will be invited to work in the Therapeutic Workplace and prescribed naltrexone for 26 weeks. The groups will differ in the contingencies imposed to work and earn salary. "Work Plus Naltrexone Contingency" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose. "Work Plus Naltrexone and Abstinence Contingency" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose of naltrexone or for providing an opiate or cocaine positive urine sample. "Work Plus Naltrexone Prescription" participants will be prescribed naltrexone, but will not be required to ingest it to work. Critical measures of opiate and cocaine use and HIV risk behaviors will be assessed. This study will provide a rigorous evaluation of a novel employment based intervention, the Therapeutic Workplace, to promote naltrexone ingestion and drug abstinence in a population of injection drug users who are at considerable risk of spreading or contracting HIV infection.