Evaluation of Dialectical Behavior Therapy (DBT)

描述（由申请人提供）： 本提案的目的是进行一项疗效试验，以确定是否辩证行为疗法（DBT）添加到suboxone（阿片类药物替代品）是一种有效的治疗自杀性阿片类药物成瘾与边缘型人格障碍（BPD）的特征，并分析影响疗效的因素，在这一人群中，以改善治疗。自杀倾向与药物滥用的结合，特别是当存在其他轴I或II障碍时，显著损害治疗结果，本研究的目的是研究DBT添加到suboxone作为该人群的有效治疗的疗效。DBT最初是为患有边缘型人格障碍（BPD）的慢性自杀女性开发的，是一种旨在改变的行为治疗策略和旨在接受的验证策略的综合，两者都由一组辩证策略和基本假设结合在一起。DBT已经通过增加1）与药物使用相关的特定靶点，2）一组附件策略，3）在治疗开始时更依赖于任意药物，4）每周尿分析，以及5）阿片类药物替代计划（suboxone，即，丁丙诺啡与纳洛酮组合）加DBT临床管理。本文提出的研究是一项双臂随机临床试验，比较了DBT + suboxone治疗海洛因成瘾者的一年治疗方案与治疗作为药物（TAU）+ suboxone的一年治疗方案。治疗照常将包括标准的药物咨询和团体治疗提供的地区美沙酮诊所加suboxone。这两种情况的参与者将根据需要服用精神药物。136名阿片类药物依赖、高自杀倾向和满足至少4项BPD标准的个体（每种疾病68名）将入组1年治疗和1年随访评估。在整个两年中，将每隔4个月对药物使用、自杀行为、保留和其他治疗相关行为、一般精神病理学以及行为技能的增加进行评估。将使用HLM和其他基于回归的程序分析结果。

DESCRIPTION (provided by applicant): The purpose of this proposal is to conduct an efficacy trial to determine whether Dialectical Behavior Therapy (DBT) added to suboxone (an opiate drug replacement) is an efficacious treatment for suicidal opiate addicts with Borderline Personality Disorder (BPD) characteristics and to analyze factors that influence efficacy in this population in order to improve the treatment. The combination of suicidality with substance abuse, particularly when other Axis I or II disorders are present, significantly compromises treatment outcome, and the purpose of this study is to investigate the efficacy of DBT added to suboxone as an effective treatment for this population. DBT, originally developed for chronically suicidal women with borderline personality disorder (BPD), is a synthesis of behavior therapy strategies aimed at change, and validation strategies aimed at acceptance, both held together by a set of dialectical strategies and underlying assumptions. DBT has been adapted for BPD substance abusers by the addition of 1) specific targets relevant to drug use, 2) a set of attachment strategies, 3) greater reliance on arbitrary reinforcers at treatment start, 4) weekly urinalysis, and 5) an opiate drug-replacement program (suboxone, i.e., buprenorphine in combination with naloxone) plus DBT clinical management. The research proposed here is a two arm, randomized clinical trial comparing a one year treatment program of DBT + suboxone for heroin addicted individuals to a one year program of Treatment-as-Usual (TAU) + suboxone. Treatment-as-usual will consist of the standard drug counseling and group therapies offered at area methadone clinics plus suboxone. Participants in both conditions will be prescribed psychotropic medications as needed. One hundred and thirty-six individuals (68 per condition) with opiate dependence, high suicidality and meeting a minimum of four BPD criterion will be enrolled in a one-year treatment and a one-year follow-up assessment. Assessments measuring drug use, suicidal behaviors, retention and other treatment-related behaviors, general psychopathology, and increases in behavioral skills will be given at four month intervals for the entire two years. Results will be analyzed using HLM and other regression-based procedures.