Evaluation of Dialectical Behavior Therapy (DBT)

描述(由申请人提供)： 这项建议的目的是进行一项疗效试验，以确定在亚博松(一种阿片类药物替代品)的基础上加用辩证行为疗法(DBT)是否对具有临界性人格障碍(BPD)特征的自杀阿片类药物成瘾者有效，并分析影响该人群疗效的因素，以提高治疗水平。自杀和药物滥用的结合，特别是当存在其他Axis I或II障碍时，显著影响治疗结果，本研究的目的是探讨在亚伯克松基础上加用DBT作为这一人群的有效治疗方法的疗效。DBT最初是为患有交界性人格障碍(BPD)的慢性自杀女性开发的，是旨在改变的行为治疗策略和旨在接受的验证策略的综合体，两者都由一系列辩证策略和潜在假设结合在一起。通过增加1)与药物使用有关的特定目标，2)一套依附策略，3)在治疗开始时更多地依赖任意增强剂，4)每周尿检，以及5)鸦片类药物替代计划(亚伯克松，即丁丙诺啡与纳洛酮联合)以及DBT临床管理，DBT已针对BPD物质滥用者进行了调整。这项研究是一项双臂随机临床试验，比较了DBT+亚伯克松治疗海洛因成瘾患者一年的方案和常规治疗(TAU)+亚伯克松的一年方案。一如既往的治疗将包括在地区美沙酮诊所提供的标准药物咨询和团体治疗加上亚伯酮。在这两种情况下的参与者将根据需要服用精神药物。136人(每种情况68人)将参加为期一年的治疗和为期一年的后续评估，这些人依赖阿片类药物，自杀率高，并至少达到每日4桶的标准。在整个两年中，将每隔四个月进行一次评估，衡量药物使用、自杀行为、保留和其他与治疗相关的行为、一般精神病理学和行为技能增长。结果将使用HLM和其他基于回归的程序进行分析。

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.