Behavior Therapy Development of Group CM in Methadone Tx

描述(由申请人提供)： 应急管理(CM)干预是在药物滥用治疗期间启动和维持药物戒断的最有效方法之一。不幸的是，社区治疗提供者认为这些程序与他们的通常做法不一致，太昂贵，太复杂。对治疗提供者的调查发现了CM干预的八个方面，他们认为这些方面令人反感或与常规护理不一致：1)CM通常以个人形式提供，而不是以小组形式提供；2)它侧重于有形的与社会的激励；3)它只奖励一种或多种行为；4)当滥用不同药物的患者倾向于在不同的小组中接受治疗时，它通常在同一组滥用药物的患者中进行研究；5)激励成本过高：6)它需要太多的工作人员时间；7)它需要更频繁的尿检，而不是诊所所能承受的；8)它引起了人们对负面副作用的担忧，比如病人之间的争吵。这项第一阶段研究的目标是确定哪些担忧可以在不严重影响干预效果的情况下得到合理解决。该项目将开发一项CM组干预措施，并进行3项Small-N逆转设计试点研究，以检查：a)一种或多种目标行为；b)减少尿检频率；c)将使用可卡因或苯二氮卓类药物的患者纳入同一组。它还将收集成本数据以估计与CM干预相关的相对费用，召集一个由当地治疗提供者组成的咨询小组，并结合研究结果使用小组反馈指导关于纳入或排除特定组CM程序的决策。最后，将收集初步数据以建立用于后续应用的ESS，该应用将比较组CM治疗与单独CM治疗和标准治疗。到本项目结束时，开发更符合社区治疗提供者需求的群体性CM干预措施所需的第一阶段研究的所有产品都将完成。还将提供关于CM干预的重要具体方面的有趣的试点数据(即目标行为数量、尿检频率)。虽然发展这一集团CM干预措施本身不会改善CM的传播，但它是朝着这一方向迈出的关键的第一步。

DESCRIPTION (provided by applicant): Contingency management (CM) interventions are among the most effective methods for initiating and maintaining drug abstinence during drug abuse treatment. Unfortunately, community treatment providers perceive these procedures as being inconsistent with their usual practices, too costly, and too complex. Surveys of treatment providers have identified eight aspects of CM interventions that they find objectionable or inconsistent with usual care: 1) CM has most often been delivered in individual vs. group formats; 2) It has focused on tangible vs. social incentives; 3) It rewards only one vs. multiple behaviors; 4) It often has been studied in groups of patients that are homogenous with respect to their preferred drugs of abuse when patients who are abusing different drugs tend to be treated in heterogeneous groups; 5) The incentive costs are excessive: 6) It requires too much staff time; 7) It requires more frequent urinalysis than clinics can afford; and 8) It raises concerns about negative side-effects such as arguing between patients. The goal of this Stage 1 research is to determine which of these concerns can be reasonably addressed without seriously compromising the efficacy of the intervention. This project will develop a Group CM intervention and conduct 3 small-N reversal design pilot studies that will examine: a) one vs. multiple target behaviors; b) reduced urine testing frequency; and c) including patients using cocaine or benzodiazepines in the same group. It also will collect cost data to estimate the relative expense associated with the CM interventions, convene an advisory panel of local treatment providers, and use panel feedback in combination with the results of studies to guide decision-making regarding the inclusion or exclusion of specific Group CM procedures. Finally, preliminary data will be collected to establish ESs for a subsequent application that will compare the Group CM treatment with Individual CM and standard treatment. By the end of this project, all the products of Stage I research necessary to develop a Group CM intervention that is more consistent with the needs of community treatment providers will have been completed. Interesting pilot data regarding important specific aspects of CM interventions will also be available (i.e., number of behaviors targeted, frequency of urine testing). While developing this Group CM intervention will not by itself result in improved dissemination of CM, it is a critical first step in this direction.