Maximizing Effectiveness of Cognitive Behavior Therapy and Contingency Management

描述(由申请人提供)： 认知-行为应对技能疗法(CBT)是一种广泛使用和公认的治疗方法，已被经验验证用于治疗一系列物质使用障碍，通常具有紧急效果，即使在治疗结束后仍有持续改善。CBT的治疗保留率和依从性与改善治疗结果有关。应急管理(CM)也有非常强大的支持，并与对目标结果的快速、强有力的影响有关。尽管CBT和CM有许多优点，但它们都不是普遍有效的。现在必须寻求战略，以最大限度地提高和扩大这两种方法的有效性，并更好地了解这些治疗方法如何发挥作用。我们建议评估有针对性的战略，以最大限度地发挥CBT和CM的有效性。为了最大限度地发挥CBT的效果，我们将评估在门诊吸毒者的标准个人CBT中加入CM的好处，并加强出席率和完成作业的能力，以便让参与者接受更多的技能培训和练习技能的机会。为了最大限度地发挥CM的有效性和持久性，我们将评估 将其与专门为减少脱落效应而设计的技能培训相结合，以便将CM的好处延长到积极治疗期之外。我们建议进行第二阶段试验：(1)评估四种条件对160名可卡因依赖门诊患者的疗效：(A)标准CBT，(B)CBT+CM强化出勤和完成作业(CBT+CM/依从性)，(C)CM单独戒除(CM/戒除)，(D)CM戒除合并CBT(CM/戒除+CBT)，以及(2)通过一年的随访评估终止研究治疗后的较长期持久性和/或延迟出现的治疗效果。次要目标将是：(A)进行详细的流程研究，以评估拟议的改进措施是否如假设的那样影响近期和远期结果，以及(B)经济分析。研究治疗将持续12周。主要结果将是禁欲天数百分比和尿毒学筛查结果。

DESCRIPTION (provided by applicant): Cognitive-behavioral coping skills therapy (CBT) is a widely used and recognized treatment that has been empirically validated for a range of substance use disorders, often with emergent effects and continuing improvement even after treatment ends. Treatment retention and compliance are associated with enhanced treatment outcomes in CBT. Contingency management (CM) also has very strong support and is associated with rapid, robust effects on targeted outcomes. Despite their many strengths, neither CBT nor CM is universally effective. It is now essential to seek strategies to maximize and extend the effectiveness of these two approaches and to better understand how these treatments exert their effects. We propose to evaluate targeted strategies to maximize the effectiveness of CBT and CM, respectively. To maximize the effectiveness of CBT, we will evaluate the benefit of adding CM, with reinforcement for session attendance and homework completion, to standard individual CBT for outpatient cocaine abusers, in order to expose participants to more skill training and opportunities for practice of skills. To maximize the effectiveness and durability of CM, we will evaluate the benefit of integrating it with skills training, specifically designed to reduce drop off effects, in order to extend CM's benefits beyond the active treatment period. We propose to conduct a Stage II trial which will: (1) Evaluate the efficacy of four conditions for 160 cocaine dependent outpatients: (a) Standard CBT, (b) CBT with CM reinforcement for attendance and completing homework (CBT+CM/adherence), (c) CM for abstinence alone (CM/abstinence), (d) CM for abstinence integrated with CBT (CM/abstinence+CBT), and (2) Evaluate the longer-term durability and / or delayed emergence of treatment effects after termination of the study treatments through a one-year follow-up. Secondary aims will be to conduct (a) detailed process studies to evaluate whether the proposed enhancements affect proximal and distal outcomes as hypothesized and (b) economic analyses. Study treatments will last 12 weeks. Primary outcomes will be percent days abstinent and results of urine toxicology screens.