The Therapeutic Workplace Intervention in Community Settings.

描述（由申请人提供）：吸毒成瘾是一种慢性疾病，其特征是过度吸毒，持续多年，常常直至死亡。我们建议评估一种新方法，对可卡因成瘾实施高效且可能实用的干预措施，以维持长期戒毒。我们的应用重点关注注射可卡因或强效可卡因的美沙酮患者，因为他们通过注射或与毒品相关的性行为感染或传播艾滋病毒的风险增加。美沙酮对海洛因成瘾有效，但许多美沙酮患者继续使用可卡因。高强度和长期的基于代金券的戒断强化是治疗毒瘾的最有效的治疗方法之一，并且可以在较长时间内维持可卡因戒断，但需要实施这种干预的实用方法。我们对治疗性工作场所模型的研究表明，以就业为基础的禁欲强化（参与者必须提供不含毒品的尿样才能进入工作场所并保持最高工资）可以在较长时间内保持对可卡因的戒断并减少与毒品相关的艾滋病毒风险行为。我们的下一个挑战是传播以就业为基础的毒瘾治疗强化措施。我们建议开发、手动化和试点测试一种社区友好的治疗性工作场所干预措施，该干预措施可以在美国和其他地方广泛实施。为了测试社区治疗工作场所干预，我们将进行一项随机试点研究。在美沙酮治疗期间使用注射或强效可卡因的美沙酮患者将被邀请参加（N = 58）并被随机分配到以下两组之一：常规护理（对照组）组或社区治疗工作场所组。正如我们之前实施的治疗工作场所干预措施一样，社区治疗工作场所参与者将参加第一阶段，以开始戒毒并获得工作技能。在第一阶段开始禁欲并获得工作技能的参与者将 在第二阶段与合作雇主一起被雇用到社区工作场所。在第二阶段，将利用美国交通部监督的工作场所药物和酒精测试的现有基础设施和程序来实施基于就业的禁欲强化应急措施。使用该系统，国家无毒品工作场所服务提供商将安排随机药物测试和基于就业的禁欲强化应急措施，其中要求员工保持无毒品状态以维持就业。我们将对手册进行试点测试，并根据员工、参与者和雇主的反馈进行修改。该研究将为参与者和雇主提供有关干预措施可接受性的重要信息，并提供有关我们维持禁欲和促进就业程序有效性的初步数据。我们在这项研究中收集的数据对于未来关于社区治疗工作场所干预措施的有效性的更大规模研究至关重要，以维持长期戒毒和减少与药物相关的艾滋病毒危险行为。]

DESCRIPTION (provided by applicant): Drug addiction is a chronic disorder characterized by excessive drug use that persists over years and often until death. We propose to evaluate a novel method for implementing a highly effective and potentially practical intervention for cocaine addiction to maintain long-term drug abstinence. Our application focuses on methadone patients who use injection or crack cocaine because of their increased risk of acquiring or transmitting HIV through injection or drug-related sexual behavior. Methadone is effective for heroin addiction, but many methadone patients continue to use cocaine. High magnitude and long-duration voucher-based abstinence reinforcement is one of the most effective treatments for drug addiction and can maintain cocaine abstinence over extended periods of time, but practical methods of implementing this intervention are needed. Our research on a model Therapeutic Workplace has shown that employment-based abstinence reinforcement, in which participants must provide drug-free urine samples to access the workplace and maintain maximum pay, can maintain cocaine abstinence and reduce drug-related HIV risk behaviors over extended time periods. Our next challenge is to disseminate employment-based reinforcement for the treatment of drug addiction. We propose to develop, manualize, and pilot test a community-friendly Therapeutic Workplace intervention that can be implemented widely throughout the US and elsewhere. To test the Community Therapeutic Workplace intervention, we will conduct a randomized pilot study. Methadone patients who use injection or crack cocaine during methadone treatment will be invited to participate (N = 58) and randomly assigned to one of two groups: Usual Care (control) group or Community Therapeutic Workplace group. As in our prior implementations of the Therapeutic Workplace intervention, Community Therapeutic Workplace participants will enroll in Phase 1 to initiate drug abstinence and acquire job skills. Participants who initiate abstinence and acquire job skills in Phase 1 will be hired into community workplaces with collaborating employers in Phase 2. During Phase 2, employment-based abstinence reinforcement contingencies will be implemented using existing infrastructure and procedures for workplace drug and alcohol testing overseen by the US Department of Transportation. Using this system, a national provider of Drug-Free Workplace Services will arrange random drug testing and employment-based abstinence reinforcement contingencies in which employees will be required to remain drug-free to maintain employment. We will pilot-test the manual and revise in response to feedback from staff, participants, and employers. The study will provide vital information on the acceptability of the intervention to participants and employers, and provide preliminary data on the effectiveness of our procedures to maintain abstinence and promote employment. The data we collect in this study will be crucial to inform future larger-scale studies on the effectiveness of the Community Therapeutic Workplace intervention to maintain long-term drug abstinence and to reduce drug-related HIV risk behaviors.]