Project#2 Extending Treatment Effects Through an Adaptive Aftercare Intervention

摘要项目#2 强化干预在减少可卡因使用方面有明显的效果。有了中心支持，我们 开发和评估低成本的加固干预措施，系统地将其通过以下阶段 从发展到传播，到临床广泛实施。在我们正在进行的中心项目中，加固 如果在治疗开始时提供增强剂并且持续时间更长，干预措施就会产生效益。 然而，只有不到一半的患者继续使用传统的强化干预措施12周， 这需要经常出席，以监测和加强禁欲。干预措施延伸到 迫切需要能够接受并能有效防止长期复发的善后护理。 增援干预措施在有效期间是有效的，试点数据表明 可变间隔(VI)加固计划，一旦行为发生变化，保持潜力 如果不经常使用，则会获得收益。评估扩大这些干预措施惠益的方法包括 至高无上的科学和临床关注。组件项目2将评估一种新方法，在该方法中 强化的频率因患者的表现而异。在此次干预中，将为以下人员提供加固 24周，按循序渐进的VI时间表，根据患者的情况进行调整。维持者 禁欲平均每三周才能获得最高强度的补充剂，而 监测和加强禁欲将增加那些复发的人，直到戒酒重新开始。 为了测试疗效，280名可卡因使用障碍患者将被随机分配到：标准护理(SC)， SC+传统每周两次强化，或SC+适应性VI强化。评估将在以下时间完成 基线和整个18个月，以评估客观和自我报告的药物使用、心理社会指数 问题，以及艾滋病毒危险行为。主要假设是(1)适应性VI强化干预将 在治疗期间和整个随访期间改善相对于标准护理的结果，以及(2) 与传统的强化系统相比，适应性VI强化干预将改善预后。 这项研究还将评估认知控制和对金钱奖励及其神经的反应的作用。 与治疗结果相关。认知控制力较好的患者有望保持更长时间 不同条件下的禁欲持续时间。预计会有对金钱奖励更敏感的患者 以在强化条件下实现更长时间的禁欲。如果这些措施不同地与 不同治疗的结果，这些结果表明配对强化干预的潜力 最有可能从中受益的个人；它们也可以指示可能的生物标志物在 特定的治疗方式。如果认知指数是治疗反应的中介，未来的研究可以改进 改善认知过程和长期结果的干预措施。

ABSTRACT Project #2 Reinforcement interventions have pronounced effects on reducing cocaine use. With Center support, we developed and evaluated a low-cost reinforcement intervention, systematically moving it through the Stages of development to dissemination and broad clinical implementation. In our ongoing Center project, reinforcement interventions are yielding benefits when reinforcers are provided at treatment initiation and for longer durations. However, less than half of patients remain engaged for 12 weeks with traditional reinforcement interventions, which require frequent attendance for monitoring and reinforcing abstinence. Interventions that extend into aftercare and that are acceptable to and efficacious in preventing long-term relapse are critically needed. Reinforcement interventions are efficacious during periods they are in effect, and pilot data show that variable interval (VI) reinforcement schedules, once behavior change occurs, hold potential for maintaining gains when administered infrequently. Assessing methods to extend benefits of these interventions is of paramount scientific and clinical concern. Component Project 2 will evaluate a novel approach in which reinforcement frequency varies by patient performance. In this intervention, reinforcement will be available for 24 weeks, on a progressive VI schedule, that adapts according to patient status. Patients who maintain abstinence earn maximum reinforcers as infrequently as every three weeks on average, while frequency of monitoring and reinforcing abstinence will increase in those who relapse until abstinence is re-instated. To test efficacy, 280 patients with cocaine use disorder will be randomly assigned to: standard care (SC), SC+traditional twice weekly reinforcement, or SC+adaptive VI reinforcement. Evaluations will be completed at baseline and throughout 18 months to assess objective and self-reported indices of drug use, psychosocial problems, and HIV risk behaviors. Primary hypotheses are (1) the adaptive VI reinforcement intervention will improve outcomes relative to standard care during the treatment period and throughout follow-up, and (2) the adaptive VI reinforcement intervention will improve outcomes relative to the traditional reinforcement system. This study will also evaluate the roles of cognitive control and reactivity to monetary rewards and their neural correlates in treatment outcome. Patients with better cognitive control are expected to maintain longer durations of abstinence across conditions. Patients with greater sensitivity to monetary rewards are expected to achieve greater durations of abstinence in reinforcement conditions. If these measures differentially relate to outcomes across treatments, such results suggest the potential of pairing reinforcement interventions to individuals most likely to benefit from them; they may also indicate possible biomarkers of response in a treatment-specific manner. If cognitive indices mediate treatment response, future studies can refine interventions to improve cognitive processes and long-term outcomes.