Evaluation Of Treatments Of Opioid And Cocaine Dependenc

本节继续调查药物滥用的药物和行为治疗，并探讨治疗的组合。我们已经证明了行为干预的有效性（可卡因阴性尿样的强化）在大的市中心静脉注射多种药物滥用者的样本，我们将继续评估应用治疗的最佳方法。我们目前正在结束一项研究的积极治疗阶段，以解决一个假设的美沙酮维持诊所如何最好地分配其资源（药理学和非药理学），以减少海洛因和可卡因滥用的问题，如果诊所要建立基于凭证的应急管理。通过将主要旨在通过行为强化（应急管理）减少可卡因使用的干预措施与另一种通过药物治疗（高剂量美沙酮维持）减少非法阿片类药物使用的干预措施相结合，我们假设，我们将看到可卡因和非法阿片类药物的戒断率比单独应用任何一种方法时都要高。为了控制成本和技术转让，我们已经开始了一项试验性研究，其中的奖励是抽奖而不是代金券，因为其他人的工作表明，以抽奖为基础的加固程序可以由社区制造商和商人的捐款资助。如果抽签程序在我们手中起作用，我们计划将其纳入一项更雄心勃勃的研究中，在这项研究中，各种低成本或无成本的激励措施都针对减少药物使用以外的广泛行为变化。我们目前的另一个研究重点来自我们的同事？实验室动物数据显示，可以用α-肾上腺素能激动剂洛非西定预防可卡因寻求和/或海洛因寻求的应激诱导的复发。我们正在进行一项剂量范围研究，以确定如何洛非西定可以最安全地与美沙酮在人类共同管理，我们计划遵循这一临床试验中，凭证发起的禁欲其次是维持洛非西定（或安慰剂），以预防应激诱导的复发。我们还在继续进行一项研究，在这项研究中，有长期注意力缺陷/多动障碍（ADHD）症状的成年可卡因滥用者接受安非他酮（或安慰剂）和认知行为治疗，前提是他们的可卡因滥用可能部分代表了自我药物治疗的尝试。使用安非他酮的理由是，它对治疗ADHD有一定的疗效，而且不易被滥用。这项研究结合了治疗前后的神经心理学测试和重复的计算机化注意力评估。

The section continues to investigate pharmacological and behavioral treatments of substance abuse and to explore combinations of treatments. We have already demonstrated the effectiveness of behavioral interventions (reinforcement of cocaine-negative urine samples) in large inner-city samples of intravenous polydrug abusers, and we continue to evaluate the best ways to apply the treatment. We are currently concluding the active-treatment phase of a study to address the question of how a hypothetical methadone-maintenance clinic could best allocate its resources (both pharmacological and nonpharmacological) to reduce both heroin and cocaine abuse, if the clinic were to institute voucher-based contingency management. By combining an intervention primarily aimed at decreasing cocaine use through behavioral reinforcement (contingency management) with another intervention focused on decreasing illicit-opiate use through pharmacological treatment (high-dose methadone maintenance), we hypothesize that we will see greater abstinence from cocaine and illicit opiates than has been seen when either approach was applied separately. In the interest of cost containment and technology transfer, we have begun a pilot study in which the reinforcers are lottery draws rather than vouchers, since work by others has shown that a lottery-based reinforcement procedure can be funded by donations from community manufacturers and merchants. If the lottery procedure works in our hands, we plan to incorporate it into a more ambitious study in which a variety of low- or no-cost incentives are targeted toward a broad range of behavioral changes beyond reductions in drug use. Another current focus of our research derives from our colleagues? laboratory-animal data showing that stress-induced reinstatement of cocaine-seeking and/or heroin-seeking can be prevented with the alpha-adrenergic agonist lofexidine. We are conducting a dose-ranging study to determine how lofexidine can most safely be coadministered with methadone in humans; we plan to follow this with a clinical trial in which voucher-initiated abstinence is followed by maintenance on lofexidine (or placebo) for prevention of stress-induced relapse. We are also continuing a study in which adult cocaine abusers with longstanding symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) are treated with bupropion (or placebo) and cognitive-behavioral therapy, on the premise that their cocaine abuse may partly represent an attempt at self-medication. The rationale for using bupropion is that it has some efficacy in treating ADHD and is not prone to abuse. The study incorporates pre- and posttreatment neuropsychological testing and repeated computerized assessments of attention.