ADAPTIVE TREATMENT FOR COCAINE ADDICTION

尽管一些治疗可卡因依赖的方法是有效的，但仍有几个主要挑战 社区环境中治疗的有效性，包括对传统专科护理缺乏兴趣 模式，早期辍学率高，以及最初参与的患者反应的相当大的变异性 在治疗中。我们小组和其他人最近所做的工作表明，适应性治疗模式可以调整- 着装中的许多问题干扰了有效的添加治疗的成功交付。这些 这些模式旨在通过提供随时间量身定做的灵活护理来增加治疗的参与度 根据患者对治疗的反应，以及患者的选择或偏好。这个项目的目标是 进一步发展为寻求治疗的可卡因依赖者提供适应性护理的模式 在以社区为基础的特殊护理计划中。完成一次强化摄入的患者(N=300) 门诊计划(1OP)将随机分为两种情况，这两种情况使用基于电话的激励 采访(Ml)，以提高标准眼压(MI-IOP)或三种眼压之一的参与率 由患者选择的治疗选项(MI-PC)。如果患者未能做到这一点，他们就有资格接受这些干预 在第1-2周定期参加IOP(非订婚组)，了解他们是否达到了最初的订婚(订婚组 组)，但随后在3-12周期间的某个时间点停止接受眼压治疗。治疗方案 在MI-PC中有眼压、电话分级护理或莫达非尼和药物管理的组合 在非参与组中；以及眼压、电话分级护理或认知行为治疗 (CBT)在参与组中。非参与组和参与组的选项略有不同， 因为我们想要为未能达到目标的患者提供非专科治疗替代方案(例如莫达非尼) 最初参与眼压，而将参与患者的选择限制为基于LOP的干预 临床上是合适的。初步分析将比较MI-IOP和MI-PC在参与率/保留率方面的差异 前12周和可卡因使用后1-24周的结果，并确定是否有预测优势 MI-PC对MI-IOP的影响随处于非参与组或参与组而变化。进一步 分析将检查MI-PC非参与的次要结果、每个治疗选项的选择率 和参与组，以及这些治疗选项中每一个的结果。

Although a number of treatments for cocaine dependence are efficacious, there are several major challenges to the effectiveness of treatment in community settings, including lack of interest in traditional specialty care models, high rates of early dropout, and considerable variability of response in patients who initially engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can ad- Dress many of the problems that interfere with the successful delivery of effective addition treatment. These models are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment, and patient choice or preference. The goal of this project is the further development of an adaptive model of care for individuals with cocaine dependence who seek treatment in community-based, specialty care programs. Patients (N=300) who complete an intake at an Intensive Outpatient Program (1OP) will be randomized into two conditions, which use telephone-based Motivational Interviewing (Ml) to increase rates of engagement in either standard IOP (MI-IOP), or in one of three treatment options selected by the patient (MI-PC). Patients are eligible for these interventions if they fail to attend IOP regularly in weeks 1-2 (the "Non-engaged" group), of if they achieve initial engagement (the "Engaged" group) but subsequently stop attending IOP at some point during weeks 3-12. The treatment options in MI-PC are IOP, telephone-based stepped care, or the combination of modafinil and medication management in the Non-engaged group; and IOP, telephone-based stepped care, or Cognitive-Behavioral Treatment (CBT) in the Engaged group. The options for the Non-engaged and the Engaged groups differ slightly, because we wanted to offer a non-specialty care alternative (e.g., modafinil) to patients who failed to achieve initial engagement in IOP, whereas limiting options in Engaged patients to lOP-based interventions seemed clinically appropriate. Primary analyses will compare MI-IOP and MI-PC on rates engagement/retention over the first 12 Weeks and cocaine use outcomes over weeks 1-24, and determine whether the predicted advantage of MI-PC over MI-IOP varies as a function of being in the Non-engaged or the Engaged groups. Further analyses will examine secondary outcomes, rates of selection of each treatment option in the MI-PC Nonengaged and Engaged groups, and outcomes within each of these treatment options.