Healthy Activities for Prize Incentives (HAPI)

描述（由申请人提供）：应急管理（CM）干预措施在提高治疗保留率和减少药物使用方面非常有效。 越来越多的证据表明，这些治疗方法可以改变各种行为，包括与健康相关的身体活动。体育活动对减少抑郁和改善健康有有益的影响。我们有试点数据表明，药物滥用患者谁从事运动，以赚取强化改善药物滥用的结果相对于那些谁不从事运动在CM治疗。在第一阶段的治疗开发项目中，我们计划开发、正式化和推导CM治疗的效应量估计值，该治疗侧重于改善健康，特别是与增加低强度体力活动（如步行、阻力训练和拉伸）相关的健康。奖励健康活动（HAPI）干预措施将针对参加艾滋病毒救助中心的艾滋病毒阳性药物滥用者进行测试。在有9名患者的第1a阶段试点项目中进行初步治疗开发后，将对治疗手册和材料进行调整和完善。在一项Ib期对照试验中，我们将招募50名物质滥用HIV阳性患者，并将其随机分配至（a）HAPI加12步易化治疗组或（B）CM戒断加12步易化治疗组。每次干预将包括每周一次的个体治疗，持续16周。 所有参与者将提供尿液和呼吸标本每周两次，将测试阿片类药物，兴奋剂，大麻和酒精。这两种情况下的患者都将有机会因提交药物阴性标本而获奖，而那些随机分配到HAPI条件下的患者也将有机会因参与健康活动而获奖。将在治疗前和治疗后第2个月和第4个月以及7个月（治疗后3个月）随访评价时测量身体活动水平、药物使用、心理症状以及主观和客观健康指标（体重指数、腰围、血压、病毒载量）。与接受CM禁欲12步促进相比，我们预计HAPI条件下的人将参加更多的体育活动，更大程度地减少药物使用，减少抑郁症的证据，并显示健康指数改善的趋势。 如果在所有领域中观察到至少小到中等范围的效应量，我们将认为该治疗适合在第2阶段治疗开发研究中进行进一步评价。

DESCRIPTION (provided by applicant): Contingency management (CM) interventions are highly efficacious in enhancing retention in treatment and reducing drug use. Growing evidence suggests these treatments can be adapted to alter a variety of behaviors, including health-related physical activities. Physical activity has beneficial effects on reducing depression and improving health. We have pilot data suggesting that drug abusing patients who engage in exercise to earn reinforcement have improved drug abuse outcomes relative to those who do not engage in exercise during CM treatments. In this Stage 1 therapy development project, we plan to develop, formalize, and derive effect size estimates of a CM therapy that focuses on improving health, especially as related to increasing low intensity physical activities, such as walking, resistance training, and stretching. The Healthy Activities for Prize Incentives (HAPI) intervention will be targeted toward and tested within HIV-positive substance abusers who attend HIV drop-in centers. After initial therapy development in a Stage 1a pilot project with 9 patients, the therapy manuals and materials will be adapted and refined. In a Stage Ib controlled trial, we will recruit and randomize 50 substance abusing HIV-positive patients to (a) HAPI plus 12-step facilitation therapy or (b) CM for abstinence plus 12-step facilitation therapy. Each intervention will consist of one weekly individual therapy session for 16 weeks. All participants will provide urine and breathe specimens twice weekly that will be tested for opioids, stimulants, marijuana and alcohol. Patients in both conditions will earn the chance to win prizes for submitting drug-negative specimens, and those randomized to the HAPI condition will also earn the chance to win prizes for engaging in healthy activities. Physical activity levels, drug use, psychological symptoms, and subjective and objective indicators of health (body mass index, waist circumference, blood pressure, viral load) will be measured pre-treatment and at months 2 and 4 (post- treatment), as well as at a 7-month (3 months after treatment) follow-up evaluation. Compared to that receiving 12-step facilitation with CM for abstinence, we expect that those in the HAPI condition will participate in more physical activities, decrease drug use to a greater extent, evidence reduced depression, and show trends toward improvements in health indices. If effect sizes in at least the small to medium range are noted across all domains, we will consider the therapy appropriate for further evaluation in a Stage 2 therapy development study.