Reinforcing Exercise in Cocaine Abusers

摘要 众所周知，体育活动对改善健康和减少肥胖有积极作用。 萧条虽然运动对减少吸烟也有一些假定的好处，但它对非法药物的影响 使用相对未经测试。运动可以作为一种健康的行为来代替吸毒。但 大多数药物滥用者是久坐不动的，很少有人成功地开始或保持锻炼 养生法应急管理（CM）干预措施在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许多行为，包括 体力活动或锻炼。我们有试点数据表明，滥用药物的病人谁从事 与那些通过锻炼获得强化的人相比， 在CM治疗期间不要进行锻炼。此外，我们还开发了一个基于CM的练习， 我们的试验数据表明，患者对这种干预反应良好，并开始 经常锻炼。 在这项研究中，我们计划评估这种基于运动的CM干预的有效性。共120 接受强化门诊治疗的可卡因滥用患者将被随机分配到以下两组之一： 条件：（a）标准护理加CM，用于完成与锻炼无关的目标相关活动（例如， 改善工作、家庭或交通问题），或（B）标准护理加CM以完成锻炼- 相关活动。每次干预将包括每周一次的个体治疗，持续16周， 两种情况的病人都有机会赢取奖品。所有参与者将 每周提供1-2次尿液和呼吸样本，用于兴奋剂，阿片类药物，大麻 和酒精。身体活动水平，药物使用，心理症状，以及主观和客观 将在治疗前测量健康指标（体重指数、腰围、血压） 以及在治疗后第2个月和第4个月，以及在6个月、9个月和12个月的随访评估时。相比 对于那些接受与目标相关的CM活动合同的人，我们预计那些在运动CM条件下的人， 将参加更多的体育活动，发展更大的力量和灵活性，减少药物使用， 更大程度上减少抑郁症状，改善健康指数。

Abstract Physical activity has known positive effects with respect to improving health and reducing depression. While exercise also has some putative benefits for decreasing smoking, its effects on illicit drug use are relatively untested. Exercise may serve as a healthy substitute behavior for drug use. However, the majority of substance abusers are sedentary, and few individuals successfully initiate or maintain exercise regimens. Contingency management (CM) interventions are highly efficacious in reducing drug use, and growing evidence suggests these treatments can be adapted to alter a number of behaviors, including physical activity or exercise. We have pilot data suggesting that substance abusing patients who engage in exercise to earn reinforcement have improved drug abuse treatment outcomes compared to those who do not engage in exercise during CM treatments. Further, we have developed a CM-based exercise intervention, and our pilot data suggest that patients respond favorably to this intervention and begin exercising regularly. In this study, we plan to evaluate the efficacy of this exercise-based CM intervention. A total of 120 cocaine abusing patients in intensive outpatient treatment will be randomly assigned to one of two conditions: (a) standard care plus CM for completing goal-related activities not related to exercising (e.g., improving work, family, or transportation issues), or (b) standard care plus CM for completing exercise- related activities. Each intervention will consist of one weekly individual therapy session for 16 weeks, and patients in both conditions will earn the chance to win prizes for completing activities. All participants will provide urine and breath specimens 1-2 times weekly that will be tested for stimulants, opioids, marijuana and alcohol. Physical activity levels, drug use, psychological symptoms, and subjective and objective indicators of health (body mass index, waist circumference, blood pressure) will be measured pre-treatment and at months 2 and 4 (post-treatment), as well as at 6-,9- and 12-month follow-up evaluations. Compared to those receiving goal-related CM activity contracting, we expect that those in the exercise CM condition will participate in more physical activities and develop greater strength and flexibility, decrease drug use to a greater extent, reduce depressive symptoms, and improve health indices.