Employment-Based Addiction Pharmacotherapy

描述（由申请人提供）：海洛因成瘾会造成毁灭性的社会、医疗和经济后果。美沙酮维持是一种有效的治疗海洛因成瘾的方法，但只有大约20%的鸦片依赖者接受这种治疗。纳曲酮是一种阿片类拮抗剂，可以为许多人提供非常有效的替代品。然而，它的效用有限，因为大多数人拒绝它。计划进行一项为期5年的随机研究，以评估治疗场所在促进失业阿片类依赖注射吸毒者纳曲酮摄入和戒断方面的有效性。治疗性工作场所是一种新颖的以就业为基础的干预措施，利用工作工资来加强临床上重要的行为改变。在这个模范工作场所，滥用药物的病人被雇佣并获得报酬。为了促进临床重要行为，工资的安排既取决于工作情况，也取决于这些行为的表现。参与者将接受阿片类药物解毒和纳曲酮诱导。完成纳曲酮诱导的参与者将被随机分配到三组之一。所有小组将被邀请到治疗场所工作，并服用纳曲酮26周。这些群体在工作和赚取工资的偶然性方面有所不同。“工作加纳曲酮应急”参与者将被要求在工作时服用纳曲酮，并因少服一剂而获得短暂的减薪。“工作加纳曲酮和戒断应急”的参与者将被要求服用纳曲酮来工作，并将因缺少纳曲酮剂量或提供鸦片或可卡因阳性尿样而获得短暂的减薪。“工作加纳曲酮处方”将给参与者开纳曲酮，但不要求他们服用纳曲酮来发挥作用。将评估阿片剂和可卡因使用以及艾滋病毒风险行为的关键措施。本研究将对一种新的基于就业的干预措施——治疗性工作场所——进行严格的评估，以促进纳曲酮摄入和药物戒断注射吸毒者的人群，他们有相当大的传播或感染艾滋病毒的风险。

DESCRIPTION (provided by applicant): Heroin addiction can have devastating social, medical and economic consequences. Methadone maintenance is an effective treatment for heroin addiction, but only about 20 percent of opiate dependent individuals receive it. Naltrexone is an opiate antagonist that could provide an extraordinarily effective alternative for many individuals. However, its utility has been limited because most individuals refuse it. A randomized study is planned over 5 years to evaluate the effectiveness of the Therapeutic Workplace in promoting naltrexone ingestion and abstinence in unemployed opiate-dependent injection drug users. The Therapeutic Workplace is a novel employment-based intervention that uses salary for work to reinforce clinically important behavior change. Drug abuse patients are hired and paid in this model workplace. To promote clinically important behaviors, salary is arranged contingent both on work and on the emission of those behaviors. Participants will be offered an opioid detoxification and naltrexone induction. Participants who complete the naltrexone induction will be randomly assigned to one of three groups. All groups will be invited to work in the Therapeutic Workplace and prescribed naltrexone for 26 weeks. The groups will differ in the contingencies imposed to work and earn salary. "Work Plus Naltrexone Contingency" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose. "Work Plus Naltrexone and Abstinence Contingency" participants will be required to ingest naltrexone to work, and will receive a brief pay decrease for missing a dose of naltrexone or for providing an opiate or cocaine positive urine sample. "Work Plus Naltrexone Prescription" participants will be prescribed naltrexone, but will not be required to ingest it to work. Critical measures of opiate and cocaine use and HIV risk behaviors will be assessed. This study will provide a rigorous evaluation of a novel employment based intervention, the Therapeutic Workplace, to promote naltrexone ingestion and drug abstinence in a population of injection drug users who are at considerable risk of spreading or contracting HIV infection.