Reinforcing Exercise in Cocaine Abusers

描述（由申请人提供）：体育活动在改善健康和减少抑郁方面具有已知的积极作用。虽然运动对减少吸烟也有一定的好处，但它对非法药物使用的影响还相对未经检验。运动可以作为一种健康的替代吸毒的行为。然而，大多数药物滥用者是久坐不动的，很少有人能成功地开始或维持锻炼方案。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，包括身体活动或锻炼。我们有试点数据表明，与那些在CM治疗期间不从事运动的药物滥用患者相比，从事运动以获得强化的药物滥用患者的药物滥用治疗结果有所改善。此外，我们开发了一种基于cm的运动干预，我们的试点数据表明，患者对这种干预反应良好，并开始定期锻炼。在本研究中，我们计划评估这种基于运动的CM干预的疗效。在门诊重症治疗中，总共120名可卡因滥用患者将被随机分配到两种情况中的一种：(A)标准治疗加CM完成与运动无关的目标相关活动（例如，改善工作、家庭或交通问题），或(b)标准治疗加CM完成与运动相关的活动。每项干预将包括每周一次的个人治疗，持续16周，两种情况下的患者都将有机会赢得完成活动的奖品。所有参与者每周将提供1-2次尿液和呼吸样本，用于检测兴奋剂、阿片类药物、大麻和酒精。将在治疗前、治疗后第2个月和第4个月以及6个月、9个月和12个月的随访评估中测量身体活动水平、药物使用、心理症状和主观和客观健康指标（体重指数、腰围、血压）。与目标相关CM活动收缩的患者相比，我们预计运动CM患者将参与更多的体育活动，发展更大的力量和柔韧性，更大程度上减少药物使用，减轻抑郁症状，改善健康指标。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Few substance abusers engage in regular physical activity, and exercise is closely linked with physical fitness and emotional well being. By utilizing contingency management procedures to increase adherence to exercise regimes, we expect that cocaine abusers will begin exercising regularly. Exercising should improve physical fitness, reduce drug use, decrease psychological symptoms, and improve indices of health in cocaine abusing patients.