Effectiveness of Extended Treatments for Drug Dependence

描述(由申请人提供)：此申请是对以下通知的回应：NIH宣布恢复法案资金可用于竞争性修订申请(NOT-OD-09-058)。有相当多的证据表明，药物使用障碍的治疗可以导致物质使用和心理社会问题严重程度的实质性改善。然而，相当大比例的患者退出得相对较快，复发率很高，而且持续护理往往不充分或不可用。在我们的NIDA家长赠款中，我们正在测试两种延长的持续护理模式，旨在管理患者长达两年的时间。这些模式结合了基于电话的低水平监测和咨询，以及在需要时提高护理水平的自适应组件。其中一种模式还包括对已完成的持续护理接触的小额激励。来自前250名参与者的数据表明，这些激励措施产生了非常高的持续护理接触率，而没有激励措施的相同干预措施(74%对52%)完成了所有可能的持续护理接触。对3个月、6个月、9个月和12个月的可卡因尿毒学样本的初步分析表明，这两种延长护理干预措施都比通常的门诊治疗产生了更好的结果。在家长研究中，我们从公共资助的社区项目中招募参保患者。延长的持续护理干预是由一群训练有素并受到密切监督的顾问提供的。作为补充，我们建议将这种持续护理模式扩展到新的高危人群，即没有任何形式保险的市中心居民，他们通过费城行为卫生局运行的一项特殊计划寻求治疗可卡因依赖。我们将培训城市电话护理经理，为参加该计划的患者提供我们的电话持续护理干预，提供12个月的定期监测、简短咨询、病例管理和与社区支持的联系，并根据需要进一步转诊到治疗服务。我们将随机挑选200名参与者接受这项干预或常规护理，并对他们进行12个月的跟踪调查。这一补充将提供一个更直接的测试，以检验我们的持续护理模式是否能够通过“真实世界”公共资助的项目及其辅助专业人员和咨询人员的工作人员成功实施，并将促进该市转变为一种以康复为导向的持续护理模式。宾夕法尼亚大学医学院为当地经济做出了巨大贡献。2008年，该学院创造了37,000个就业机会和54亿美元的地区经济活动，该地区训练有素的劳动力仅为840个空缺的宾夕法尼亚大学教职员工研究职位就产生了超过24,600份申请。目前的提案将创造或保留16个就业机会。 公共卫生相关性：药物使用障碍的治疗通常包括相对较短的护理，这些护理不能适当地解决这些疾病的慢性、复发性。在父母资助和其他先前的工作中，我们开发了一种基于电话的持续护理模式，提供长期护理，并在几项仔细控制的研究中被证明是有效的。拟议的补充方案将决定这一持续护理方案的12个月版本是否可以有效地用于在公共资助的市中心项目中寻求治疗的弱势可卡因依赖个人。

DESCRIPTION (provided by applicant): This application is in response to the following notice: NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications (NOT-OD-09-058). There is considerable evidence that treatment for drug use disorders can lead to substantial improvements in substance use and psychosocial problem severity. However, a significant percentage of patients drop out relatively quickly, rates of relapse are high, and continuing care is often inadequate or unavailable. In our NIDA parent grant, we are testing two extended continuing care models designed to manage patients for up to two years. These models combine low-level telephone-based monitoring and counseling, with an adaptive component to step up level of care when needed. One of these models also includes small incentives for completed continuing care contacts. Data from the first 250 participants indicates these incentives produce very high rates of continuing care contact, compared to the same intervention without incentives (74% vs. 52% of all possible continuing care contacts completed). Preliminary analyses of cocaine urine toxicology samples at 3, 6, 9, and 12 months indicated that both extended care interventions are producing better outcomes than outpatient treatment as usual. In the parent study, we are recruiting insured patients out of publicly funded community programs. The extended continuing care interventions are provided by a group of highly trained and closely supervised counselors. For the supplement, we propose to extend this continuing care model into a new population of high risk individuals, inner city residents without any kind of insurance who seek treatment for cocaine dependence through a special program run by the City of Philadelphia's Behavioral Health Department. We will train city telephone care managers to deliver our telephone continuing care intervention to patients who enter this program, to provide 12 months of regular monitoring, brief counseling, case management and linkage to community supports, and further referral to treatment services as needed. We will randomize 200 participants to receive this intervention or usual care, and follow them up for 12 months. This supplement will provide a more direct test of whether our continuing care model can be implemented successfully by "real world" publicly funded programs and their staff of paraprofessionals and counselors, and will facilitate the City's transformation into a recovery-oriented, continuing care model of addiction treatment. The University of Pennsylvania School of Medicine contributes substantially to the local economy. In 2008, the School created 37,000 jobs and $5.4 billion in regional economic activity, with the area's highly trained workforce producing more than 24,600 applications for just 840 open Penn staff research positions. The current proposal will create or retain 16 jobs. PUBLIC HEALTH RELEVANCE: Treatment for substance use disorders generally consists of relatively brief episodes of care that do not properly address the chronic, relapsing nature of these disorders. In the parent grant and other prior work, we have developed a telephone-based continuing care model that provides extended care and has proved efficacious in several carefully controlled studies. The proposed supplement will determine whether a 12 month version of this continuing care protocol can be used effectively in disadvantaged cocaine dependent individuals seeking treatment in publicly funded, inner-city programs.