IMPROVING COMBINED BUPRENORPHINE-BEHAVIORAL TREATMENT

改善丁丙诺啡联合行为治疗

• 批准号: 6634289
• 负责人: Warren K Bickel
• 金额: $ 91.97万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-03-10 至 2005-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6634289
• 关键词: behavior modification; behavior test; behavioral /social science research tag; buprenorphine; clinical research; clinical trials; cocaine; combination therapy; computer assisted patient care; counseling; drug abuse therapy; drug addiction; endogenous opioid; enzyme linked immunosorbent assay; health care cost /financing; high risk behavior /lifestyle; human subject; human therapy evaluation; patient care management; questionnaires; statistics /biometry; urinalysis

The Community Reinforcement Approach (CRA) with contingency management is an efficacious drug abuse treatment. Unfortunately, efficacy alone is not sufficient for a treatment to be adopted by treatment programs. Adoption of CRA with contingency management may be facilitated if it could be delivered in ways that are less costly. The aim of this proposal is to examine the efficacy of two modifications to CRA with contingency management that make it less costly to provide. The first method will consist of delivering CRA via computer-based interactive technology. Such technology may render the treatment less costly by decreasing counselor contact time. The second method will reduce costs by using an incentive system that employs buprenorphine privileges contingent on drug abstinence as opposed to monetary-based incentives. We propose to examine the efficacy of these cost-reducing methods in the context of buprenorphine maintenance treatment of opioid dependence. While opioid dependence is frequently acknowledged as a public health problem of urban areas, it is less frequently acknowledged as an issue for rural areas. Opioid dependence, however, can be a serious problem in rural areas, especially with the current threat of AIDS due to high-risk behavior by substance abusers. The aims of this project are to address this serious public health concern by continuing the first and only outpatient clinic to provide pharmacotherapies for opioid dependence in the State of Vermont. While in treatment, patients will participate in two randomized clinical trials. In the first trial, patients will be randomly assigned to receive one of three treatments: (1) computer- delivery CRA with the voucher incentive system (e.g., provision of monetary vouchers contingent on drug abstinence), (2) therapist-delivered CRA with the voucher incentive systems, or (3) standard counseling. In the second treatment, patients will be randomly assigned to receive one of three treatments: (1) CRA with buprenorphine-related contingency management (alternative dose regimens and dose adjustment), (2) CRA with the voucher incentive program, or (3) standard counseling. Contingency management procedures in both trials will target both opioid and cocaine abstinence in this population. Primary outcome measures will include abstinence, retention and cost-effectiveness. Measures will also be taken of HIV-risk behavior. Overall, this research will contribute new empirical information by identifying the efficacy of two methods of reducing costs of CRA with contingency management treatment. Such information may contribute to the adoption of this efficacious treatment. This research will also examine the utility of computerizing substance abuse treatment. The computerization of some substance abuse treatment services is a novel approach that may positively impact the future of drug abuse treatment services. Finally, by providing the only outpatient pharmacotherapy services for opioid dependence in the State of Vermont, this project will contribute positively to this region's public health.

具有应急管理的社区强化方法（CRA）是一种有效的滥用药物治疗。不幸的是，仅疗效就不足以由治疗计划采用治疗。 如果可以以较低成本的方式交付CRA，则可以促进CRA使用应急管理。 该提案的目的是检查两种修改对CRA的功效，并具有应急管理，从而使提供的成本降低。 第一种方法将包括通过基于计算机的交互式技术提供CRA。 通过减少辅导员接触时间，这种技术可能会使治疗的成​​本降低。 第二种方法将通过使用具有丁丙诺啡特权的激励系统来降低成本，该特权取决于戒毒，而不是基于货币的激励措施。 我们建议在丁丙诺啡维持治疗阿片类药物依赖性的情况下检查这些降低成本的方法的功效。虽然阿片类药物依赖经常被认为是城市地区的公共卫生问题，但它被认为是农村地区的问题。 然而，在农村地区，阿片类药物依赖可能是一个严重的问题，尤其是由于药物滥用者的高风险行为引起的艾滋病威胁。该项目的目的是通过继续第一个也是唯一的门诊诊所来解决这一严重的公共卫生问题，以便为佛蒙特州的阿片类药物依赖提供药物治疗。在治疗中，患者将参加两项随机临床试验。 在第一次试验中，将随机分配患者接受三种治疗方法之一：（1）用代金券激励系统（例如，提供货币凭证的提供，包括药物禁欲的货币凭证），（2）治疗师与凭证持续性持续性系统或（3）标准咨询有关。 在第二次治疗中，将随机分配患者接受三种治疗方法之一：（1）与丁丙诺啡相关的应急管理（替代剂量方案和剂量调整）的CRA，（2）带有优惠券激励计划的CRA或（3）标准咨询。 两项试验中的应急管理程序将针对该人群中的阿片类药物和可卡因戒酒。 主要结果指标将包括禁欲，保留和成本效益。还将采取措施对艾滋病毒风险行为。总体而言，这项研究将通过确定两种通过应急管理治疗来降低CRA成本的疗效来贡献新的经验信息。 这样的信息可能有助于采用这种有效的治疗方法。 这项研究还将检查计算机化药物滥用治疗的实用性。 某些药物滥用治疗服务的计算机化是一种新颖的方法，可能会对药物滥用治疗服务的未来产生积极影响。 最后，通过为佛蒙特州的阿片类药物依赖提供唯一的门诊药物治疗服务，该项目将对该地区的公共卫生产生积极贡献。