Science-Based Treatment for Opioid-Dependent Adolescents

对阿片类药物依赖青少年的科学治疗

• 批准号: 6817782
• 负责人: Lisa A. Marsch
• 金额: $ 49.56万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-29 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6817782
• 关键词: adolescence (12-20); behavior therapy; behavioral /social science research tag; buprenorphine; clinical research; clinical trials; combination chemotherapy; combination therapy; drug abuse chemotherapy; drug addiction; drug administration rate /duration; drug withdrawal; human subject; human therapy evaluation; interview; naltrexone; opiate alkaloid; patient oriented research; questionnaires; reinforcer; sample collection

DESCRIPTION (provided by applicant): Adolescents are increasingly abusing and becoming dependent on heroin and other opioids. The number of emergency room visits related to heroin among 12-17 year olds rose almost 600%, and the self-reported prevalence of heroin use among this group more than doubled in the last decade. As a result of the increased availability of high-potency, low-cost heroin, many adolescents initiate heroin use by snorting it, however, many often then progress to injection of heroin. Despite the critical need to identify efficacious treatments for this population, virtually no research has been conducted to systematically characterize or evaluate treatment interventions for adolescent heroin and opioid abusers. We recently conducted the first controlled study funded by NIDA to systematically evaluate the efficacy of several pharmacotherapies as detoxification agents along with intensive behavioral interventions in the treatment of this population. The purpose of this proposal is to evaluate ways to further improve on the promising outcomes from our initial study via combined behavioral-buprenorphine treatment for opioid-dependent youth. The primary aim is to examine if improved treatment outcomes can be achieved if the duration of buprenorphine detoxification is lengthened (when the rate of decrease in buprenorphine dose is slower, withdrawal symptoms may be of reduced intensity and youth are provided with a greater opportunity to learn new skills and behaviors addressing how they might best discontinue their opiate use, prevent relapse, and meet treatment goals). A secondary aim is to examine if the provision of monetary voucher-based incentives contingent on consumption of the opioid antagonist, naltrexone, reduces rates of relapse to opiate use in adolescents post-detoxification compared to when no such incentives are provided. This analysis may provide critical empirical information regarding how to best prevent relapse to opioid use among opioid- dependent youth. Another secondary aim is to identify significant predictors of treatment outcome. We will thus conduct an exploratory evaluation of demographic, baseline drug use, psychological and other history variables that may predict successful treatment outcomes. This work may help inform the refinement of treatment interventions for various sub-populations of opioid-dependent youth. Outcome measures will include opiate and other drug abstinence, retention, opiate withdrawal symptoms, HIV risk behavior, family relationships, as well as a variety of other secondary outcome measures. We plan to collect these measures at intake, during treatment and at several post-treatment follow-up timepoints. Overall, this research will contribute new empirical information that will inform the development of effective treatment interventions for the largely unstudied and rapidly expanding population of opioid-dependent youth.

描述（由申请人提供）： 青少年越来越多地滥用海洛因和其他阿片类药物并变得依赖。 12-17 岁青少年因海洛因而到急诊室就诊的人数增加了近 600%，该群体自报的海洛因吸毒流行率在过去十年中增加了一倍多。由于高效、低成本海洛因的供应量增加，许多青少年通过吸食海洛因开始使用海洛因，然而，许多人往往随后发展为注射海洛因。尽管迫切需要为这一人群确定有效的治疗方法，但实际上还没有进行任何研究来系统地描述或评估青少年海洛因和阿片类药物滥用者的治疗干预措施。我们最近进行了第一项由 NIDA 资助的对照研究，系统评估了几种药物疗法作为解毒剂的功效以及治疗该人群的强化行为干预措施。该提案的目的是评估如何通过对阿片类药物依赖的青少年进行行为-丁丙诺啡联合治疗，进一步改善我们初步研究的有希望的结果。主要目的是检验如果延长丁丙诺啡解毒的持续时间是否可以改善治疗结果（当丁丙诺啡剂量减少的速度较慢时，戒断症状可能会减轻，并且为青少年提供更多的学习机会）新的技能和行为解决了他们如何最好地停止使用阿片类药物、防止复发并实现治疗目标）。第二个目的是检查与不提供此类激励措施时相比，根据阿片类拮抗剂纳曲酮的消费提供基于货币券的激励措施是否可以降低青少年戒毒后阿片类药物使用的复发率。该分析可能提供有关如何最好地预防阿片类药物依赖青少年复发阿片类药物的关键经验信息。另一个次要目标是确定治疗结果的重要预测因素。因此，我们将对人口统计、基线药物使用、心理和其他可能预测成功治疗结果的历史变量进行探索性评估。这项工作可能有助于为阿片类药物依赖青年的各个亚群的治疗干预措施的完善提供信息。结果指标将包括阿片类药物和其他药物的戒断、保留、阿片戒断症状、艾滋病毒危险行为、家庭关系以及各种其他次要结果指标。我们计划在摄入时、治疗期间和治疗后的几个随访时间点收集这些测量值。总体而言，这项研究将提供新的经验信息，为针对很大程度上未经研究且迅速扩大的阿片类药物依赖青年群体制定有效的治疗干预措施提供信息。