Evaluation Of Treatments Of Opioid And Cocaine Dependence

阿片类药物和可卡因依赖的治疗评估

• 批准号: 8336419
• 负责人: Kenzie Preston
• 金额: $ 73.93万
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8336419
• 关键词: Abstinence; Address; Amaze; Behavior; Behavior Therapy; Behavioral; Buprenorphine; Characteristics; Cigarette; Clinic; Clinical Trials; Cocaine; Cocaine Dependence; Cocaine Users; Cognitive Therapy; Collaborations; Commit; Communities; Computer software; Cross-Over Studies; Data; Data Analyses; Devices; Drug usage; Electronics; Elements; Environment; Environmental Exposure; Evaluation; Evidence based treatment; Exposure to; Frequencies; Goals; Heroin Users; Incentives; Individual; Intervention; Management Decision Support Systems; Measures; Methadone; Moods; National Institute of Drug Abuse; Nicotine; Opiate Addiction; Opioid; Outcome; Outpatients; Pamphlets; Participant; Patients; Personal Digital Assistant; Pilot Projects; Population Intervention; Professional counselor; Psychological reinforcement; Randomized; Research Infrastructure; Resources; Sampling; Schedule; Simulate; Smoke; Smoker; Solutions; Spottings; Stress; Substance Addiction; System; Technology; Technology Transfer; Testing; Text; Treatment outcome; Urine; Withholding Treatment; Work; addiction; biomedical informatics; cigarette smoking; contingency management; cost; craving; design; diaries; drug abstinence; effective therapy; improved; insight; medication compliance; non-smoker; programs; psychosocial; response; self reported behavior; smoking cessation; stressor; substance abuser; technology development; treatment program; trend; usability

The Treatment Section has been engaged in a long-term project to improve treatment for substance dependence through behavioral, pharmacologic, or combined behavioral and pharmacologic interventions. Substantial effort has been directed toward identifying the most effective ways to deliver contingency management, a behavioral treatment in which incentives are used to increase the frequency of desirable behaviors, such as drug abstinence or medication adherence. A major challenge associated with contingency management is its likely prohibitive cost and staff/resource intensity, especially when the reinforcement follows an escalating schedule (i.e., when each consecutive occurrence of the desired behavior is reinforced more than the lastan especially effective treatment). One of the major implementation challenges for community clinics is keeping track of each patients prior earnings so that current earnings can be calculated on the spot. To address this and related challenges, in collaboration with the Biomedical Informatics Section of the NIDA IRP, we developed a software application, the Automated Contingency Management (ACM) decision support system for abstinence reinforcement. We are continuing to improve the system and to develop mechanisms to make it available to community treatment programs at no cost to them. We are completing a project field-testing the usability and robustness of the current version of the software, Motivational Incentives Implementation Software (MIIS), implemented under conditions simulating those of a community treatment program little technology infrastructure or staff expertise. This system will be distributed to community treatment programs to promote technology transfer and increase community use of evidence-based treatments for addiction. In further technology-development work, we are exploring the use of handheld electronic devices for treatment delivery in patients daily environments. We have completed a pilot study using these devices to remind patients to complete homework assigned by counselors as part of Cognitive-Behavioral Therapy (CBT). We conducted a within-subjects 2x2 randomized-block-design crossover study to investigate the effects of homework-task difficulty and electronic-diary reminders on compliance to and quality of homework completion among methadone-maintained cocaine and heroin users in CBT. Participants, in addition to completing a homework task between each of 12 weekly therapy sessions, carried a personal digital assistant (PDA), which was programmed to provide a daily reminder regarding homework completion during alternate weeks of the study. Homework was given in two different forms during alternating 3-week blocks: standard sheets of text versus simplified, illustrated booklets. Neither the simplified homework nor the PDA reminders significantly increased homework completion rates. For homework simplification, there were (non-significant) trends toward beneficial effects on homework completion; however, electronic prompting as implemented in this study had (non-significant) deleterious effects on homework completion. There were trends for the simplified homework tasks to be rated higher by counselors in terms of participants enthusiasm and understanding, although, unexpectedly, electronically prompted homework was also rated higher in terms of participants understanding. We suspect that a mobile intervention for this population may need to go beyond a reminder beep and incorporate interactive elements; we are beginning to pursue this line of intervention. In related work, we are developing Geographical Momentary Assessment, a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers. The Treatment Section continues to investigate predictors that might be useful for patient-treatment matching to improve the delivery of appropriate treatments to individual patients. We recently undertook a secondary analysis of data from one of our outpatient clinical trials of buprenorphine treatment for concurrent cocaine and opioid dependence (13 weeks, N = 200). We evaluated the association between cigarette smoking (lifetime cigarette smoking status, number of cigarettes smoked per day prior to study entry) and short-term treatment outcome (% of urine samples positive for cocaine or opioids, treatment retention). Nicotine-dependent smokers (66% of participants) had a significantly higher percentage of cocaine-positive urine samples than non-smokers (12% of participants) (76% vs. 62%), but did not differ in percentage of opioid-positive urine samples or treatment retention. Number of cigarettes smoked per day at baseline was positively associated with percentage of cocaine-positive urine samples, even after controlling for baseline sociodemographic and drug-use characteristics, but was not significantly associated with percentage of opioid-positive urine samples or treatment retention. These results suggest that cigarette smoking is associated with poorer short-term outcome in outpatient treatment for cocaine dependence, but perhaps not for concurrent opioid dependence, and support the importance of offering smoking-cessation treatment to cocaine-dependent patients.

治疗部分已经参与了一个长期项目，旨在通过行为，药理或行为和药理干预措施改善对物质依赖的治疗。 已经大力努力确定提供应急管理的最有效方法，这种行为待遇使用激励措施来增加所需行为的频率，例如戒毒或药物依从性。与应急管理相关的一个重大挑战是其可能的成本和人员/资源强度，尤其是当强化遵循逐渐升级的时间表时（即，当每次连续发生所需的行为都比Lastan更加强化时）。 社区诊所面临的主要实施挑战之一是跟踪每个患者的事先收入，以便可以当场计算当前的收入。为了应对这一问题和相关的挑战，与NIDA IRP的生物医学信息学部分合作，我们开发了一个软件应用程序，即自动应变管理（ACM）防止加强的决策支持系统。我们将继续改善系统，并开发机制，使其无需支付社区治疗计划。我们正在完成一个项目现场测试该软件的可用性和鲁棒性，即动机激励实施软件（MII），该软件在模拟社区治疗计划的条件下实施了很少的技术基础架构或员工专业知识。该系统将分配给社区治疗计划，以促进技术转移并增加社区对成瘾的循证治疗的使用。 在进一步的技术开发工作中，我们正在探索使用手持电子设备在患者日常环境中治疗交付的使用。我们已经完成了一项使用这些设备的试点研究，以提醒患者完成辅导员为认知行为疗法（CBT）的一部分分配的家庭作业。我们进行了一项受试者内2x2随机块设计的跨界研究，以研究家庭作业难度和电子二者的提醒对CBT美沙酮维护可卡因和海洛因使用者的合规性和家庭作业完成质量的影响。 参加者除了完成12个每周治疗课程之间的每一次家庭作业任务外，还携带了一个个人数字助理（PDA），该助理旨在在研究的替代周中提供有关家庭作业完成的每日提醒。在交替的3周块中以两种不同的形式提供了作业：标准文字与简化的插图小册子。简化的家庭作业和PDA都没有大幅提高作业完成率。为了简化家庭作业，有（不重要的）趋势对完成作业的有益影响；但是，这项研究中实施的电子提示对完成作业的完成（无显着）有害影响。从参与者的热情和理解方面，辅导员将简化的家庭作业任务评为更高的趋势，尽管出乎意料的是，以电子方式提示的作业在参与者的理解方面也被评为更高的评价。 我们怀疑该人群的移动干预可能需要超越提醒哔哔声，并结合互动元素。我们开始采取这种干预措施。 在相关工作中，我们正在开发地理瞬时评估，这是一种描述性的方法，可以更好地衡量和了解情绪，药物使用和环境与社会心理压力源的关系。我们仍然致力于将描述转变为干预措施。例如，我们已经表明，电子二进制研究可以在治疗过程中对滥用药物的日常生活和对行为变化敏感的数据的日常生活提供惊人的见解。使我们能够收集有关吸毒，渴望和野外压力的数据的技术也可以用于在野外提供治疗，也许是为了响应患者自己的自我报告行为或先前确定的触发器。 治疗部门继续研究可能对患者治疗匹配有用的预测因子，以改善向个别患者的适当治疗。最近，我们对丁丙诺啡治疗的门诊临床试验之一的数据进行了辅助分析，该数据并非可卡因和阿片类药物依赖性（13周，n = 200）。我们评估了吸烟（终身吸烟状态，研究入学前每天吸烟的香烟数量）与短期治疗结果（可卡因或阿片类药物呈阳性的尿液样本的百分比，治疗保留）之间的关联。依赖尼古丁的吸烟者（66％的参与者）的可卡因阳性尿液样本百分比明显高于非吸烟者（占参与者的12％）（76％vs. 62％），但阿片类阳性尿液样品的百分比没有差异。即使在控制基线社会人口统计学和药物使用特征之后，基线时每天抽烟的香烟与可卡因阳性尿液样本的百分比呈正相关，但与阿片类药物阳性尿液样本或保留率的百分比没有显着相关。这些结果表明，吸烟与可卡因依赖的门诊治疗中的短期结局较差有关，但也许不是同时进行阿片类药物依赖性，并支持为可卡因依赖性患者提供吸烟治疗的重要性。