Incentivizing adherence to Prolonged Exposure for PTSD in substance users

激励物质使用者坚持长期接触 PTSD

• 批准号: 8385113
• 负责人: JESSICA M PEIRCE
• 金额: $ 26.93万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8385113
• 关键词: Achievement; Address; Adherence; Adverse event; Arousal; Behavior; Behavioral; Caring; Clinical; Cognitive; Drug usage; Effectiveness; Event; Evidence based intervention; Female; Fright; Gold; Incentives; Intervention; Medical; Memory; Methadone; Monitor; Opioid; Outcome; Patient Self-Report; Patients; Population; Post-Traumatic Stress Disorders; Psychiatry; Randomized; Research; Sampling; Schedule; Services; Specimen; Staging; Substance Use Disorder; Substance abuse problem; Symptoms; Urine; Work; base; clinical practice; contingency management; effective therapy; follow-up; improved; male; patient population; randomized trial; standard care; substance abuse treatment; therapy development; treatment program; voucher

DESCRIPTION (provided by applicant): The present resubmission application will address the urgent need for a more effective treatment approach for the 25% of substance use disordered (SUD) patients who have co-occurring posttraumatic stress disorder (PTSD). The "gold standard" treatment for PTSD in psychiatry is Prolonged Exposure, which uses a cognitive- behavioral approach that repeatedly and systematically exposes patients to memories of their traumatic events to reduce fear and arousal. Prolonged Exposure has only rarely been offered to SUD patients, in part due to concern that the intensive treatment will provoke increased drug use. In the handful of demonstration studies of exposure-based therapy for SUD patients, the primary limitation to its efficacy is poor adherence, rather than increased drug use. As many as 75% of SUD patients fail to complete the prescribed course of Prolonged Exposure sessions, which dramatically limits its effectiveness for SUD patients. Poor adherence to specialized psychiatric and other medical services in SUD populations is a common problem, and decades of substance abuse research have established that voucher-based contingency management approaches are highly effective in increasing low base-rate healthy behaviors in substance users. In this Stage Ib treatment development study, 62 male and female opioid-dependent and methadone treated patients with co-occurring current PTSD will be offered Prolonged Exposure therapy. Half of the sample will be randomly assigned to a Reinforced Prolonged Exposure condition that provides monetary-based incentives for attending the therapy sessions. The comparison condition will be assigned to a Standard Prolonged Exposure condition without the attendance incentives intervention. Groups will be compared primarily on adherence to the Prolonged Exposure therapy schedule, improvement in PTSD symptoms, and rates of drug use (urine specimens, self- reported use). The potential for increased drug use in particular, as well as other adverse events, will be proactively monitored and clinically managed throughout the treatment episode. The primary aims of the study are: Aim 1 - Evaluate the efficacy of adding voucher-based attendance incentives to Prolonged Exposure for PTSD to increase adherence in SUD patients in a methadone treatment program. Aim 2 - Evaluate the efficacy of adding voucher-based attendance incentives to Prolonged Exposure for PTSD to reduce PTSD symptoms in SUD patients. Aim 3 - Evaluate the effect of Prolonged Exposure for PTSD on rates of drug use in SUD patients. This study bridges two independent and important clinical achievements in psychiatric and substance abuse treatment to improve outcomes for SUD patients with co-occuring PTSD. This will also be the first known study to join the two evidence-based interventions of contingency management and the highly effective but poorly attended Prolonged Exposure for PTSD treatment. The potential impact of this work on research and clinical practice is considerable and far-reaching if, as anticipated, greater attendance to Prolonged Exposure reduces PTSD symptoms in SUD patients without increasing drug use. PUBLIC HEALTH RELEVANCE: Up to 25% of substance users in treatment have co-occurring posttraumatic stress disorder, and no treatments to date have proven effective. The proposed treatment development study has the great potential to find the first efficacious treatment for posttraumatic stress disorder in this population.

描述（由申请人提供）：目前的重新提取申请将迫切需要对具有共同发生的创伤后应激障碍（PTSD）的25％的药物使用障碍（SUD）患者采用更有效的治疗方法。精神病学中PTSD的“黄金标准”治疗方法是长时间的暴露，它使用一种认知行为方法，该方法反复，系统地将患者暴露于对创伤事件的记忆，以减少恐惧和唤醒。长时间的暴露仅限于SUD患者，部分原因是人们担心强化治疗会引起增加的药物使用。在对SUD患者的基于暴露治疗的示范研究中，其功效的主要局限性是依从性不佳，而不是增加药物使用。多达75％的SUD患者未能完成长时间暴露课程的规定过程，这极大地限制了其对SUD患者的有效性。对SUD人群中专业的精神病和其他医疗服务的依从性较差是一个普遍的问题，数十年来，滥用药物的研究已经确定，基于优惠券的应急管理方法对于增加药物使用者的低碱率健康行为非常有效。在此阶段，IB治疗开发研究中，将提供62例男性和女性阿片类药物依赖性和美沙酮治疗的同时发生PTSD患者，将提供长时间的暴露疗法。一半的样本将随机分配到加强长时间的暴露条件下，该状态为参加治疗课程提供了基于货币的激励措施。比较条件将分配给标准的延长暴露条件，而无需出席激励措施干预。将主要根据遵守长期暴露疗法时间表，改善PTSD症状和药物使用率（尿液标本，自我报告的使用）进行比较。在整个治疗事件中，尤其是增加药物使用的潜力以及其他不良事件的可能性将被主动监测和临床管理。该研究的主要目的是：目标1-评估增加基于凭证的出勤激励措施以延长PTSD的暴露措施的功效，以增加美沙酮治疗计划中SUD患者的依从性。 AIM 2-评估增加基于优惠券的出勤激励措施以延长PTSD暴露以减少SUD患者的PTSD症状的功效。 AIM 3-评估PTSD长期暴露对SUD患者药物使用率的影响。这项研究桥接了精神病和药物滥用治疗方面的两项独立且重要的临床成就，以改善共依赖PTSD的SUD患者的预后。这也将是首次加入两种基于证据的应急管理干预措施以及高度有效但经历较差的PTSD治疗暴露。如果如预期的那样，这项工作对研究和临床实践的潜在影响是相当大的，并且有深远的影响，那么长时间暴露会减少SUD患者的PTSD症状而不增加药物使用。 公共卫生相关性：多达25％的治疗中的药物使用者患有创伤后应激障碍，迄今为止尚无治疗方法已被证明有效。拟议的治疗开发研究具有很大的潜力，可以找到该人群创伤后应激障碍的首次有效治疗。