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: 8736709
• 负责人: Kenzie Preston
• 金额: $ 113.28万
• 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/8736709
• 关键词: Abstinence; Amaze; Behavioral; Clinical Trials; Cocaine; Cocaine Dependence; Commit; Communities; Controlled Study; Cues; Data; Dose; Double-Blind Method; Drug usage; Education; Effectiveness; Electronics; Emotional; Environmental Exposure; Evaluation; Evidence based treatment; Exposure to; Failure; Future; Goals; HIV risk; HIV/STD; Heroin; Individual; Intervention; Knowledge; Measures; Methadone; Moods; Opiate Addiction; Opioid; Participant; Patients; Physiological; Placebos; Population; Propranolol; Randomized; Risk Reduction; Solutions; Stress; Substance Addiction; Technology; Technology Transfer; Testing; addiction; base; craving; cue reactivity; design; diaries; dosage; improved; insight; meetings; non-compliance; psychosocial; response; self reported behavior; stressor; substance abuser; trend

The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. We completed a clinical trial examining the effectiveness of individualized methadone dosages of 100 to 190 mg/day, compared in a randomized, double-blind design with fixed dosages of 100 mg/day. Surprisingly, polydrug use (effect-size h = .30) and heroin craving (effect-size d = .87) were significantly greater in the individualized high-dose group than in the fixed-dose group, with no trend toward lower heroin use in the individualized high-dose group. This counterintuitive finding requires replication, but supports the need for additional controlled studies of high-dose methadone. We also completed a double-blind interventional study of propranolol on cue-induced cocaine craving, in which a single administration of propranolol was intended to block reconsolidation of cocaine-associated emotional responses, thereby leading to an enduring reduction in cue-induced craving. Again, the results were unexpected. Cue reactivity, as assessed by craving scales and physiological responses, was unexpectedly greater in the propranolol group than in the placebo group. This counter-hypothesized group difference was present both acutely after propranolol administration and during the subsequent test sessions. Our results do not support the use of propranolol for cue-induced cocaine craving in opioid-maintained patients. We also developed and deployed a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessment. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability as is in the population: they achieved median scores of &#8804;2.5 on a 5-point Likert scale; &#8804;20% of individuals gave them the most negative rating on the scale; and a majority of individuals stated they would not prefer other formats over video-based smartphone-delivered (all p<0.05). Additionally, all of our video modules met our a priori criteria for feasibilty: &#8804;20% of data were missing due to participant noncompliance and &#8804;20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable and feasible, and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings. Finally we continue to develop Geographical Momentary Assessment (GMA), 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.

治疗科继续其长期项目，通过行为、药理学以及行为和药理学相结合的干预措施来改善物质依赖的治疗。 我们完成了一项临床试验，检验了 100 至 190 毫克/天的个体化美沙酮剂量的有效性，并与 100 毫克/天的固定剂量的随机双盲设计进行了比较。 令人惊讶的是，个体化高剂量组的多种药物使用（效应值 h = .30）和海洛因渴望（效应值 d = .87）显着高于固定剂量组，且没有海洛因使用量减少的趋势在个体化高剂量组中。 这一违反直觉的发现需要重复，但支持需要对高剂量美沙酮进行额外的对照研究。 我们还完成了普萘洛尔对提示诱发的可卡因渴望的双盲干预研究，其中单次服用普萘洛尔旨在阻止可卡因相关情绪反应的重新巩固，从而导致提示诱发的渴望的持久减少。 结果再次出乎意料。 通过渴望量表和生理反应评估，普萘洛尔组的提示反应性出乎意料地高于安慰剂组。 这种反假设的组间差异在普萘洛尔给药后和随后的测试过程中都明显存在。我们的结果不支持使用普萘洛尔来缓解阿片类药物维持患者的提示诱导的可卡因渴望。 我们还开发并部署了基于视频的智能手机提供的移动艾滋病毒风险降低 (mHIVRR) 干预措施。 我们开发了 3 个视频模块，其中包括 10 分钟的 HIVRR 视频、11 个可接受性问题和 3 个知识问题，并将它们部署为更大的生态瞬时和地理瞬时评估研究中的辅助研究。 留在主要研究中足够长的时间的所有 24 名个体都完成了 mHIVRR 二次研究。所有 3 个视频均符合我们在人群中的先验可接受性标准：在 5 点李克特量表中，它们的中位分数≤2.5； ≤20%的人在量表上给出了最负面的评价；大多数人表示，与基于视频的智能手机交付相比，他们不喜欢其他格式（所有 p<0.05）。此外，我们所有的视频模块都满足我们先验的可行性标准：≤20% 的数据因参与者不合规而丢失，≤20% 的数据因技术故障而丢失。 我们的结论是，通过智能手机提供基于视频的 mHIVRR 教育是可以接受和可行的，并且可以增加降低艾滋病毒/性病风险的知识。 未来的研究，包括干预前的知识评估和随机分配，需要证实这些发现。 最后，我们继续开发地理瞬时评估（GMA），这是一种描述性方法，可以更好地测量和理解情绪、药物使用和社会心理压力源环境暴露之间的关系。我们仍然致力于将描述转化为干预。例如，我们已经证明，电子日记研究可以提供对药物滥用者在治疗期间日常生活的惊人洞察，以及对即使是短暂的戒断期间的行为变化敏感的数据。使我们能够在现场收集有关药物使用、渴望和压力数据的技术也可用于在现场提供治疗，也许是为了响应患者自己报告的行为或之前确定的触发因素。