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.

治疗部门继续其长期项目，以通过行为，药理和行为和药理干预措施来改善对物质依赖的治疗。 我们完成了一项临床试验，研究了单个美沙酮剂量为100至190 mg/天的有效性，以随机的双盲设计进行比较，固定剂量为100 mg/day。 令人惊讶的是，在个性化的高剂量组中，多药的使用（效应大小H = .30）和海洛因渴望（效应大小d = .87）明显高于固定剂量组，而在个性化的高剂量组中，没有降低海洛因使用的趋势。 这一违反直觉的发现需要复制，但支持对高剂量美沙酮进行其他对照研究的需求。 我们还完成了对可卡因渴望的普萘洛尔的双盲介入研究，其中单一的普萘洛尔给药旨在阻止可卡因相关的情绪反应的重新溶解，从而导致提示引起的渴望的持久减少。 同样，结果是出乎意料的。 通过渴望量表和生理反应评估的提示反应性在普萘洛尔组中出乎意料地比安慰剂组更大。 在普萘洛尔给药后和随后的测试课程中，这种反刺激的群体差异都存在急性存在。我们的结果不支持普萘洛尔用于阿片类药物维护患者的提示引起的可卡因渴望。 我们还开发了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，并将其部署为对生态瞬时和地理瞬时评估的更大研究中的二级研究。 留在主要研究中的所有24个人都完成了MHIVRR二级研究。所有3个视频都按照人口的可接受性符合我们的先验标准：他们在5分李克特量表上达到了≤2.5的中位数； ≤20％的个体给予他们最高的评分。大多数人表示，他们不喜欢其他格式而不是基于视频的智能手机传递（全部p <0.05）。此外，我们所有的视频模块都符合我们的先验标准：≤20％的数据由于参与者的不合规而缺少，并且由于技术故障而缺少≤20％。 我们得出的结论是，通过智能手机提供的基于视频的MHIVRR教育是可以接受且可行的，并且可能会增加HIV/STD风险降低知识。 需要对知识和随机分配进行干预预先评估的未来研究来确认这些发现。 最后，我们继续开发地理瞬时评估（GMA），这是一种描述性方法，可以更好地衡量和了解情绪，吸毒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。