Project#2 Extending Treatment Effects Through an Adaptive Aftercare Intervention

项目

• 批准号: 8742767
• 负责人: NANCY M PETRY
• 金额: $ 43.78万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8742767
• 关键词: Abstinence; Address; Aftercare; Behavior; Behavioral; Biological Markers; Cellular Phone; Clinic; Clinical; Cocaine; Cognitive; Communicable Diseases; Communities; Data; Development; Disease; Drug abuse; Drug usage; Effectiveness of Interventions; Evaluation; Frequencies; Functional Magnetic Resonance Imaging; Future; Gender; HIV risk; Individual; Intervention; Lead; Long-Term Effects; Measures; Mediating; Methods; Modeling; Monitor; Neurocognitive; Outcome; Patient Self-Report; Patients; Performance; Policies; Procedures; Process; Provider; Psychological reinforcement; Psychotherapy; Quality of life; Randomized; Reinforcement Schedule; Relapse; Relative (related person); Rewards; Risk Behaviors; Role; Sampling; Schedule; Staging; Symptoms; System; Testing; Time; Treatment outcome; United States National Institutes of Health; Urine; Withholding Treatment; base; behavior change; cocaine use; cognitive control; cost; cost effective; cost effectiveness; design; effective intervention; efficacy testing; follow-up; high risk sexual behavior; improved; indexing; neuroimaging; novel strategies; prevent; psychosocial; reinforcer; relating to nervous system; research and development; response; standard care; treatment duration; treatment effect; treatment response

ABSTRACT Project #2 Reinforcement interventions have pronounced effects on reducing cocaine use. With Center support, we developed and evaluated a low-cost reinforcement intervention, systematically moving it through the Stages of development to dissemination and broad clinical implementation. In our ongoing Center project, reinforcement interventions are yielding benefits when reinforcers are provided at treatment initiation and for longer durations. However, less than half of patients remain engaged for 12 weeks with traditional reinforcement interventions, which require frequent attendance for monitoring and reinforcing abstinence. Interventions that extend into aftercare and that are acceptable to and efficacious in preventing long-term relapse are critically needed. Reinforcement interventions are efficacious during periods they are in effect, and pilot data show that variable interval (VI) reinforcement schedules, once behavior change occurs, hold potential for maintaining gains when administered infrequently. Assessing methods to extend benefits of these interventions is of paramount scientific and clinical concern. Component Project 2 will evaluate a novel approach in which reinforcement frequency varies by patient performance. In this intervention, reinforcement will be available for 24 weeks, on a progressive VI schedule, that adapts according to patient status. Patients who maintain abstinence earn maximum reinforcers as infrequently as every three weeks on average, while frequency of monitoring and reinforcing abstinence will increase in those who relapse until abstinence is re-instated. To test efficacy, 280 patients with cocaine use disorder will be randomly assigned to: standard care (SC), SC+traditional twice weekly reinforcement, or SC+adaptive VI reinforcement. Evaluations will be completed at baseline and throughout 18 months to assess objective and self-reported indices of drug use, psychosocial problems, and HIV risk behaviors. Primary hypotheses are (1) the adaptive VI reinforcement intervention will improve outcomes relative to standard care during the treatment period and throughout follow-up, and (2) the adaptive VI reinforcement intervention will improve outcomes relative to the traditional reinforcement system. This study will also evaluate the roles of cognitive control and reactivity to monetary rewards and their neural correlates in treatment outcome. Patients with better cognitive control are expected to maintain longer durations of abstinence across conditions. Patients with greater sensitivity to monetary rewards are expected to achieve greater durations of abstinence in reinforcement conditions. If these measures differentially relate to outcomes across treatments, such results suggest the potential of pairing reinforcement interventions to individuals most likely to benefit from them; they may also indicate possible biomarkers of response in a treatment-specific manner. If cognitive indices mediate treatment response, future studies can refine interventions to improve cognitive processes and long-term outcomes.

抽象项目＃2 加强干预对减少可卡因的使用有明显的影响。在中心支持下，我们 开发和评估了低成本的增强干预措施，系统地将其移动到 开发传播和广泛的临床实施。在我们正在进行的中心项目中 当治疗启动和更长的持续时间提供增强剂时，干预措施会产生益处。 但是，只有不到一半的患者继续进行12周的传统加强干预措施， 这需要频繁出席以监视和加强禁欲。延伸到 需要至关重要的及其预防长期复发的后果和有效性。 强化干预措施在有效的时期有效，而试点数据表明 可变间隔（VI）增强计划，一旦发生行为改变，就具有维护的潜力 不经常给药时会增加。评估扩大这些干预措施益处的方法是 最重要的科学和临床关注。组件项目2将评估一种新颖的方法 增强频率因患者表现而异。在此干预措施中，可以使用加固 按照渐进式VI时间表，24周根据患者身份适应。维持的患者 禁欲平均每三周很少获得最大的增强剂，而频率为 监测和加强禁欲将增加那些复发的人，直到戒酒被重新审议为止。 为了测试疗效，280例可卡因使用障碍患者将随机分配给：标准护理（SC）， SC+传统每周两次强化，或SC+自适应VI增强。评估将在 基线以及整个18个月以评估吸毒的客观和自我报告指标，心理社会 问题和艾滋病毒风险行为。主要假设是（1）自适应VI强化干预将 在治疗期内和整个随访期间，相对于标准护理的结果改善，（2） 自适应VI强化干预将相对于传统加强系统改善结果。 这项研究还将评估认知控制和对货币奖励及其神经的反应性的作用 治疗结果相关。认知能力更好的患者预计将保持更长的时间 跨条件的节制持续时间。预计对金钱奖励敏感的患者将会 为了在加强条件下达到更大的戒酒持续时间。如果这些措施与 跨疗法的结果，这些结果表明将增强干预措施的潜力 个人最有可能从中受益；它们还可能表明在 特定治疗的方式。如果认知指数介导治疗反应，未来的研究可以完善 改善认知过程和长期结局的干预措施。