ADAPTIVE TREATMENT FOR COCAINE ADDICTION

可卡因成瘾的适应性治疗

• 批准号: 7675461
• 负责人: JAMES R. MCKAY
• 金额: $ 41.54万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 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/7675461
• 关键词: Abstinence; Accounting; Alcohol or Other Drugs use; Algorithms; Appointment; Behavior Therapy; Caring; Cells; Cocaine; Cocaine Dependence; Cognitive; Cognitive Therapy; Communities; Condition; Development; Disease; Dropout; Drops; Drug usage; Effectiveness; Experimental Designs; Goals; HIV; Individual; Intake; Intervention; Measures; Mediating; Mediator of activation protein; Medical; Medication Management; Modafinil; Modeling; Monitor; Motivation; Numbers; Outcome; Outpatients; Patient Preferences; Patients; Pharmaceutical Preparations; Protocols documentation; Publishing; Randomized; Rate; Relapse; Relative (related person); Sampling; Sampling Studies; Screening procedure; Selection for Treatments; Self Efficacy; Services; Standards of Weights and Measures; Sterile coverings; Substance Use Disorder; Techniques; Telephone; Testing; Time; Treatment Effectiveness; Week; Work; addiction; base; behavioral health; day; design; early /brief intervention /therapy; high risk behavior; improved; innovation; interest; medical specialties; model design; motivational enhancement therapy; preference; programs; response; self help

Although a number of treatments for cocaine dependence are efficacious, there are several major challenges to the effectiveness of treatment in community settings, including lack of interest in traditional specialty care models, high rates of early dropout, and considerable variability of response in patients who initially engage in treatment. Recent work done by our group and others suggests that adaptive treatment models can ad- Dress many of the problems that interfere with the successful delivery of effective addition treatment. These models are designed to increase participation in treatment by providing flexible care that is tailored over time on the basis of patient response to treatment, and patient choice or preference. The goal of this project is the further development of an adaptive model of care for individuals with cocaine dependence who seek treatment in community-based, specialty care programs. Patients (N=300) who complete an intake at an Intensive Outpatient Program (1OP) will be randomized into two conditions, which use telephone-based Motivational Interviewing (Ml) to increase rates of engagement in either standard IOP (MI-IOP), or in one of three treatment options selected by the patient (MI-PC). Patients are eligible for these interventions if they fail to attend IOP regularly in weeks 1-2 (the "Non-engaged" group), of if they achieve initial engagement (the "Engaged" group) but subsequently stop attending IOP at some point during weeks 3-12. The treatment options in MI-PC are IOP, telephone-based stepped care, or the combination of modafinil and medication management in the Non-engaged group; and IOP, telephone-based stepped care, or Cognitive-Behavioral Treatment (CBT) in the Engaged group. The options for the Non-engaged and the Engaged groups differ slightly, because we wanted to offer a non-specialty care alternative (e.g., modafinil) to patients who failed to achieve initial engagement in IOP, whereas limiting options in Engaged patients to lOP-based interventions seemed clinically appropriate. Primary analyses will compare MI-IOP and MI-PC on rates engagement/retention over the first 12 Weeks and cocaine use outcomes over weeks 1-24, and determine whether the predicted advantage of MI-PC over MI-IOP varies as a function of being in the Non-engaged or the Engaged groups. Further analyses will examine secondary outcomes, rates of selection of each treatment option in the MI-PC Nonengaged and Engaged groups, and outcomes within each of these treatment options.

尽管许多可卡因依赖的治疗方法有效，但仍有一些主要挑战 在社区环境中治疗的有效性，包括对传统专业护理缺乏兴趣 模型，早期辍学率高以及最初参与的患者反应差异很大 在治疗中。我们小组和其他人最近完成的工作表明，自适应治疗模型可以广告 打扮许多干扰成功提供有效添加治疗的问题。这些 模型旨在通过提供随着时间的推移量身定制的灵活护理来增加治疗的参与 根据患者对治疗以及患者选择或偏爱的反应。这个项目的目标是 为可卡因依赖人寻求治疗的个体的适应性护理模型进一步发展 在基于社区的专业护理计划中。患者（n = 300），在密集型中完成摄入量 门诊计划（1OP）将被随机分为两个条件，使用基于电话的动机 采访（ML）以提高标准IOP（MI-IOP）或三个中的参与率 患者选择的治疗方案（MI-PC）。如果患者不这样做，则有资格接受这些干预措施 在第1-2周（“非参与”小组）定期参加IOP，如果他们达到初步参与（“参与” 小组），但随后在第3-12周的某个时候停止参加IOP。治疗选择 在MI-PC中，是IOP，基于电话的阶梯护理或Modafinil和药物管理的组合 在非参与群体中；和IOP，基于电话的阶梯护理或认知行为治疗 （CBT）在订婚小组中。非参与群体和参与群体的选项略有不同， 因为我们想为未能实现的患者提供非专业护理替代方案（例如莫达非尼） 最初参与IOP，而限制患者的限制选择似乎是基于LOP的干预措施 临床适当。主要分析将将MI-IOP和MI-PC与费率参与/保留进行比较 前12周和可卡因在第1-24周内使用结果，并确定是否预测优势 MI-PC上的MI-IOP的不同因素而变化，这是在非参与或参与的组中的函数。更远 分析将检查次要结果，MI-PC中每个治疗选项的选择率 和订婚的群体，以及这些治疗方案中的结果。