Treating Cocaine Abuse: A Behavioral Approach

治疗可卡因滥用：行为方法

• 批准号: 8269063
• 负责人: Stephen T Higgins
• 金额: $ 59.6万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-09-30 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8269063
• 关键词: Abstinence; Aftercare; Alcohol consumption; Alcohol dependence; Alcohols; Area; Attention; Behavior Therapy; Behavioral; Characteristics; Clinical; Cocaine; Cocaine Abuse; Cocaine Dependence; Cocaine Users; Commit; Currently Married; Diagnosis; Disease; Disulfiram; Dose; Drug usage; Economics; Employee Strikes; Equilibrium; Exhibits; Funding; Goals; Heterogeneity; Individual Differences; Intervention; Intranasal Administration; Intravenous; Investigation; Lead; Marital Status; Measures; Methods; Modeling; Monitor; Outcome; Outpatients; Patients; Play; Population; Psychological reinforcement; Public Health; Quality of Care; Randomized; Randomized Clinical Trials; Research; Research Design; Role; Route; Schedule; Selection for Treatments; Severities; Smoke; Smoker; Stream; Testing; Toxicology; Treatment outcome; Unmarried; Urine; base; brief intervention; cocaine use; cost; discount; discounting; economic value; efficacy testing; flexibility; improved; payment; practical application; programs; research and development; response; therapy development; therapy duration; treatment duration; treatment response; voucher

DESCRIPTION (provided by applicant): This is the first revision of an application to continue researching the CRA + Vouchers treatment for cocaine dependence. Cocaine dependence is an entrenched U.S. public-health problem. While excellent progress has been made in developing efficacious behavioral therapies for this disorder, there is considerable room for improvement. One promising area for improvement is in matching treatment parameters to patient characteristics so that lower-severity patients not receive more treatment or higher-severity patients less treatment than necessary for a positive treatment outcome. Treatment development for cocaine dependence is often biased towards optimizing efficacy without appropriate attention to constraining costs or reducing costs without sufficient attention to undermining efficacy. Matching the dose of treatment to characteristics that moderate treatment response has the potential to strike a balance between those two biases. We are proposing two matching studies. Study 1 will examine the efficacy of a 6-week contingent voucher intervention with and without voucher values matched to patient severity. We will use marital status (currently married vs. other) and route of cocaine administration (intranasal vs. smoked/intravenous) to classify severity. This severity measure moderates response to the voucher component of the CRA + Vouchers treatment. Cocaine-dependent outpatients will be randomly assigned to CRA plus one of three 6-week voucher conditions: non-contingent vouchers, contingent vouchers set at usual values for all patients, or contingent vouchers set at usual values for low-severity and twice-usual value for high-severity users. We hypothesize a significant interaction between treatment condition and severity, with the efficacy of the 6-week contingent voucher condition being dependent on patient severity when vouchers are set at the usual values, but not when values are matched to patient severity. Study 2 will examine the efficacy of combining 6 weeks of vouchers with CRA delivered as a brief intervention (2 weeks), a moderate-duration intervention (6 weeks), or an intervention wherein duration is matched to two moderators of response to CRA therapy, marital status (currently married vs. other) and alcohol dependence (with vs. without). We hypothesize a significant interaction between treatment condition and severity, with the efficacy of CRA being dependent on marital status and alcohol dependence in the uniform-duration conditions, but not in the condition where CRA duration is matched to patient characteristics. We also are proposing two secondary aims to (a) examine the role played by the behavioral-economic concept of delayed discounting as a potential moderator of treatment response and (b) further understanding of how patient drug-use severity moderates treatment response. Overall, the proposed studies have the potential to advance understanding of how to better match treatment parameters to patient severity in the treatment of cocaine dependence with the goal of streamlining the costs of the interventions without compromising the quality of care offered to more severe patients.

描述（由申请人提供）：这是继续研究可卡因依赖的CRA +代金券处理的申请的首次修订。可卡因依赖是一个根深蒂固的美国公共卫生问题。尽管在为这种疾病开发有效的行为疗法方面取得了出色的进步，但仍有很大的改进空间。改进的一个有希望的领域是将治疗参数与患者特征相匹配，因此，较低的严重患者不会接受更多的治疗或更高严重的患者，而比阳性治疗结果所需的治疗要比所需的较少。可卡因依赖性的治疗开发通常会偏向优化功效，而无需适当关注约束成本或降低成本，而没有足够注意破坏疗效。将治疗剂量与中等治疗反应的特征相匹配，有可能在这两个偏见之间取得平衡。我们提出了两项​​匹配研究。 研究1将检查与患者严重程度相匹配的6周临时凭证干预的疗效。我们将使用婚姻状况（目前已婚）和可卡因管理（鼻内与烟雾/静脉内）的途径来分类严重性。这种严重程度衡量了对CRA +代金券处理凭证组件的响应。可卡因依赖性门诊患者将被随机分配给CRA加上三个为期6周的代金券条件之一：非固定凭证，所有患者通常值的临时优惠券，或以平常值设置的低价值和高价用户的两次平均值设置的偶然凭证。我们假设治疗条件和严重程度之间存在显着相互作用，而在以通常的值设置优惠券时，6周或凭证状况的疗效取决于患者的严重性，而当值与患者的严重程度匹配时，则不取决于患者的严重性。研究2将研究将6周的凭证与CRA合并为短暂干预（2周），中度持续干预（6周）或干预措施的功效，其中将持续时间与CRA治疗，婚姻状况（目前已婚的VS.其他）和酒精依赖的两个调节剂相匹配（与无关）。我们假设治疗条件和严重程度之间存在显着相互作用，而CRA的功效取决于统一持续状态下的婚姻状况和酒精依赖，但在CRA持续时间与患者特征相匹配的情况下不存在。我们还提出了两个次要的目标，以（a）研究行为经济概念延迟折现作为治疗反应的潜在主持人的作用，以及（b）进一步了解患者药物使用的严重性如何适应治疗反应。总体而言，拟议的研究有可能提高人们对可卡因依赖性治疗的治疗方法与患者严重程度相匹配的理解，目的是简化干预措施的成本，而不会损害更严重的患者提供的护理质量。