Novel Intervention for Drug Use and HIV Risk among Anxiety Sensitive Heroin Users

针对焦虑敏感海洛因使用者吸毒和艾滋病毒风险的新干预措施

• 批准号: 7554085
• 负责人: Carl W Lejuez
• 金额: $ 37.11万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7554085
• 关键词: Abstinence; Accounting; Acquired Immunodeficiency Syndrome; Address; Alcohol or Other Drugs use; American; Anxiety; Area; Arousal; Attitude; Basic Science; Behavior; Belief; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Cognitive; Combined Modality Therapy; Comorbidity; Contracts; Data; Dropout; Drops; Drug usage; Educational process of instructing; Effectiveness; Esthesia; Event; Exercise; Fright; Goals; HIV; HIV Infections; Heroin; Heroin Users; Hypersensitivity; Individual; Individual Differences; Injection of therapeutic agent; Intervention; Knowledge; Life; Link; Mediator of activation protein; Minority; Modeling; Moods; Needles; Nondirective Therapy; Outcome; Outcome Measure; Patients; Pattern; Population; Poverty; Prevalence; Process; Protocols documentation; Psychological Models; Public Health; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Relapse; Relative (related person); Reliance; Research; Residential Treatment; Risk; Risk Behaviors; Safety; Sex Behavior; Staging; Structure; Symptoms; Testing; Treatment outcome; United States Substance Abuse and Mental Health Services Administration; Work; active control; base; bodily sensation; brief intervention; coping; craving; high risk sexual behavior; improved; inner city; novel; prevent; psychologic; sex risk; skills; social; therapy design; therapy development; transmission process; treatment center

More than 850,000 Americans are currently living with AIDS and an estimated 40,000 continue to contract HIV each year (CDC, 2004). Minority individuals living in urban and poverty-stricken areas who engage in injection heroin use are particularly at risk for HIV infection (Chitwood et aI., 2000; De Rossi et aI., 1988; SAMHSA, 2003). These findings suggest the importance of developing treatments focused on helping individuals achieve abstinence from injection heroin use, especially within inner-city minority popUlations. However, inner-city minorities are less likely to have access to longer-term substance use treatment (Bernstein et aI., 2005), and within residential treatment centers, the likelihood of drop-out and relapse to substance use among injection heroin users is strikingly high (Manu et aI., 1994). Therefore, there is a need for targeted, brief interventions that can be conducted as an adjunct to substance use treatment to reduce vulnerability for treatment drop-out and relapse to substance use, reducing risk for further injection drug use and HIV infection or transmission. Building from contemporary models of psychological vulnerability (Barlow, 2002), there is conceptual and robust empirical reason to explore cognitive factors reflecting a hypersensitivity to aversive events in order to better understand the factors that contribute to treatment dropout and relapse to substance use among heroin users (Brown et aI., 2005). One such cognitive vulnerability that holds promise is anxiety sensitivity (AS). AS, a relative stable individual difference characteristic representing the tendency to fear anxiety-related symptoms due to the belief that these symptoms will have negative consequences (Reiss, 1991), has recently been linked to heroin use (Lejuez et aI., 2006) and has been found to significantly and uniquely predict treatment drop-out among heroin users (Lejuez et aI., 2007). Our group has subsequently developed an exposure-based individual intervention specifically tailored to inner-city heroin users with heightened AS - the Anxiety Sensitivity Treatment for Heroin Users (ASTH; Tull et aI., 2007). Pilot data indicate the feasibility of the treatment with patients evidencing reduced AS and heroin cravings. Additionally, if the treatment is successful, there is a counterintuitive potential for increased HIV risk through sexual contact resulting from a reduction in heroin use and/or anxiety. Therefore, we propose to utilize an integrated treatment combining ASTH with Healthy Relationships (HR; Kalichman et aI., 2001), a targeted intervention designed to prevent high risk sexual behavior. The combined intervention (ASTH+HR) is now structured to reduce risk for HIV infection/transmission by (a) promoting heroin abstinence by reducing AS, and (b) preventing engagement in risky sexual behaviors using a social cognitive approach aimed at increasing one's understanding of interpersonal/intimate relationships and potential for risky sexual behaviors in those relationships, combined with skill building to help the individual more effectively cope and remain sexually safe in those situations. We also collected pilot data to establish the safety, feasibility, and acceptability of this combined intervention. The objective of the present proposal is to provide a two year Stage 1b randomized control trial of 60 patients receiving standard residential substance use treatment comparing ASTH combined with modules from a modified Healthy Relationships (HR; a brief intervention designed to reduce risky sex behaviors; Kalichman et aI., 2001) to nondirective therapy (NT+HR), with a focus on the substance use outcomes of treatment drop-out from the residential treatment and relapse following the residential treatment across 3 months, as well as engagement in HIV-risk behaviors including injection drug use and risky sexual behavior across this period.

目前有超过85万美国人居住在艾滋病中，估计有40,000人继续签约艾滋病毒 每年（CDC，2004年）。居住在城市和贫困地区的少数民族个人 海洛因使用尤其有艾滋病毒感染的风险（Chitwood et ai。，2000; de Rossi et ai。，1988; Samhsa， 2003）。这些发现表明，开发旨在帮助个人实现的治疗的重要性 禁止注射海洛因使用，尤其是在城市少数群体中。但是，内城 少数族裔不太可能获得长期药物使用治疗（Bernstein et ai。，2005），并且 在住宅治疗中心中，辍学的可能性和在注射中复发到药物的可能性 海洛因使用者非常高（Manu et ai。，1994）。因此，需要进行针对性的简短干预措施 可以作为药物使用治疗的辅助性进行，以减少治疗辍学的脆弱性 并复发到药物使用，降低了进一步注射药物使用和HIV感染或传播的风险。 从当代心理脆弱性模型建立（Barlow，2002），有概念性和 强大的经验理由探索认知因素，反映出对厌恶事件的超敏反应 更好地了解有助于治疗辍学和对海洛因物质使用的因素 用户（Brown et ai。，2005）。持有承诺的一种认知脆弱性是焦虑敏感性（AS）。 AS， 相对稳定的个体差异特征，代表了害怕焦虑相关症状的趋势 由于相信这些症状会带来负面后果（Reiss，1991），最近已连接 使用海洛因（Lejuez et ai。，2006），并被发现可以显着预测治疗的辍学 在海洛因使用者中（Lejuez et ai。，2007）。我们的小组随后开发了基于曝光的 专门针对城市内海洛因使用者量身定制的个人干预措施，焦虑症 海洛因使用者的敏感性治疗（Asth; Tull et ai。，2007）。试验数据表明 证明患者的治疗降低了AS和海洛因的渴望。此外，如果治疗成功， 通过减少性接触而导致的性接触有违反直觉的潜力 海洛因使用和/或焦虑。因此，我们建议利用将哮喘与 健康关系（HR； Kalichman et ai。，2001），旨在防止高风险的有针对性干预措施 性行为。现在结构的干预措施（ASTH+HR）的结构是降低艾滋病毒的风险 通过（a）通过减少AS来促进海洛因禁欲的感染/传播，（b）防止参与 使用社会认知方法的有风险的性行为，旨在提高人们对 人际关系/亲密关系和在这些关系中有风险的性行为的潜力，结合在一起 通过技能建设来帮助个人更有效地应对并在这种情况下保持性安全。我们 还收集了飞行员数据，以确定此组合干预措施的安全性，可行性和可接受性。这 本提案的目的是为60名患者提供两年的1B随机对照试验 接受标准的住宅物质使用治疗，比较ASTH与来自A的模块相比 修改了健康的关系（人力资源；旨在减少风险性行为的短暂干预； Kalichman ET AI。，2001年）至非指导疗法（NT+HR），重点是治疗辍学结果 从住院治疗和住宅治疗后3个月的复发以及 在此期间，参与包括注射药物使用和风险性行为在内的艾滋病毒风险行为。