Prize CM for Cocaine Dependent Methadone Patients

可卡因依赖美沙酮患者 CM 奖

基本信息

批准号：
8840553
负责人：
SHEILA MARIE ALESSI
金额：
$ 39.5万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2000
资助国家：
美国
起止时间：
2000-09-01 至 2018-04-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): In the past two grant cycles, we examined schedules of reinforcement in contingency management (CM) treatments, with the goal of identifying the most efficacious and least costly CM approach. We found that voucher and prize CM are equally efficacious in reducing cocaine use when magnitude of reinforcement is equal (Petry et al., 2005a). Although magnitude affects efficacy (Petry et al., 2004), prize CM can engender equal benefits to voucher CM even when prize CM arranges for lower reinforcement magnitude (Petry et al., 2007a). We also found prize CM to be more cost-effective than voucher CM (Olmstead & Petry, 2009). Our next step relates to understanding how aspects of the prize reinforcement approach impact outcomes. We usually arrange for a 50 percent chance of winning a $1, $20 or $100 prize with each draw. A retrospective analysis (Ghitza et al., 2008) suggests probabilities of winning prizes impact abstinence in the short term, and our data indicate that probabilities of winning $20 and $100 prizes are most strongly related to abstinence during and after treatment. In addition, patients desire a greater variety of prize categories, and availability of more prize category options may improve outcomes. This will be the first prospective trial varying probabilities of winning and prize categories available. We will randomize 300 cocaine-dependent methadone patients to 1 of 6 conditions: (a) a control group, (b) a CM condition that arranges a 100 percent probability of winning a prize with each draw and has 3 prize categories, (c) a CM condition that arranges a 31 percent probability of winning and has 3 prize categories, (d) a CM condition that arranges a 100 percent probability of winning and has 7 prize categories, (e) a CM condition that arranges a 31 percent probability of winning and has 7 prize categories, or (f) usual prize CM with a 50 percent probability of winning from 3 prize categories. Magnitudes of reinforcement will be identical across conditions, but lower overall probability conditions arrange for greater chances of winning larger magnitude prizes. We expect that the new CM conditions will reduce cocaine use relative to the control condition, that 31 percent probability conditions will decrease drug use relative to 100 percent conditions, and that 7-prize category conditions will reduce drug use compared to 3-prize category conditions. In addition, the 31 percent/7-category condition is expected to be most efficacious and improve outcomes relative to usual CM. We will also evaluate effects on secondary outcome measures such as HIV risk behaviors and predictors of outcomes. Results will be instrumental for further developing prize CM to improve outcomes of cocaine-dependent methadone patients.

描述（由申请人提供）：在过去的两个赠款周期中，我们检查了应急管理（CM）治疗中的加固时间表，目的是确定最有效且成本最低的CM方法。我们发现，当加固幅度相等时，代金券和奖金CM同样有效地减少可卡因的使用（Petry等，2005a）。尽管幅度会影响疗效（Petry等，2004），但即使奖品CM安排较低的加固幅度，奖金CM也可以对代金券CM产生同等的好处（Petry等，2007a）。我们还发现CM比凭证CM更具成本效益（Olmstead＆Petry，2009年）。我们的下一步涉及了解奖品强化方法的各个方面如何影响结果。我们通常会安排50％的机会赢得$ 1，20美元或100美元的奖金。回顾性分析（Ghitza等，2008）表明，在短期内赢得奖品的戒烟的概率，我们的数据表明，赢得20美元和100美元的奖品的概率与治疗期间和治疗期间的禁欲最密切相关。此外，患者希望更多的奖品类别，以及更多奖品类别选择的可用性可能会改善结果。这将是可用的获奖和奖品类别的第一个前瞻性试验概率。我们将将300名可卡因依赖的白沙酮患者随机为6个条件中的1例：（a）对照组，（b）一个CM条件，该条件安排了100％赢得奖品的可能性，每次抽奖均具有3个奖金类别，（c）CM条件，该条件是奖金的31％奖励类别，并安排了3个奖励类别，（d）有7％的条件（d）100％和100％的条件（d）。安排了31％的获胜概率，并拥有7个奖品类别，或（f）平常的奖品CM，其中30％的奖项奖励概率为50％。加固的幅度将在各种条件下相同，但较低的总体概率条件为赢得更大幅度奖品的机会更大。我们预计，新的CM条件将减少相对于控制条件的可卡因使用，而与100％的条件相比，与100％的条件相比，31％的概率条件将减少药物使用情况，而与3-Pribe类别条件相比，7-Pribe类别条件将减少药物使用情况。此外，相对于通常的CM，预计31％/7类别的条件将是最有效的，并且相对于常规CM的结果有所改善。我们还将评估对诸如HIV风险行为和预后预测指标的影响。结果将有助于进一步开发奖励CM，以改善可卡因依赖性美沙酮患者的预后。