Chutuape M A, Silverman K, Stitzer M
Behavioral Pharmacology Research Unit, Johns Hopkins University, School of Medicine, Baltimore, MD 21224, USA.
Drug Alcohol Depend. 1999 Mar 1;54(1):69-81. doi: 10.1016/s0376-8716(98)00144-6.
This study examined the efficacy of a urinalysis-based contingency management program for preventing relapse to abused drugs following a brief residential detoxification. Fourteen methadone maintenance patients who were chronic benzodiazepine users were enrolled in a 7-day inpatient benzodiazepine detoxification and randomly assigned to receive Contingency Management (N = 7) or Standard Care (N = 7) therapy upon return to outpatient methadone treatment. In the Contingency Management condition, a methadone take-home dose or a US $25 voucher (patient's choice) could be earned for each urine sample submitted on a Monday, Wednesday or Friday that was free of opiates, cocaine and benzodiazepines. Data analysis and interpretation focused on within-group post-hoc differences due to group differences on employment and legal status, potentially confounding baseline variables. Repeated measures analysis of variance showed that Contingency Management patients submitted significantly more drug-free urine samples during the intervention compared to pre-detoxification (p < 0.01), whereas no significance changes were observed from pre- to post-detoxification in the Standard Care patients. Employment and legal status of patients may have facilitated response to contingency management procedures, but did not prevent relapse when contingency management procedures were withdrawn. Overall, these preliminary results suggest that abstinence-based contingency management is a promising strategy for preventing relapse to multiple drugs of abuse in a subset of methadone maintenance patients when abstinence has been initiated through brief inpatient treatment.
本研究考察了基于尿液分析的应急管理方案在短期住院戒毒后预防滥用药物复吸方面的效果。14名长期使用苯二氮䓬类药物的美沙酮维持治疗患者参加了为期7天的住院苯二氮䓬类药物戒毒治疗，并在返回门诊美沙酮治疗时被随机分配接受应急管理治疗（N = 7）或标准护理治疗（N = 7）。在应急管理治疗组中，若周一、周三或周五提交的尿液样本中不含阿片类药物、可卡因和苯二氮䓬类药物，每次可获得一次美沙酮带回家剂量或一张25美元的代金券（由患者选择）。数据分析和解释聚焦于因就业和法律状况等组间差异导致的组内事后差异，这些因素可能会混淆基线变量。重复测量方差分析表明，与戒毒前相比，应急管理治疗组患者在干预期间提交的无毒品尿液样本显著更多（p < 0.01），而标准护理治疗组患者从戒毒前到戒毒后未观察到显著变化。患者的就业和法律状况可能促进了对应急管理程序的反应，但在撤销应急管理程序后并不能防止复吸。总体而言，这些初步结果表明，当通过短期住院治疗开始戒断时，基于禁欲的应急管理是预防一部分美沙酮维持治疗患者多种滥用药物复吸的一种有前景的策略。
