Robles E, Silverman K, Preston K L, Cone E J, Katz E, Bigelow G E, Stitzer M L
University of Arkansas for Medical Sciences, Little Rock 72205-7199, USA.
Drug Alcohol Depend. 2000 Feb 1;58(1-2):205-12. doi: 10.1016/s0376-8716(99)00090-3.
This study assessed the effectiveness of a brief abstinence reinforcement procedure for initiating cocaine abstinence in methadone maintenance patients. On Monday of the test week, 72 cocaine-abusing methadone patients were offered a $100 voucher if urine samples collected on Wednesday indicated that they had abstained from cocaine across that 2-day period. A patient was considered abstinent and the voucher delivered if the urine benzoylecgonine concentration decreased by 50% from Monday to Wednesday (quantitative criterion) or if the concentration of Wednesday's urine sample was < or = 300 ng/ml. Overall, 79% of study patients showed urinalysis evidence of abstention from cocaine between Monday and Wednesday of the test week. In a subsample with complete data (n = 50), significantly more patients abstained from cocaine from Monday to Wednesday of the test week (84%) than from Monday to Wednesday of the week before (36%) or after (32%) the test week. Furthermore, while almost all patients (94%) decreased their benzoylecgonine concentration from Monday to Wednesday of the test week, significantly fewer patients' benzoylecgonine concentrations decreased from Monday to Wednesday of the week before (56%) or after (48%) the test week. This highly efficacious procedure may have clinical application where reliable abstinence initiation is desired, either on a temporary basis (e.g. sobriety sampling) or at the start of longer-term interventions. It may also be possible to use the brief abstinence test as an experimental model to assess the effects of other therapeutic interventions on abstinence initiation in treatment settings.
本研究评估了一种简短的禁欲强化程序在美沙酮维持治疗患者中启动可卡因戒断的有效性。在测试周的周一，72名滥用可卡因的美沙酮患者被告知，如果周三采集的尿液样本显示他们在这两天内未使用可卡因，将获得一张100美元的代金券。如果尿液中苯甲酰爱康宁浓度从周一到周三下降50%（定量标准），或者周三尿液样本浓度≤300 ng/ml，则患者被视为戒断且发放代金券。总体而言，79%的研究患者在测试周的周一至周三期间尿检显示未使用可卡因。在有完整数据的子样本（n = 50）中，在测试周的周一至周三期间戒断可卡因的患者（84%）显著多于测试周前（36%）或后（32%）同一周的周一至周三期间。此外，虽然几乎所有患者（94%）在测试周的周一至周三期间其苯甲酰爱康宁浓度下降，但在测试周前（56%）或后（48%）同一周的周一至周三期间苯甲酰爱康宁浓度下降的患者显著减少。这种高效的程序可能在需要可靠启动戒断的临床应用中有用，无论是暂时的（例如清醒采样）还是在长期干预开始时。也有可能将简短的禁欲测试用作实验模型，以评估其他治疗干预措施对治疗环境中戒断启动的影响。
