Robles Elias, Stitzer Maxine L, Strain Eric C, Bigelow George E, Silverman Kenneth
Department of Pharmacology, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA.
Drug Alcohol Depend. 2002 Jan 1;65(2):179-89. doi: 10.1016/s0376-8716(01)00160-0.
Methadone detoxification is often used in the treatment of opiate dependence. This procedure, however, is frequently associated with continued opiate use, and high rates of attrition and relapse. In this study, a 90-day methadone detoxification was enhanced by adding voucher-based reinforcement of opiate abstinence before, during and after the dose tapering schedule. After 4 weeks of standard methadone maintenance (baseline), subjects were randomized to either the abstinence (n=26), or attendance reinforcement (n=22) condition. During the remaining 22 weeks of the study, the abstinence reinforcement group could receive vouchers with monetary value three times per week for providing opiate-negative urine specimens, while subjects in the attendance reinforcement group received vouchers of equal value for attending the clinic, regardless of urinalysis results. Methadone maintenance continued during weeks 5-10, dose tapering was implemented during weeks 11-23, and during weeks 24-26 the voucher schedule remained in effect but no medication was provided. Fifty percent of clients in both groups completed dose tapering, and 40% completed the vouchers-only phase. Subjects in the abstinence as compared with the attendance reinforcement group had lower rates of opiate use during the maintenance and detoxification phases, and longer periods of opiate abstinence during the detoxification phase. Cocaine use was also lower in the abstinence than the attendance reinforcement group during the maintenance and detoxification phases. In addition, abstinence as compared with attendance reinforcement subjects reported significantly fewer intravenous injections during the detoxification phase. Voucher-based reinforcement procedures could be useful for successfully transitioning patients into opiate antagonist therapy, or drug-free treatments.
美沙酮脱毒常用于阿片类药物依赖的治疗。然而，该程序经常与持续使用阿片类药物以及高脱落率和高复发率相关。在本研究中，通过在剂量递减计划之前、期间和之后添加基于代金券的阿片类药物戒断强化措施，对为期90天的美沙酮脱毒进行了改进。在4周的标准美沙酮维持治疗（基线期）后，受试者被随机分为戒断组（n = 26）或出勤强化组（n = 22）。在研究的剩余22周内，戒断强化组每周可因提供阿片类药物阴性尿液样本而获得三次具有货币价值的代金券，而出勤强化组的受试者无论尿液分析结果如何，只要到诊所就诊就可获得同等价值的代金券。美沙酮维持治疗在第5 - 10周继续进行，剂量递减在第11 - 23周实施，在第24 - 26周，代金券计划仍然有效，但不再提供药物。两组中50%的患者完成了剂量递减，40%的患者完成了仅使用代金券的阶段。与出勤强化组相比，戒断组的受试者在维持治疗和脱毒阶段的阿片类药物使用率较低，在脱毒阶段的阿片类药物戒断时间较长。在维持治疗和脱毒阶段，戒断组的可卡因使用率也低于出勤强化组。此外，与出勤强化组的受试者相比，戒断组的受试者在脱毒阶段报告的静脉注射次数明显较少。基于代金券的强化程序可能有助于成功地使患者过渡到阿片类拮抗剂治疗或无药物治疗。
