Brooner Robert K, Kidorf Michael S, King Van L, Stoller Kenneth B, Peirce Jessica M, Bigelow George E, Kolodner Ken
The Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center Baltimore, MD 21224, USA.
J Subst Abuse Treat. 2004 Oct;27(3):223-32. doi: 10.1016/j.jsat.2004.07.005.
Poor patient adherence remains a serious obstacle to improving the effectiveness of many drug abuse therapies and the overall quality of care delivered in programs. The present study evaluated the utility and efficacy of incorporating behavioral contingencies in a stepped care treatment approach to motivate patient attendance to the varying amounts of prescribed weekly counseling. Study participants were opioid-dependent patients (n = 127) newly admitted to an ambulatory treatment program that provides methadone. Participants were randomly assigned to a Motivated Stepped Care condition (MSC; n = 65) with behavioral contingencies to specifically motivate counseling attendance vs. a Standard Stepped Care condition (SSC; n = 62) without these contingencies. The MSC vs. SSC condition was associated with a higher rate of counseling attendance (83% vs. 44%, p < .001) and a lower rate of poor treatment response (46% vs. 79%, p < .001). The behavioral contingencies were well tolerated and strongly associated with excellent attendance across both lower and higher doses of weekly counseling.
患者依从性差仍然是提高许多药物滥用治疗效果以及项目所提供整体护理质量的严重障碍。本研究评估了在逐步护理治疗方法中纳入行为应急措施以激励患者按规定参加不同时长每周咨询的效用和效果。研究参与者为新进入一个提供美沙酮的门诊治疗项目的阿片类药物依赖患者（n = 127）。参与者被随机分配到有行为应急措施以专门激励咨询参与度的动机性逐步护理组（MSC；n = 65）和无这些应急措施的标准逐步护理组（SSC；n = 62）。MSC组与SSC组相比，咨询参与率更高（83%对44%，p <.001），治疗反应差的比率更低（46%对79%，p <.001）。行为应急措施耐受性良好，并且与较低和较高剂量每周咨询的高参与率密切相关。
