Bickel Warren K, Marsch Lisa A, Buchhalter August R, Badger Gary J
University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR 72205, USA.
Exp Clin Psychopharmacol. 2008 Apr;16(2):132-43. doi: 10.1037/1064-1297.16.2.132.
The authors evaluated the efficacy of an interactive, computer-based behavioral therapy intervention, grounded in the community reinforcement approach (CRA) plus voucher-based contingency management model of behavior therapy. Our randomized, controlled trial was conducted at a university-based research clinic. Participants comprised 135 volunteer adult outpatients who met DSM-IV criteria for opioid dependence. All participants received maintenance treatment with buprenorphine and were randomly assigned to one of three treatments: (a) therapist-delivered CRA treatment with vouchers, (b) computer-assisted CRA treatment with vouchers, or (c) standard treatment. The therapist-delivered and computer-assisted CRA plus vouchers interventions produced comparable weeks of continuous opioid and cocaine abstinence (M = 7.98 and 7.78, respectively) and significantly greater weeks of abstinence than the standard intervention (M = 4.69; p < .05), yet participants in the computer-assisted CRA condition had over 80% of their intervention delivered by an interactive computer program. The comparable efficacy obtained with computer-assisted and therapist-delivered therapy may enable more widespread dissemination of the evidence-based CRA plus vouchers intervention in a manner that is cost-effective and ensures treatment fidelity.
作者评估了一种基于社区强化法（CRA）加代金券式行为疗法应急管理模型的交互式计算机行为疗法干预措施的疗效。我们的随机对照试验在一家大学研究诊所进行。参与者包括135名符合阿片类药物依赖DSM-IV标准的成年门诊志愿者。所有参与者均接受丁丙诺啡维持治疗，并被随机分配到三种治疗方法之一：（a）治疗师提供的带代金券的CRA治疗，（b）计算机辅助的带代金券的CRA治疗，或（c）标准治疗。治疗师提供的和计算机辅助的CRA加代金券干预措施产生了相当的连续阿片类药物和可卡因戒断周数（分别为M = 7.98和7.78），并且比标准干预措施的戒断周数显著更多（M = 4.69；p < 0.05），然而计算机辅助CRA组的参与者超过80%的干预是通过交互式计算机程序进行的。计算机辅助治疗和治疗师提供的治疗获得的类似疗效可能会使基于证据的CRA加代金券干预措施以具有成本效益且能确保治疗保真度的方式得到更广泛的传播。
