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美沙酮维持治疗患者可卡因使用的权变管理:何时能戒除?

Contingency management for cocaine use in methadone maintenance patients: when does abstinence happen?

机构信息

Department of Medicine, University of Connecticut Health Center, Calhoun Cardiology Center, Farmington, CT 06030-3944, USA.

出版信息

Psychol Addict Behav. 2010 Jun;24(2):282-91. doi: 10.1037/a0017542.


DOI:10.1037/a0017542
PMID:20565154
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2891572/
Abstract

Contingency management (CM) is an efficacious intervention for cocaine abusing methadone patients, but typically only about half of patients respond. By investigating time to onset of cocaine abstinence and factors associated with abstinence, we may be able to more efficiently direct CM approaches to patients most likely to benefit. Onset of cocaine abstinence was evaluated in cocaine abusing methadone maintenance patients (N = 193) enrolled in one of three randomized clinical trials of CM. Participants received standard treatment with frequent urine toxicology monitoring or standard treatment plus CM during the trials. Slightly more than half the sample obtained at least 1 week of cocaine abstinence, and approximately a third of the sample obtained at least 4 weeks of cocaine abstinence. Discrete-time survival and hazard analyses found Weeks 1 and 2 of the intervention period had the greatest probability for the initiation of abstinence, and few participants initiated any period of abstinence after Week 4. Patients randomized to CM, those with more years of cocaine use, and those with less recent cocaine use were more likely to achieve abstinence. Overall, these results indicate onset of cocaine abstinence is likely to occur early in treatment and in individuals with less severe cocaine use. Practical implications of these results for designing and implementing CM interventions in methadone maintenance clinics are discussed.

摘要

应急管理(CM)是一种有效的干预措施,适用于可卡因滥用美沙酮维持治疗患者,但通常只有约一半的患者对此有反应。通过研究可卡因戒断的起始时间和与戒断相关的因素,我们或许能够更有效地将 CM 方法应用于最有可能受益的患者。在一项针对可卡因滥用美沙酮维持治疗患者(N=193)的三项随机临床试验之一中,评估了可卡因戒断的起始时间。参与者在试验期间接受标准治疗和频繁的尿液毒理学监测,或标准治疗加 CM。略超过一半的样本至少获得了 1 周的可卡因戒断,约三分之一的样本至少获得了 4 周的可卡因戒断。离散时间生存和危险分析发现,干预期的第 1 周和第 2 周最有可能开始戒断,而且很少有参与者在第 4 周后开始任何戒断期。被随机分配到 CM 的患者、可卡因使用年限较长的患者和可卡因使用年限较短的患者更有可能实现戒断。总的来说,这些结果表明,可卡因戒断很可能在治疗早期和可卡因使用程度较轻的个体中发生。讨论了这些结果对美沙酮维持诊所设计和实施 CM 干预的实际意义。

相似文献

[1]
Contingency management for cocaine use in methadone maintenance patients: when does abstinence happen?

Psychol Addict Behav. 2010-6

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
A two-week pilot study of intranasal oxytocin for cocaine-dependent individuals receiving methadone maintenance treatment for opioid use disorder.

Addict Res Theory. 2016

[2]
Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention.

J Subst Abuse Treat. 2017-1

[3]
Standard magnitude prize reinforcers can be as efficacious as larger magnitude reinforcers in cocaine-dependent methadone patients.

J Consult Clin Psychol. 2015-6

[4]
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Drug Alcohol Depend. 2014-8-1

[5]
Prize-based contingency management for the treatment of substance abusers: a meta-analysis.

Addiction. 2014-9

[6]
Initiation of abstinence in adolescents treated for marijuana use disorders.

J Subst Abuse Treat. 2012-10-22

[7]
Placebo-group responders in methamphetamine pharmacotherapy trials: the role of immediate establishment of abstinence.

Exp Clin Psychopharmacol. 2012-8-6

[8]
Treatment of substance abusing patients with comorbid psychiatric disorders.

Addict Behav. 2011-9-14

本文引用的文献

[1]
Early abstinence in cocaine pharmacotherapy trials predicts successful treatment outcomes.

J Subst Abuse Treat. 2009-10

[2]
Statewide adoption and initial implementation of contingency management for substance-abusing adolescents.

J Consult Clin Psychol. 2008-8

[3]
Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients.

J Consult Clin Psychol. 2007-12

[4]
Clinic variation in the cost-effectiveness of contingency management.

Am J Addict. 2007

[5]
Effectiveness of abstinence-based incentives: interaction with intake stimulant test results.

J Consult Clin Psychol. 2007-10

[6]
Contingency management for treatment of substance abuse.

Annu Rev Clin Psychol. 2006

[7]
Treatment outcome predictors for cocaine dependence.

Am J Drug Alcohol Abuse. 2007

[8]
Comparing adaptive stepped care and monetary-based voucher interventions for opioid dependence.

Drug Alcohol Depend. 2007-5

[9]
Contingency management for treatment of substance use disorders: a meta-analysis.

Addiction. 2006-11

[10]
Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes.

Drug Alcohol Depend. 2007-3-16

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