Department of Medicine, University of Connecticut Health Center, Calhoun Cardiology Center, Farmington, CT 06030-3944, USA.
Psychol Addict Behav. 2010 Jun;24(2):282-91. doi: 10.1037/a0017542.
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.
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。
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