Jiang Haifeng, Du Jiang, Wu Fei, Wang Zhaowei, Fan Shujun, Li Zhibin, Hser Yih-Ing, Zhao Min
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
University of California, Los Angeles, California, United States.
Shanghai Arch Psychiatry. 2012 Feb;24(1):11-9. doi: 10.3969/j.issn.1002-0829.2012.01.002.
Compliance with methadone maintenance treatment (MMT) in China is poor.
To evaluate the effects of adjunctive contingency management (CM) on the efficacy of methadone maintenance treatment (MMT) in patients with opioid dependence.
A 12-week prize-based contingency management (CM) intervention can increase the retention and compliance of heroin abusers to standardized MMT programs in Shanghai.
160 heroin-dependent patients from three voluntary MMT clinics in Shanghai were randomly assigned to a treatment as usual group (MMT, n=80) and an intervention group (MMT+CM, n=80). Daily use of methadone was recorded and urine drug tests were conducted weekly during the first 12 weeks and then at week 16, week 20 and week 24.
The 12-week retention rates for the intervention (MMT+CM) and treatment-as-usual (MMT) groups were both quite high: 87.5% and 86.2%, respectively. The average durations of using methadone in the two groups were equal (70 days versus 71 days, respectively). There was a non-significant increase in the mean longest drug-free period (7.4 weeks versus 6.5 weeks) and in the mean number of negative urine tests (7.9 versus 7.6). Secondary analysis of the 24-week outcomes (12 weeks after termination of the adjunctive CM treatment) also found no significant differences between the groups. Among those who remained in the program the severity of addiction as assessed by the Addiction Severity Index decreased dramatically over the 24 weeks but, again, there were no significant differences in the addiction measures between those in the intervention group and those in the treatment-as-usual group.
Prize-based CM is not effective in improving the retention and compliance of heroin abusers to MMT in Shanghai. The main reasons for failure to replicate western studies were the unexpectedly high baseline rates of compliance in this sample (86%) and the relatively weak financial incentives provided by the CM program. CM programs are context dependent so a careful preliminary situational analysis is needed to determine their potential effectiveness at a particular site and to identify the types of incentives (prizes) that will effectively encourage behavioral change in the target participants.
中国美沙酮维持治疗（MMT）的依从性较差。
评估辅助性应急管理（CM）对阿片类药物依赖患者美沙酮维持治疗（MMT）疗效的影响。
一项为期12周的基于奖励的应急管理（CM）干预可提高上海海洛因成瘾者对标准化MMT项目的留存率和依从性。
来自上海三家自愿MMT诊所的160名海洛因依赖患者被随机分为常规治疗组（MMT，n = 80）和干预组（MMT + CM，n = 80）。记录美沙酮的每日使用情况，并在最初12周内每周进行尿毒品检测，然后在第16周、第20周和第24周进行检测。
干预组（MMT + CM）和常规治疗组（MMT）的12周留存率都相当高，分别为87.5%和86.2%。两组美沙酮的平均使用时长相等（分别为70天和71天）。平均最长戒毒期（7.4周对6.5周）和平均尿检测阴性次数（7.9对7.6）有不显著的增加。对24周结局（辅助CM治疗结束后12周）的二次分析也发现两组之间无显著差异。在留在项目中的患者中，成瘾严重程度指数评估的成瘾严重程度在24周内显著下降，但同样，干预组和常规治疗组在成瘾指标上没有显著差异。
基于奖励的CM对提高上海海洛因成瘾者对MMT的留存率和依从性无效。未能重复西方研究结果的主要原因是该样本中意外高的基线依从率（86%）以及CM项目提供的经济激励相对较弱。CM项目因具体情况而异，因此需要进行仔细的初步情况分析，以确定其在特定地点的潜在效果，并确定能有效鼓励目标参与者行为改变的激励（奖励）类型。
