Petitjean Sylvie A, Dürsteler-MacFarland Kenneth M, Krokar Marina Croquette, Strasser Johannes, Mueller Sandra E, Degen Bigna, Trombini Mauro V, Vogel Marc, Walter Marc, Wiesbeck Gerhard A, Farronato Nadine S
Psychiatric Hospital of the University of Basel, Division of Substance Use Disorders, 4012 Basel, Switzerland.
Psychiatric Hospital of the University of Basel, Division of Substance Use Disorders, 4012 Basel, Switzerland.
Drug Alcohol Depend. 2014 Dec 1;145:94-100. doi: 10.1016/j.drugalcdep.2014.09.785. Epub 2014 Oct 16.
Cocaine has become one of the drugs of most concern in Switzerland, being associated with a wide range of medical, psychiatric and social problems. Available treatment options for cocaine dependence are rare. The study sought to compare combined prize-based contingency management (prizeCM) plus cognitive-behavioral therapy (CBT) to CBT alone in cocaine-dependent patients.
Sixty cocaine-dependent patients participated in a randomized, controlled trial with two treatment conditions. The participants were randomly assigned to the experimental group (EG; n = 29), who received CBT combined with prizeCM, or to the control group (CG; n = 31), who received CBT only during 24 weeks. The primary outcome measures were retention, at least 3 consecutive weeks of cocaine abstinence, the maximum number of consecutive weeks of abstinence and proportions of cocaine-free urine samples during the entire 24-week and at 6-month follow-up.
Sixty-three percent of the participants completed the study protocol. Participants in both groups significantly reduced cocaine use over time. Overall, no difference in cocaine-free urine screens was found across the two treatment groups, except at weeks 8, 9, 10, 17 and 21 in favor of the EG.
The addition of prizeCM to CBT seems to enhance treatment effects, especially in the early treatment period, supporting results from previous studies. Both the combined intervention and CBT alone, led to significant reductions in cocaine use during treatment and these effects were sustained at 6-month follow-up. These findings underline the importance in implementing CM and CBT interventions as treatment options for cocaine dependence in the European context.
可卡因已成为瑞士最受关注的毒品之一，与一系列医学、精神和社会问题相关。现有的可卡因依赖治疗方案很少。该研究旨在比较基于奖励的联合应急管理（prizeCM）加认知行为疗法（CBT）与单纯CBT对可卡因依赖患者的治疗效果。
60名可卡因依赖患者参与了一项有两种治疗条件的随机对照试验。参与者被随机分配到实验组（EG；n = 29），接受CBT联合prizeCM，或对照组（CG；n = 31），仅在24周内接受CBT。主要结局指标包括治疗保留率、至少连续3周的可卡因戒断、连续戒断的最长周数以及在整个24周和6个月随访期间可卡因阴性尿液样本的比例。
63%的参与者完成了研究方案。两组参与者随着时间的推移可卡因使用量均显著减少。总体而言，除了在第8、9、10、17和21周时实验组更有优势外，两个治疗组在可卡因阴性尿液筛查方面没有差异。
在CBT中加入prizeCM似乎能增强治疗效果，尤其是在治疗早期，这与先前研究的结果相符。联合干预和单纯CBT均导致治疗期间可卡因使用量显著减少，且这些效果在6个月随访时得以维持。这些发现强调了在欧洲背景下实施CM和CBT干预作为可卡因依赖治疗选择的重要性。
