Montgomery LaTrice, Carroll Kathleen M, Petry Nancy M
Mental Health and Substance Abuse Counseling Program, School of Human Services, University of Cincinnati.
Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System.
J Consult Clin Psychol. 2015 Jun;83(3):473-81. doi: 10.1037/a0039021. Epub 2015 Mar 23.
Limited research has evaluated African American substance users' response to evidence-based treatments. This study examined the efficacy of contingency management (CM) in African American and White cocaine users.
A secondary analysis evaluated effects of race, treatment condition, and baseline cocaine urine sample results on treatment outcomes of African American (n = 444) and White (n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care.
African American and White patients who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type; CM was efficacious in both races in terms of engendering longer durations of abstinence in patients who began treatment abstinent. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period.
CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. Future research on improving treatment outcomes in this population is needed.
针对非裔美国药物使用者对循证治疗的反应进行评估的研究有限。本研究考察了应急管理（CM）对非裔美国和白人可卡因使用者的疗效。
一项二次分析评估了种族、治疗条件以及可卡因尿液样本基线结果对参与六项将CM与标准护理进行比较的随机临床试验之一的非裔美国（n = 444）和白人（n = 403）可卡因滥用者治疗结果的影响。
无论治疗类型如何，以可卡因阴性尿液样本开始治疗的非裔美国和白人患者接受治疗的时长相似，且在治疗期间提交阴性样本的比例相当；对于开始治疗时已戒除毒品的患者，CM在促使二者延长戒毒时长方面均有效。以可卡因阳性样本开始治疗的白人在被分配接受CM治疗时，接受治疗的时间更长，且提交阴性样本的比例更高。然而，以可卡因阳性样本开始治疗的非裔美国人与接受标准护理相比，接受CM治疗的时间并没有更长，而且在药物使用结果方面的改善相对于白人而言并不显著。这种交互效应在9个月的随访期内持续存在。
CM在减少所有亚组尤其是治疗开始时使用可卡因的非裔美国患者的药物使用方面并非同样有效。需要对改善该人群治疗结果开展进一步研究。
