应急管理对于促进有既往治疗反应不佳病史的快克可卡因使用者戒除毒瘾并坚持治疗是有效的：一项交叉试验。
Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial.
作者信息
de Queiroz Constantino Miguel André, Sandi Madruga Clarice, Simões Viviane, Yamauchi Rodolfo, da Silva Claudio Jerônimo, McDonell Michael, McPherson Sterling, Roll John, Laranjeira Ronaldo Ramos, de Jesus Mari Jair
机构信息
National Institute of Policies on Alcohol and Drugs (INPAD) of the Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua: Dr. Diogo de Faria, 1036, 3º Andar-Vila Clementino, São Paulo, SP, Brazil.
Department of Psychiatry and Medical Psychology, Federal University of São Paulo (UNIFESP), Rua Borges Lagoa, 570 - 1o andar - Vila Clementino, São Paulo, SP, 04038-030, Brazil.
出版信息
Psicol Reflex Crit. 2019 Jul 15;32(1):14. doi: 10.1186/s41155-019-0127-2.
BACKGROUND
Crack use has become a severe health problem in Brazil. Contingency management has shown robust evidence of efficacy in the treatment of cocaine use disorder (CUD) in high-income countries; however, it is still unclear how this intervention can impact treatment in low-income countries.
OBJECTIVE
To evaluate the efficacy of contingency management in the treatment of CUD among individuals with a previous history of poor treatment response in Brazil.
METHODS
Six months after the end of treatment, 32 participants previously allocated to the usual care condition (UCC) were invited to receive an additional 12 weeks of treatment in a contingency management condition (CMC), and 16 accepted the invitation. We compared data obtained from only the 16 participants (14 male) exposed to both treatment conditions.
RESULTS
Participants attended more treatment sessions and were retained in treatment for a longer period during the CMC than during the UCC (p < .01 for both). The proportion of negative cocaine samples submitted, the mean longest duration of cocaine abstinence, and the odds of being abstinent from cocaine during the 12 weeks of treatment were significantly higher during treatment in the CMC when compared to the UCC (p < .05).
CONCLUSIONS
This study provides further evidence that contingency management is effective in promoting abstinence and retention in treatment among individuals with CUD with a history of poor treatment response. Our findings argue for the incorporation of CM among public treatment services for CUD in Brazil.
TRIAL REGISTRATION
This study was registered at ClinicalTrials.gov as NCT01815645 on March 21, 2013.
背景
在巴西，吸食强效纯可卡因已成为一个严重的健康问题。在高收入国家，应急管理已显示出在治疗可卡因使用障碍（CUD）方面有强有力的疗效证据；然而，这种干预措施在低收入国家如何影响治疗仍不清楚。
目的
评估应急管理对巴西既往治疗反应不佳的个体治疗CUD的疗效。
方法
治疗结束6个月后，邀请32名先前被分配到常规护理组（UCC）的参与者接受为期12周的应急管理组（CMC）额外治疗，16人接受了邀请。我们比较了仅16名接受两种治疗的参与者（14名男性）的数据。
结果
与UCC期间相比，参与者在CMC期间参加的治疗疗程更多，且在治疗中保留的时间更长（两者p均<0.01）。与UCC相比，在CMC治疗期间，提交的可卡因阴性样本比例、可卡因戒断的平均最长持续时间以及治疗12周内可卡因戒断的几率显著更高（p<0.05）。
结论
本研究提供了进一步的证据，表明应急管理对于促进有治疗反应不佳病史的CUD个体的戒断和坚持治疗是有效的。我们的研究结果支持在巴西针对CUD的公共治疗服务中纳入CM。
试验注册
本研究于2013年3月21日在ClinicalTrials.gov注册，注册号为NCT01815645。
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