Motivational Incentive Policy Group (Drs Rawson, Erath, Chalk, Clark, Wattenberg, and Roll, and Ms McDaid); Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont (Drs Rawson and Erath); Community and Behavioral Health Department, College of Medicine, Washington State University, Pullman, Washington (Drs Roll, McDonell, and Parent); and UCLA Integrated Substance Abuse Programs, Los Angeles, California (Drs Rawson and Freese).
J Ambul Care Manage. 2023;46(2):152-159. doi: 10.1097/JAC.0000000000000450. Epub 2023 Feb 3.
The United States is currently in the fourth wave of the overdose crisis wherein stimulants together with fentanyl are the major drivers of overdose deaths. To date, there has been limited effort outside the US Veterans Administration Health System health system to disseminate evidence-based treatment for people with stimulant use disorder. Contingency management, a behavioral intervention in which positive reinforcement is provided for a target behavior indicating treatment progress, has decades of empirical support but limited implementation in real-world, non-US Veterans Administration Health System settings. The purpose of the report is to provide an overview of contingency management, the barriers to adoption, and recommendations for overcoming these barriers.
美国目前正处于阿片类药物过量危机的第四波，兴奋剂和芬太尼是导致过量死亡的主要因素。迄今为止，除了美国退伍军人事务部医疗系统以外，几乎没有在其他地方开展推广兴奋剂使用障碍的循证治疗的工作。而作为一种行为干预措施，附带管理为目标行为提供积极强化，以表明治疗进展，有几十年的经验支持，但在现实世界中，除了美国退伍军人事务部医疗系统之外，实施的情况有限。本报告的目的是概述附带管理，以及采用附带管理所面临的障碍，并为克服这些障碍提出建议。
