Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA.
Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, 1100 Veterans Drive, Lexington, KY 40536-0086, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171. Funkhouser Drive, Lexington, KY 40506-0044, USA.
Drug Alcohol Depend. 2023 Dec 1;253:111030. doi: 10.1016/j.drugalcdep.2023.111030. Epub 2023 Nov 18.
BACKGROUND: Contingency Management (CM) is being piloted as a treatment for stimulant use disorder in several US states, highlighting the need for treatment optimization. One important goal of optimization is decreasing drug use during the early stages of treatment, which has predicted success in other interventions. However, this "critical period" has not been reported in CM trials. The purpose of this analysis was to determine if, after accounting for baseline abstinence and incentive condition, abstinence in a CM trial for people with Cocaine Use Disorder (CUD) could be predicted by cocaine use during a first-week critical period. METHODS: Eighty-seven participants with CUD were randomized to receive contingent high or low value incentives for cocaine abstinence or were in a non-contingent control group. Generalized estimating equations (GEE) were used to analyze urine test results over 36 timepoints during the 12-week intervention. To assess for a critical period, the first three visits were included in the GEE as a covariate for remaining urine test results. RESULTS: Participants who provided more negative samples during the critical period were significantly more likely to produce a negative urine sample during the remainder of the trial, though some effects of group remained after controlling for the critical period. CONCLUSIONS: These results indicate that a critical period exists for CM trials, and it can explain a substantial amount of future performance. Early contact with an abstinence-contingent high magnitude alternative reinforcer may explain additional performance beyond the critical period, further justifying the use of high magnitude alternative reinforcers.
背景:应急管理(CM)正在美国的几个州作为治疗兴奋剂使用障碍的方法进行试点,突出了优化治疗的必要性。优化的一个重要目标是减少治疗早期的药物使用,这在其他干预措施中已经预测到了成功。然而,在 CM 试验中并没有报告这个“关键时期”。本分析的目的是确定在考虑基线戒断和激励条件后,可卡因使用障碍(CUD)患者的 CM 试验中的戒断是否可以通过可卡因在第一周关键期的使用来预测。
方法:87 名 CUD 患者被随机分配接受可卡因戒断的高或低价值奖励或非奖励条件。使用广义估计方程(GEE)分析了 12 周干预期间 36 个时间点的尿液检测结果。为了评估关键时期,将前三个访视作为 GEE 的协变量,纳入剩余尿液检测结果。
结果:在关键期提供更多阴性样本的参与者在试验的剩余时间里产生阴性尿液样本的可能性显著增加,尽管在控制了关键期后,一些组的效果仍然存在。
结论:这些结果表明 CM 试验存在一个关键时期,它可以解释大量的未来表现。早期接触与戒断相关的高幅度替代强化物可能会解释关键期之外的额外表现,进一步证明了使用高幅度替代强化物的合理性。
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