Silverman K, Wong C J, Higgins S T, Brooner R K, Montoya I D, Contoreggi C, Umbricht-Schneiter A, Schuster C R, Preston K L
NIH/NIDA/Intramural Research Program, Clinic Trials Section, Baltimore, MD 21224, USA.
Drug Alcohol Depend. 1996 Jun;41(2):157-65. doi: 10.1016/0376-8716(96)01246-x.
Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided: the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted. (P < or = 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P < or = 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P < or = 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.
海洛因依赖仍然是一个严重且代价高昂的公共卫生问题，即使在接受美沙酮维持治疗的患者中也是如此。本研究采用受试者内反转设计，以评估基于代金券的戒断强化措施在减少市中心一个项目中接受美沙酮维持治疗患者的阿片类药物使用方面的有效性。在整个研究过程中，受试者接受标准的美沙酮维持治疗，包括美沙酮、咨询和尿液监测（每周三次）。13名在为期5周的基线期内持续定期使用阿片类药物的患者参加了一个为期12周的项目，在该项目中，他们每提供一份无阿片类药物的尿液样本就会获得一张代金券：代金券的货币价值随着连续无阿片类药物尿液数量的增加而增加。在代金券项目停止后（恢复到基线），受试者继续接受标准的美沙酮维持治疗8周。Tukey事后对比显示，实施代金券项目时，阿片类药物检测呈阳性的尿液样本百分比显著下降（P≤0.01），然后在恢复到基线状态且代金券项目停止时显著上升（P≤0.01）。恢复到基线状态时阿片类药物阳性尿液的发生率仍显著低于初始基线期观察到的发生率（P≤0.01）。总体而言，该研究表明，基于代金券的强化意外事件可以减少接受美沙酮维持治疗的海洛因依赖患者的阿片类药物使用。
