Margolin A, Avants S K, Rounsaville B, Kosten T R, Schottenfeld R S
Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA.
J Psychoactive Drugs. 1997 Apr-Jun;29(2):205-12. doi: 10.1080/02791072.1997.10400189.
Phamacotherapy trials for cocaine abuse among methadone-maintained patients have typically reported negative findings as well as high rates of cocaine use during the trial. The contribution of motivational factors to these results is a potentially important, under investigated area. This article points out that some methadone-maintained patients may enter a trial for cocaine abuse with little desire for treatment, motivated primarily to continue receiving methadone or to avoid program sanctions for continued cocaine use. Participants in clinical trials may constitute a phase delaying discharge in a cyclic pattern of multiple treatment episodes. Testing a pharmacologic agent in a motivationally inappropriate sample may not provide a good estimate of the agent's effectiveness. In view of the important public health role that methadone maintenance programs play in preventing HIV transmission, and the subversion of this role by intravenous cocaine use, solutions to these problems are urgently needed. The authors suggest several possible approaches, including pre- and posttreatment motivation assessment, as well as the inclusion of psychosocial interventions that provide the context for the emergence of potential medication effects.
针对美沙酮维持治疗患者中可卡因滥用的药物治疗试验通常报告了负面结果以及试验期间可卡因的高使用率。动机因素对这些结果的影响是一个潜在重要但研究不足的领域。本文指出，一些美沙酮维持治疗患者可能进入可卡因滥用试验时对治疗几乎没有欲望，主要动机是继续接受美沙酮或避免因持续使用可卡因而受到项目制裁。临床试验的参与者可能构成多疗程循环模式中延迟出院的一个阶段。在动机不适当的样本中测试一种药物制剂可能无法很好地评估该制剂的有效性。鉴于美沙酮维持治疗项目在预防艾滋病毒传播方面所起的重要公共卫生作用，以及静脉注射可卡因使用对这一作用的破坏，迫切需要解决这些问题的办法。作者提出了几种可能的方法，包括治疗前和治疗后的动机评估，以及纳入提供潜在药物效果出现背景的社会心理干预措施。
