对从事多种物质使用的妇女实施应急管理。

IF 3.2 2区 医学 Q1 SUBSTANCE ABUSE
Kathleen M Ward, Adam W Carrico, Daniel Vader, Reneé H Moore, K Rivet Amico, Allison K Groves, Scarlett L Bellamy, Susan G Sherman, Douglas Krakower, Silvana Mazzella, Alexis M Roth
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引用次数: 0

摘要

背景:应急管理(CM)是一种有效的干预措施,提供财政激励,作为减少阿片类药物或兴奋剂使用的积极强化。然而,尚未在使用多种药物的注射毒品妇女人群中进行测试。方法:我们的目的是比较两种CM方案的可行性,这些方案旨在鼓励参加正在进行的HIV预防试验的WWID患者戒断非法兴奋剂和阿片类药物。参与者完成了为期3个月的CM期,在此期间,他们每周提交三次尿液毒理学筛查(UTOX)。在“戒除兴奋剂和阿片类药物”方案中,当尿液中未检测到兴奋剂和阿片类药物的代谢物时,参与者将获得5美元的奖励。在“部分戒断方案”中,当没有检测到兴奋剂或阿片类药物的代谢物时,他们获得5美元的奖励,从而使每次就诊获得的潜在奖励增加一倍。女性在连续三次UTOX阴性后也会获得扩展奖金(5- 15美元)。我们使用描述性统计来总结(1)完成的utox总数和(2)分配的奖金。计算每个人每月的参与率(即完成UTOX的总人数/3个月*24名参与者)。参与率按CM协议期进行比较。结果:参与者主要是白人女性(67%),平均年龄为47岁。自我报告的多种药物使用很常见(96%),妇女报告平均每天注射5次(四分位数范围:2-7)。参与者(N = 24)在3个月的CM期间共提交了177份UTOX。在部分戒断方案中,非反应性UTOX结果的比率略高于兴奋剂和阿片类药物戒断方案(每月2.9比每月1.0)。部分戒断方案(每个参与者每月0.50奖金)比戒断兴奋剂和阿片类药物方案(没有)获得更多奖金。在CM期间,两组均未发生与研究相关的不良事件。结论:研究结果证明了CM方案的可行性,该方案为部分戒断、有记录的兴奋剂或阿片类药物戒断期间以及两者的戒断提供经济激励,而不会发生医源性效应。未来的研究重点是具有更灵活的激励结构的CM协议仍然至关重要。试验注册:NCT05192434。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Implementation of contingency management with women engaging in polysubstance use.

Background: Contingency management (CM) is an effective intervention that provides financial incentives as positive reinforcement for reducing opioid or stimulant use. However, it has not been tested in populations of women who inject drugs (WWID) engaging in polysubstance use.

Methods: We aimed to compare the feasibility of two CM protocols designed to encourage illicit stimulant and opioid abstinence among WWID participating in an ongoing HIV prevention trial. Participants completed a 3-month CM period during which they submitted thrice weekly urine toxicology screenings (UTOX). In the 'abstinence from stimulants and opioids' protocol, participants received a $5 USD incentive when metabolites of stimulants and opioids were not detected in urine. In the 'partial-abstinence protocol', they received a $5 USD incentive when metabolites of stimulants or opioids were not detected, thus doubling the potential incentive obtained each visit. Women also received scaling bonuses after three consecutive negative UTOX ($5-$15 USD). We used descriptive statistics to summarize the total number of (1) UTOXs completed and (2) bonuses distributed. Rates of engagement per person per month were calculated (i.e., total number of completed UTOX/3 months*24 participants). Rates of engagement were compared by CM protocol period.

Results: Participants were primarily White women (67%) with an average age of 47 years. Self-reported polysubstance use was common (96%) with women reporting injecting an average of 5 times daily (Interquartile Range: 2-7). Participants (N = 24) collectively submitted 177 UTOX during their 3-month CM periods. Rates of non-reactive UTOX results were slightly higher in the partial-abstinence protocol compared to the abstinence from stimulants and opioids protocol (2.9 per month versus 1.0 per month). More bonuses were earned in the partial-abstinence protocol (0.50 bonuses per participant per month) compared to the abstinence from stimulants and opioids protocol (none). There were no study related adverse events in either protocol group during the CM period.

Conclusions: Findings demonstrate the feasibility of a CM protocol that provided financial incentives for partial abstinence, periods with documented stimulant or opioid abstinence, as well as abstinence to both, without the occurrence of iatrogenic effects. Future research focusing on CM protocols with more flexible incentive structures remains critical.

Trial registration: NCT05192434.

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来源期刊
Addiction Science & Clinical Practice
Addiction Science & Clinical Practice Psychology-Clinical Psychology
CiteScore
3.90
自引率
10.80%
发文量
64
审稿时长
28 weeks
期刊介绍: Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings. Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use. Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations. Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.
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