关键词:
Contingency management
Heroin-assisted treatment
Cocaine dependence
Heroin dependence
摘要:
Aims: To determine the efficacy of contingency management (CM), targeting cocaine use, as an add-on intervention for heroin dependent patients in supervised heroin-assisted treatment (HAT) with frequent cocaine use. Design: Multi-center, open-label, parallel group, randomized controlled trial. Setting: Twelve specialized addiction treatment centers for HAT in The Netherlands;April 2006-January 2011. Participants: 214 chronic, treatment-refractory heroin dependent patients in HAT, with frequent cocaine use. Interventions: Routine, daily supervised diacetylmorphine treatment, co-prescribed with oral methadone (HAT), with and without 6 months contingency management for cocaine use as an add-on intervention;HAT + CM and HAT-only, respectively. Measurements: Primary outcome was the longest, uninterrupted duration of cocaine abstinence, based upon laboratory urinalysis. Secondary outcome measures included other cocaine-related measures, treatment retention in HAT, and multi-domain health-related treatment response. Findings: In an intention-to-treat analysis, HAT + CM was more effective than HAT-only in promoting longer, uninterrupted duration of cocaine abstinence (3.7 weeks versus 1.6 weeks;negative binomial regression: Exp(B) = 2.34, 95%-CI: 1.70-3.23;p < 0.001). This result remained significant in sensitivity analyses and was supported by all secondary, cocaine-related outcome measures. Treatment retention in HAT was high (91.6%) with no difference between the groups. The improvement in multi-domain health-related treatment response during the trial was numerically higher in HAT + CM (from 37.4% to 53.1%;+15.7%) than in HAT-only (from 44.5% to 46.5%;+2.0%), but this difference was statistically not significant. Conclusions: Contingency management is an effective add-on intervention to promote longer, uninterrupted periods of cocaine abstinence in chronic, treatment-refractory heroin dependent patients in heroin-assisted treatment with frequent cocaine use. The trial h