There is a long-standing literature showing the presence of conditioned opiate-like and opiate-withdrawal responses in opiate dependent animals and humans. These data suggest that learned responses may be particularly important to relapse and readdiction yet no current treatment method directly addresses this aspect of addiction. Previous work has shown that attempts to abruptly extinguish conditioned responses in addicts lead to a high drop-out rate. We now have pilot data indicating that a proceudre including gradual extinction of conditioned responses to drug-related stimuli integrated with cognitive therapy is well-accepted by methadone treatment patients. In order to test whether extinction of conditioned responses has usefulness in a treatment program, we propose a randomized clinical trial among 120 stabilized methodone patients who desire impatient detoxification. Three groups will be studied. The cognitive/extinction group (CE) will receive a hierarchical presentation of stimuli involved with drug procuring and self-administration. The conditioned responses evoked by these stimuli will be reduced by repetition in the absence of drug effects and by relaxation training. This will be integrated with cognitive therapy. The control groups will spend equivalent time receiving either cognitive therapy with relaxation (CT) or drug counseling only (DC). A full range of pre-, during-, and post-treatment as well as follow-up measures will be used. The purpose of this study will be to determine 1) whether conditioned responses in opiate addicts vary over time and whether such responses relate to clinical outcome; 2) whether a gradual extinction program can reduce or eliminate these conditioned responses; 3) whether there is any benefit to adding treatment of conditioned responses to standard treatment and, if so, which patients will benefit.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA003008-04
Application #
3207653
Study Section
Drug Abuse Clinical and Behavioral Research Review Committee (DACB)
Project Start
1983-06-01
Project End
1987-05-31
Budget Start
1986-06-01
Budget End
1987-05-31
Support Year
4
Fiscal Year
1986
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Ehrman, R N; Robbins, S J; Cornish, J W (2001) Results of a baseline urine test predict levels of cocaine use during treatment. Drug Alcohol Depend 62:1-7
Robbins, S J; Ehrman, R N; Childress, A R et al. (2000) Mood state and recent cocaine use are not associated with levels of cocaine cue reactivity. Drug Alcohol Depend 59:33-42
Robbins, S J; Ehrman, R N; Childress, A R et al. (1999) Comparing levels of cocaine cue reactivity in male and female outpatients. Drug Alcohol Depend 53:223-30
Ehrman, R N; Robbins, S J; Childress, A R et al. (1998) Laboratory exposure to cocaine cues does not increase cocaine use by outpatient subjects. J Subst Abuse Treat 15:431-5
Robbins, S J; Ehrman, R N (1998) Cocaine use is associated with increased craving in outpatient cocaine abusers. Exp Clin Psychopharmacol 6:217-24
Robbins, S J; Ehrman, R N; Childress, A R et al. (1997) Relationships among physiological and self-report responses produced by cocaine-related cues. Addict Behav 22:157-67
Ehrman, R N; Robbins, S J; Cornish, J W (1997) Comparing self-reported cocaine use with repeated urine tests in outpatient cocaine abusers. Exp Clin Psychopharmacol 5:150-6
Ehrman, R N; Robbins, S J; Cornish, J W et al. (1996) Failure of ritanserin to block cocaine cue reactivity in humans. Drug Alcohol Depend 42:167-74
O'Brien, C P; Woody, G E; McLellan, A T (1995) Enhancing the effectiveness of methadone using psychotherapeutic interventions. NIDA Res Monogr 150:5-18
Droungas, A; Ehrman, R N; Childress, A R et al. (1995) Effect of smoking cues and cigarette availability on craving and smoking behavior. Addict Behav 20:657-73

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