The Treatment Section continues its long-term projects to improve treatment for substance dependence through behavioral, pharmacologic, and combined behavioral and pharmacologic interventions. We completed a clinical trial examining the effectiveness of individualized methadone dosages of 100 to 190 mg/day, compared in a randomized, double-blind design with fixed dosages of 100 mg/day. Surprisingly, polydrug use (effect-size h = .30) and heroin craving (effect-size d = .87) were significantly greater in the individualized high-dose group than in the fixed-dose group, with no trend toward lower heroin use in the individualized high-dose group. This counterintuitive finding requires replication, but supports the need for additional controlled studies of high-dose methadone. We also completed a double-blind interventional study of propranolol on cue-induced cocaine craving, in which a single administration of propranolol was intended to block reconsolidation of cocaine-associated emotional responses, thereby leading to an enduring reduction in cue-induced craving. Again, the results were unexpected. Cue reactivity, as assessed by craving scales and physiological responses, was unexpectedly greater in the propranolol group than in the placebo group. This counter-hypothesized group difference was present both acutely after propranolol administration and during the subsequent test sessions. Our results do not support the use of propranolol for cue-induced cocaine craving in opioid-maintained patients. We also developed and deployed a video-based smartphone-delivered mobile HIV Risk Reduction (mHIVRR) intervention. We developed 3 video modules that consisted of a 10-minute HIVRR video, 11 acceptability questions, and 3 knowledge questions and deployed them as a secondary study within a larger study of ecological momentary and geographical momentary assessment. All 24 individuals who remained in the main study long enough completed the mHIVRR secondary study. All 3 videos met our a priori criteria for acceptability as is in the population: they achieved median scores of ≤2.5 on a 5-point Likert scale;≤20% of individuals gave them the most negative rating on the scale;and a majority of individuals stated they would not prefer other formats over video-based smartphone-delivered (all p<0.05). Additionally, all of our video modules met our a priori criteria for feasibilty: ≤20% of data were missing due to participant noncompliance and ≤20% were missing due to technical failure. We concluded that video-based mHIVRR education delivered via smartphone is acceptable and feasible, and may increase HIV/STD risk reduction knowledge. Future studies, with pre-intervention assessments of knowledge and random assignment, are needed to confirm these findings. Finally we continue to develop Geographical Momentary Assessment (GMA), a descriptive approach to better measure and understand the relationships among mood, drug use, and environmental exposure to psychosocial stressors. We remain committed to transforming description into intervention. For example, we have shown that electronic-diary studies can provide amazing insight into the daily lives of substance abusers during treatment and data that are sensitive to behavioral changes during even brief periods of abstinence. The technologies that enable us to collect data on drug use, craving, and stress in the field may also be used for delivery of treatment in the field, perhaps in response to the patients own self-reported behaviors or previously identified triggers.
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