A sequential multiple assignment randomized trial for cocaine cessation and relapse prevention: Tailoring treatment to the individual

Drug addiction is a chronic, devastating, but treatable disorder. A core principle of drug addiction treatment states that no single treatment is appropriate for everyone (NIDA, 2012); treatments need to adjust based on patient characteristics and response in order to be maximally effective. For coc...

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Veröffentlicht in:Contemporary clinical trials 2018-02, Vol.65, p.109-115
Hauptverfasser: Schmitz, Joy M., Stotts, Angela L., Vujanovic, Anka A., Weaver, Michael F., Yoon, Jin H., Vincent, Jessica, Green, Charles E.
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container_end_page 115
container_issue
container_start_page 109
container_title Contemporary clinical trials
container_volume 65
creator Schmitz, Joy M.
Stotts, Angela L.
Vujanovic, Anka A.
Weaver, Michael F.
Yoon, Jin H.
Vincent, Jessica
Green, Charles E.
description Drug addiction is a chronic, devastating, but treatable disorder. A core principle of drug addiction treatment states that no single treatment is appropriate for everyone (NIDA, 2012); treatments need to adjust based on patient characteristics and response in order to be maximally effective. For cocaine use disorders (CUD), specifically, the most potent intervention currently available for initiating abstinence is behavior therapy using contingency management (CM) procedures, with early cessation being a robust predictor of future abstinence. This raises two key questions for treatment development research: First, can we significantly improve initial CM response rates with targeted adjunctive interventions? Second, for individuals who fail to achieve initial abstinence with CM, is pharmacotherapy an effective augmentation strategy? This paper describes how a sequential, multiple assignment, randomized trial (SMART) design has advantages over a fixed-intervention approach when it comes to collecting data needed to answer both questions. The first aim will examine whether Acceptance and Commitment Therapy (ACT) in combination with CM increases initial abstinence response rates (i.e., 2 consecutive weeks of cocaine-negative urine screens). The second aim will examine whether ACT+CM in combination with modafinil promotes abstinence achievement in initial non-responders. Results are expected to inform how we tailor treatment of CUD to maximize outcomes.
doi_str_mv 10.1016/j.cct.2017.12.015
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subjects Acceptance and Commitment Therapy (ACT)
Adolescent
Adult
Bayesian approach
Behavior Therapy - methods
Central Nervous System Stimulants - therapeutic use
Cocaine use disorder
Cocaine-Related Disorders - drug therapy
Cocaine-Related Disorders - therapy
Contingency management (CM)
Female
Humans
Male
Middle Aged
Modafinil
Modafinil - therapeutic use
Multiple assignment
Patient Care Planning
Randomized Controlled Trials as Topic
Randomized trial (SMART)
Sequential
Young Adult
title A sequential multiple assignment randomized trial for cocaine cessation and relapse prevention: Tailoring treatment to the individual
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