BEPE/FAPESP international training for the project effectiveness of contingency management in the treatment of crack addiction for individuals living in the Crackland region: a crossover randomized clinical trial

Abstract

Crack addiction has become a severe public health problem in Brazil with crack users presenting elevated prevalence rates of psychiatric comorbidities, sexual transmitted infections and unemployment with high probability of living or have lived in the streets, history of incarceration and engagement in illegal activities. For the last 20 years a treatment called Contingency Management (CM) have achieved the best results regarding reduction of substance use, promotion of abstinence, treatment attendance and retention in treatment. The objective of this study is to evaluate the effectiveness of CM for crack users living in the "Crackland" region. To achieve this goal, regular treatment staff from Unidade Helvétia and CRATOD treatment services will be capacitated in CM to latter-on apply the CM intervention in their respective services. The design will be a multicenter crossover randomized clinical trial composed of a sample of 200 subjects with current diagnose for crack/cocaine dependence. After 12 weeks of intervention, participants in the control condition (standard treatment alone) will receive 12 weeks of the experimental treatment (standard treatment plus CM) and participants in the experimental condition will receive 12 weeks of the control procedure. Our hypothesis is that participants will have significantly better response in treatment attendance, retention in treatment, reduction of crack use and continuous crack abstinence outcomes when receiving treatment in the CM condition. CM's benefits on secondary outcomes are also expected. The objective of this postdoctoral internship at the Department of Psychiatry of Yale University is to work with a group of scientist considered to be an international reference in the development of evidence based psychosocial intervention for substance abuse, such as Contingency Management. As descried in the submitted project, during this postdoctoral internship experience the research fellow will work in two projects that being currently by Prof. Carroll's group involving the use of Contingency Management in substance abuse treatments (same intervention used in his PhD and postdoctoral project). He will also conduct secondary analyses in a dataset of completed clinical trials for cocaine dependence with the intention of producing new manuscript and submit it to peer-review journals. Finally, the postdoctoral fellow will also attend state of the art postdoctoral training courses supported by the Division of Substance Use and the Department of Psychiatry at Yale University. Regarding direct benefits of this experience in his postdoctoral project in Brazil the postdoctoral fellow will have access to novel assessment instruments to evaluate treatment outcomes, will learn about design, statistical approaches, and methods to promote data collection (reduce missing data) for clinical trials involving Contingency Management treatment for substance use disorders. It will also allow him to discuss and analyze his findings with an international reference research center in his field of research. Finally, this postdoctoral research fellowship experience will provide him additional research and training in his area of expertise to develop better skills, advancing the scholarly mission of his ongoing postdoctoral program in the Federal University of São Paulo. It is also expected that this experience will help him in producing relevant publications with his research outcomes in prominent peer-reviewed academic journals. Therefore, strengthening the partnership with Yale University through this specific research group will be a unique opportunity with direct impact on his ongoing postdoctoral research project and his future academic career. (AU)