Evaluation of Clinical Effectiveness, Cost, and Implementation Factors to Optimize Scalability of Treatment for Co-Occurring SUD and PTSD Among Teens

评估临床有效性、成本和实施因素，以优化青少年同时发生的 SUD 和 PTSD 治疗的可扩展性

• 批准号: 10185396
• 负责人: CARLA KMETT DANIELSON
• 金额: $ 76.55万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10185396
• 关键词: Address; Adolescence; Adolescent; Adult; Affect; Area; Attitude; Caregivers; Child Advocacy; Childhood; Clinic; Clinical; Clinical Trials Network; Clinical effectiveness; Colorado; Communities; Cost Effectiveness Analysis; Cues; Data; Decision Making; Discipline; Ecology; Emotional; Evaluation; Evidence based intervention; Evidence based treatment; Family; Family psychotherapy; Frequencies; Funding; Goals; Grant; Individual; Interpersonal Violence; Intervention; Interview; Justice; Left; Link; Longevity; Memory; Mental Health; Mental disorders; Methods; National Institute of Drug Abuse; Negative Reinforcements; Outcome; Outpatients; Participant; Policy Maker; Policy Making; Population; Post-Traumatic Stress Disorders; Prognostic Factor; Public Health; Randomized; Randomized Controlled Trials; Reaction; Recording of previous events; Relapse; Reporting; Research; Respondent; Risk Factors; Risk Reduction; Sampling; Science; Self Medication; Sexual abuse; Site; South Carolina; Substance Use Disorder; Surveys; Symptoms; Teenagers; Theoretical model; Thinking; Violence; Work; Youth; addiction; adolescent substance use; base; behavioral health; comorbidity; cost; cost effectiveness; cost-effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; experience; follow up assessment; functional disability; high risk; high-risk adolescents; hybrid type 1 design; implementation barriers; implementation determinants; implementation facilitators; improved; interest; mental health organization; negative affect; physical abuse; practice setting; protective factors; psychosocial; recruit; reduced substance use; research clinical testing; satisfaction; social; standard care; substance use; substance use treatment; traumatic event; treatment as usual; treatment center; uptake; young adult

Psychosocial traumatic events, and interpersonal violence experiences in particular, during childhood serve as strong and consistent predictors of substance use problems (SUP) during adolescence and adulthood. PTSD that extends from such IPV often co-occurs with SUP. Despite this well-established link, standard care for adolescents with co-occurring SUP and PTSD for the last several decades has been to treat these problems separately. This compartmentalized approach to treatment creates burden on teens and families, raises unique challenges to clinicians in both mental health and addiction domains, and may contribute to high rates of SUP relapse among adolescents with co-occurring PTSD. To address this problem, our team recently completed a rigorous NIDA-funded randomized controlled trial (RCT) supporting the efficacy of an integrative, exposure- based treatment we developed, Risk Reduction through Family Therapy (RRFT), in greater long term reductions in SUP, as well as PTSD avoidance and hyperarousal symptoms, in comparison to standard treatment in a large teen sample. The proposed RCT, with an effectiveness-implementation Hybrid Type I design, substantially builds on that prior research by proposing to: 1) evaluate whether RRFT's clinical effectiveness for reducing SUP and PTSD can be extended to youth in outpatient substance use treatment settings—where youth are presenting for SUP treatment and where clinicians often have less experience treating PTSD (Aim 1); 2) evaluate the cost- effectiveness of RRFT and to explore inner context variables (e.g., perceived treatment acceptability, attitudes, and satisfaction among the participating adolescents, caregivers, agency leaders, and therapists and barriers to and facilitators of implementation) that might affect RRFT implementation in diverse practice settings (Aim 2). The proposed effectiveness-implementation trial will recruit adolescents (13-18 years) with a history of IPV presenting with SUP and PTSD symptoms for outpatient substance use disorder treatment at sites in Denver, Colorado affiliated with NIDA's Clinical Trials Network. Participants will be urn randomized to RRFT or Treatment as Usual. A multi-method, multi-respondent approach will track clinical outcomes (SUP, PTSD, and putative targets of treatment, such as emotional suppression) at 3, 6, and 12 months post-baseline. To reduce the science-to-practice gap, as an Exploratory Aim, we will assemble and engage an Advisory Board of leaders from Colorado state departments (Offices of Behavioral Health and Criminal/Juvenile Justice for Colorado, which have committed to participate) and community mental health organizations that oversee policy and decision- making in selection and implementation of psychosocial treatments for high-risk adolescents, with the goal of building capacity for large scale (e.g., state-wide) uptake of evidence-interventions for teen SUP and PTSD, like RRFT, upon completion of the grant. This proposal is directly in line with NIDA's recent release of NOT-DA-20- 004, a Notice of Special Interest encouraging research on comorbid substance use, substance use disorders, and other psychiatric disorders.

心理社会创伤事件，尤其是童年时期的人际暴力经历，可以作为 青春期和成年期物质使用问题（SUP）的强有力且一致的预测因素。 从此类 IPV 延伸而来的疾病通常与 SUP 同时发生，尽管存在这种牢固的联系，但仍存在标准护理。 过去几十年来，针对同时患有 SUP 和 PTSD 的青少年一直在治疗这些问题 这种分开治疗的方法给青少年和家庭带来了负担，引发了独特的 人群在心理健康和成瘾领域面临挑战，并可能导致 SUP 的高比例 为了解决这个问题，我们的团队最近完成了一项研究。 严格的 NIDA 资助的随机对照试验 (RCT) 支持综合暴露的功效 我们开发的治疗方法是通过家庭治疗降低风险 (RRFT)，以实现更大的长期降低 与大范围的标准治疗相比，SUP 以及 PTSD 回避和过度警觉症状 拟议的 RCT 采用有效性实施混合 I 型设计，显着构建了青少年样本。 基于先前的研究，建议：1) 评估 RRFT 是否具有减少 SUP 的临床有效性，以及 创伤后应激障碍（PTSD）可以扩展到门诊药物使用治疗环境中的青少年——青少年在这些地方接受药物滥用治疗。 SUP 治疗以及忠诚者通常缺乏治疗 PTSD 经验的情况（目标 1）评估成本- RRFT 的有效性并探索内部背景变量（例如，感知的治疗可接受性、态度、 参与青少年、照顾者、机构领导和治疗师的满意度以及障碍 和实施的促进者）可能会影响不同实践环境中 RRFT 的实施（目标 2）。 拟议的有效性实施试验将招募有 IPV 病史的青少年（13-18 岁） 出现 SUP 和 PTSD 症状，在丹佛的门诊接受物质使用障碍治疗， 隶属于 NIDA 临床试验网络的科罗拉多州参与者将被随机分配接受 RRFT 或治疗。 与往常一样，多方法、多受访者方法将跟踪临床结果（SUP、PTSD 和假定的）。 基线后 3、6 和 12 个月的治疗目标（例如情绪抑制）。 科学与实践之间的差距，作为探索性目标，我们将组建并聘请一个由领导者组成的咨询委员会 来自科罗拉多州各部门（科罗拉多州行为健康和刑事/少年司法办公室， 已承诺参与）和监督政策和决策的社区心理健康组织 为高危青少年选择和实施心理社会治疗，目标是 建设针对青少年 SUP 和 PTSD 的大规模（例如全州）采用证据干预措施的能力，例如 RRFT，在拨款完成后，该提案与 NIDA 最近发布的 NOT-DA-20- 直接一致。 004，特别关注通知，鼓励对共病物质使用、物质使用障碍进行研究， 和其他精神疾病。