Adolescents with Major Depression and AUD: Community-based Integrated Treatment

患有重度抑郁症和 AUD 的青少年：基于社区的综合治疗

基本信息

批准号：
8296799
负责人：
Anthony Spirito
金额：
$ 67.31万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-04-20 至 2017-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8296799
关键词：
Accident and Emergency department Address Admission activity Adolescence Adolescent Adult Affect Aftercare Alcohol abuse Alcohol consumption Anxiety Disorders Area Behavior Caring Clinic Cognitive Cognitive Therapy Communities Comorbidity Data Depressed mood Diagnosis Disease Disease remission Early treatment Event Goals Healthy People 2020 Home environment Hospitalization Hospitals Impairment Imprisonment Individual Inpatients Intervention Licensing Major Depressive Disorder Marijuana Smoking Mediating Mental Depression Mental Health Mental disorders Methods Modeling Morbidity - disease rate National Institute of Drug Abuse National Institute of Mental Health National Institute on Alcohol Abuse and Alcoholism Nature Outcome Outpatients Parents Persons Population Population Research Problem Solving Procedures Professional counselor Protocols documentation Psychopathology Randomized Randomized Clinical Trials Reading Recording of previous events Regulation Services Severities Strategic Planning Substance abuse problem Suicide attempt Supervision Techniques Teenagers Testing Trauma Treatment outcome Visit Work addiction adolescents with alcohol use disorders aged alcohol use disorder base clinically significant community intervention depressive symptoms design drinking drinking behavior efficacy testing externalizing behavior follow-up high risk improved intervention effect parental monitoring programs psychosocial reduced alcohol use response social standard care suicidal suicidal risk trial comparing

项目摘要

DESCRIPTION (provided by applicant): Studies have consistently shown an association between mental health disorders and alcohol use disorders (AUD) during adolescence. In particular, the comorbidity of AUD with Major Depressive Disorder (MDD) is well established and associated with a range of negative outcomes including longer and more severe episodes of illness and greater psychosocial impairment including behavior disturbance. This population may be even more challenging to treat than their adult counterparts because adolescents with MDD/AUD so often have other externalizing disorders besides AUD. Treatment research for this population is quite limited and Healthy People 2020 Objective MHMD HP 2020-14 directly addresses this area: "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders". The purpose of this application is to conduct a randomized clinical trial comparing Cognitive Behavioral Therapy - Integrated (CBT- I) for adolescents with MDD and AUD to standard care (SC), i.e. an eclectic mix of therapy techniques. A two group randomized design will be used to test the primary hypothesis that the integrated CBT- I protocol designed to treat adolescents aged 12 to 18 years with AUD/ MDD will produce better treatment outcomes compared to standard care with respect to 1) heavy volume alcohol use/ alcohol problems which can contribute to both depression and externalizing behaviors, the most severe of which result in costly residential placements and arrests/incarceration; and 2) depression and suicidal events, the latter potentially requiring expensive Emergency Department visits and inpatient psychiatric hospitalizations. Both the integrated CBT-I and SC condition will be delivered by licensed mental health counselors at a community mental health clinic that uses an Intensive Outpatient Program model to treat adolescents with AUD and mental health disorders who have failed prior outpatient therapy and require more intensive services. Clinicians in the CBT-I condition will receive weekly supervision that focuses on use of the CBT-I protocol. Clinicians in SC will be provided standard clinic supervision that is more eclectic in nature, consistent with typical community care. Outcome data will be collected at one year post treatment. Successful completion of the project aims could change how services are delivered to this high risk group. Its clinical significance lies in ts addressing a critical barrier to the field: how to treat MDD/AUD adolescents. PUBLIC HEALTH RELEVANCE: Adolescents who have both alcohol use disorders and psychiatric disorders typically have major impairment that affects multiple aspects of their functioning. Improved methods for treating these individuals have the potential to decrease the morbidity associated with both conditions. The relevance of this problem is reflected in Healthy People 2020 Objective MHMD HP 2020-14 which reads: "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders."

描述（由申请人提供）：研究始终显示出精神健康障碍与酒精使用障碍（AUD）之间的关联（AUD）。特别是，AUD患有重度抑郁症（MDD）的合并症已经建立了良好，并且与一系列负面结果有关，包括较长和更严重的疾病发作和更大的社会心理障碍，包括行为障碍。该人群的治疗可能比成年人更具挑战性，因为MDD/AUD的青少年除了AUD以外，经常还具有其他外部性疾病。该人群的治疗研究非常有限，健康的人2020目标MHMD HP 2020-14直接解决了这一领域：“增加同时发生药物滥用和精神障碍的人的比例，这些人接受两种疾病的治疗”。该应用的目的是进行一项随机临床试验，以比较具有MDD和AUD到标准护理（SC）的青少年的认知行为疗法（CBT- I），即治疗技术的折衷组合。两组随机设计将用于测试主要假设，即旨在治疗12至18岁的青少年的综合CBT-I方案与AUD/ MDD的青少年相比，与标准护理相比，与1）相对于1）大量的酒精使用/酒精问题会产生更好的治疗结果，这些问题会导致抑郁症和外部化行为，这是抑郁症和外部性造成的，这些行为最严重，这是成本上的常备和固定式的待命/ INCCRATIONS/ INCCAR/ INSCAR的; 2）抑郁症和自杀事件，后者可能需要昂贵的急诊就诊和住院的精神病患者。综合CBT-I和SC状况都将由社区心理健康诊所的许可心理健康顾问提供，该诊所使用密集的门诊计划模型来治疗患有AUD和心理健康疾病的青少年，而这些疾病和精神健康疾病均未通过先前的门诊治疗失败并需要更深入的服务。处于CBT-I状况的临床医生将接受每周的监督，重点是使用CBT-I方案。 SC中的临床医生将得到标准的诊所监督，本质上更折衷，与典型的社区护理一致。结果数据将在治疗后一年收集。成功完成项目目标可能会改变服务方式的方式。它的临床意义在于TS解决该领域的关键障碍：如何治疗MDD/AUD青少年。公共卫生相关性：既有酒精使用障碍和精神疾病的青少年通常都会影响其功能的多个方面的重大损害。改进的治疗这些人的方法有可能降低与两种情况相关的发病率。该问题的相关性反映在健康人2020目标MHMD HP 2020-14中，上面写着：“增加同时发生药物滥用和精神障碍的人的比例，这些人接受两种疾病的治疗。”