Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity

药物使用治疗结果：精神共病的影响

• 批准号: 10634124
• 负责人: Rosa M. Crum
• 金额: $ 36.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634124
• 关键词: Abstinence; Address; Anxiety Disorders; Behavior Therapy; Caring; Characteristics; Clinical; Clinical Trials; Cocaine; Communities; Criminal Justice; Data; Disease; Drug usage; Effectiveness; Exclusion; Family; Future; General Population; Health; Health Services; Heterogeneity; Individual; Investments; Legal; Measures; Medical; Mental Health Services; Mental disorders; Meta-Analysis; Metadata; Methamphetamine; Methodology; Methods; Modeling; Modernization; Mood Disorders; National Institute of Drug Abuse; Observational Study; Occupational; Outcome; Outcome Measure; Participant; Patient Care; Patient Self-Report; Patients; Pharmaceutical Preparations; Placebos; Psychiatric Diagnosis; Psychiatric therapeutic procedure; Randomized, Controlled Trials; Research; Sample Size; Sampling; Scoring Method; Services; Site; Social Justice; Social outcome; Standardization; Stimulant; Substance Use Disorder; Target Populations; Techniques; Toxicology; Treatment outcome; Urine; Variant; Weight; Work; analytical method; comorbidity; data harmonization; experience; improved; multidisciplinary; optimal treatments; pharmacologic; psychiatric comorbidity; psychological distress; psychosocial; reduced substance use; screening; severe mental illness; social; sociodemographics; substance use treatment; treatment adherence; treatment arm; treatment as usual; treatment effect; treatment program; trial design

Project Summary Many individuals with substance use disorders (SUDs) also experience significant psychological distress or meet the criteria for common mood and anxiety disorders with potentially significant implications for SUD outcomes and SUD treatment effects. Examining these implications is important for identifying optimal treatments for patients with comorbid conditions. Past research on the impact of such comorbidities has produced mixed results, mainly due to small sample sizes or reliance on observational studies. In this proposal, a large-scale study of the impact of 1) mood and anxiety disorder as well as 2) psychological distress comorbidity on SUD outcomes and SUD treatment effects is proposed using data from over 5,000 patients from 20 randomized controlled trials (RCTs) of pharmacological and psychosocial treatments of SUDs sponsored by the National Institute on Drug Abuse. Our aims include the use of modern individual participant meta-analytic methods to combine the individual level data and to examine whether and to what extent SUD outcomes and SUD treatment effects vary among patients with and without comorbidity. Outcomes will include retention in treatment to the end of the trial, continued use of drugs ascertained by urine toxicology and self- report, and social outcomes (including occupational outcomes and criminal justice involvement). In Aim 1, data from RCTs will be combined to examine the impact of psychiatric comorbidity (i.e., mood and anxiety disorders as well as psychological distress, jointly and separately) on the SUD outcomes, irrespective of treatment arm, using mixed effect regression models. The RCT samples will be balanced with regards to socio-demographic and clinical factors that may vary across studies using propensity score methods. Aim 2 will use a similar methodology to examine the moderating effect of comorbidity on SUD treatment effects by examining interaction terms of SUD treatment by comorbidity in mixed regression models. In Aim 3, we will examine whether concomitant medication treatment of mood and anxiety disorders will change the impact of these disorders on the SUD outcomes and SUD treatment effects. In Aim 4, we will reweight the RCT samples to resemble target samples of individuals with SUDs receiving treatment in the general population to address exclusion (and possible under-representation) of patients with severe psychiatric conditions from SUD RCTs. The results from reweighted samples will be compared with the results of the original unweighted samples. The project significantly advances research on the impact of these comorbidities on SUD outcomes and SUD treatment effects using individual participant data from an unprecedentedly large group of rigorously conducted trials that have used a core set of standardized assessments and consistent outcome measures.

项目概要 许多患有药物滥用障碍 (SUD) 的人也会经历严重的心理困扰或 满足常见情绪和焦虑障碍的标准，对 SUD 具有潜在的重大影响 结果和 SUD 治疗效果。检查这些影响对于确定最佳方案很重要 对患有合并症的患者进行治疗。过去对此类合并症影响的研究 产生的结果好坏参半，主要是由于样本量小或依赖观察性研究。在这个 提案，一项针对 1) 情绪和焦虑障碍以及 2) 心理困扰影响的大规模研究 使用超过 5,000 名患者的数据提出了 SUD 结果和 SUD 治疗效果的合并症 来自 20 项 SUD 药理学和心理社会治疗的随机对照试验 (RCT) 由国家药物滥用研究所赞助。我们的目标包括利用现代个人参与者 荟萃分析方法结合个体水平数据并检查是否以及在何种程度上进行SUD 有或没有合并症的患者的结局和 SUD 治疗效果有所不同。结果将包括 保留治疗至试验结束，继续使用通过尿液毒理学和自我检查确定的药物 报告和社会成果（包括职业成果和刑事司法参与）。在目标 1 中，数据 来自随机对照试验的结果将被结合起来，以检查精神共病（即情绪和焦虑障碍）的影响 以及心理困扰（共同或单独）对 SUD 结果的影响，无论治疗组如何， 使用混合效应回归模型。 RCT 样本将在社会人口统计学方面进行平衡 以及使用倾向评分方法进行的研究中可能有所不同的临床因素。目标 2 将使用类似的 通过检查合并症对 SUD 治疗效果的调节作用的方法 混合回归模型中合并症对 SUD 治疗的相互作用项。在目标 3 中，我们将检查 情绪和焦虑症的联合药物治疗是否会改变这些疾病的影响 疾病对 SUD 结果和 SUD 治疗效果的影响。在目标 4 中，我们将重新加权 RCT 样本 类似于一般人群中接受治疗的 SUD 个体的目标样本，以解决 SUD RCT 中排除（并且可能代表性不足）患有严重精神疾病的患者。 重新加权样本的结果将与原始未加权样本的结果进行比较。这 项目显着推进了这些合并症对 SUD 结果和 SUD 影响的研究 使用来自前所未有的大量严格执行的个体参与者数据的治疗效果 使用一套核心标准化评估和一致结果衡量标准的试验。