Integrated Treatment for Enhancing Growth in Recovery during Adolescence (InTEGRA)

促进青春期恢复生长的综合治疗 (InTEGRA)

• 批准号: 10680616
• 负责人: YIFRAH KAMINER
• 金额: $ 76.64万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-20 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680616
• 关键词: Abstinence; Achievement; Acute; Address; Administrator; Adolescence; Adolescent; Adoption; Adult; Age; Alcohol or Other Drugs use; Alcoholics Anonymous; Alcohols; Behavioral; Behavioral Mechanisms; Capital; Caring; Clinic; Clinical; Cognitive; Cognitive Therapy; Combined Modality Therapy; Communities; Complex; Development; Diagnosis; Disease; Disease remission; Drug Use Disorder; Elements; Environment; Funding; Growth; Health Care Costs; Hybrids; Impulsivity; Intervention; Intervention Studies; Investigation; Link; Manuals; Modeling; Morbidity - disease rate; Motivation; Narcotics Anonymous; Neurocognitive; Outcome; Persons; Pharmaceutical Preparations; Phase; Pilot Projects; Premature Mortality; Process; Provider; Public Health; Randomized; Recovery; Recovery Support; Resources; Risk; Sampling; Science; Self Efficacy; Severities; Site; Social Change; Social Network; Substance Use Disorder; System; Testing; Therapeutic; Time; United States National Institutes of Health; Work; Youth; base; behavior change; biobehavior; care episode; clinical research site; cohort; coping; cost effective; cost effective treatment; effective therapy; effectiveness/implementation design; effectiveness/implementation hybrid; efficacious treatment; efficacy testing; emerging adulthood; experience; follow-up; high risk; implementation barriers; implementation design; implementation facilitators; intervention effect; meetings; motivational enhancement therapy; novel; peer; programs; prolonged abstinence; recovery services; resilience; response; skills; social; support network

Project Summary/Abstract: Approximately 10% of adolescents are diagnosed with an alcohol or other drug (AOD) use disorder each year in the U.S. Such disorders increase risk of premature mortality and morbidity and confer negative effects on social and neurocognitive functioning, biobehavioral maturation, and the achievement of developmental milestones. Despite advances in intervention research for adolescent AOD,1-4 the science base, in general, has lagged sorely behind that of adults.5-7 Furthermore, few studies have tested effective treatment models that can sustain youth remission over time as adolescents navigate the high-risk period of emerging adulthood. While many different interventions for youth AOD disorders have been developed and tested producing similar results,1 absent is one that links youth to ubiquitous, freely available, community recovery resources, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Systematic clinical linkages to these 12-step community resources have the potential to extend and enhance formal interventions’ effects because they have been shown to mobilize the same kinds of therapeutic mechanisms mobilized by formal treatments (e.g., by enhancing motivation/self-efficacy, changing social networks),8, 9 but do so for free and over the long-term in the community.10, 11 The evidence in support of adult participation in these organizations has grown substantially with findings supporting clinic-based Twelve-Step Facilitation (TSF)12-17 interventions and community 12-step group participation12, 18, 19 in enhancing remission rates while reducing health costs.20-22 In more recent years, several naturalistic studies have examined the clinical and public health utility of systematically linking young people with these prevalent resources 23-31 showing long-term benefits from AA/NA8, 28, 30 and in reducing health care costs,31 similar to adults. While dozens of studies have tested adult TSF efficacy,17, 32, 33 until recently, none had tested youth TSF efficacy, despite 80% of youth programs using 12-step practices and linkage.28, 34 In the first NIH-funded study to develop and test a replicable, manualized, adolescent TSF, however, we found that youth randomly assigned to receive a novel combination treatment (Integrated Treatment for Enhancing Growth in Recovery during Adolescence [InTEGRA]) that incorporated key elements of TSF in addition to Motivational Enhancement Therapy/Cognitive-Behavioral Therapy (MET/CBT), showed moderate-large clinically meaningful advantages that grew across follow-ups when compared to youth receiving MET/CBT alone. They also attended two to three times as many 12-step meetings during treatment, with 12-step attendees showing significantly greater abstinence.35 Given initial efficacy and potential for widespread adoption and implementation,34, 36, 37 InTEGRA now needs to be tested in a larger sample, with additional emphases on how (i.e., mechanisms) and for whom (i.e., moderators) it works. Using a type I hybrid implementation-effectiveness design,38 this study proposes to: 1. Conduct an adequately powered (N=294) Phase II RCT to test InTEGRA efficacy relative to MET/CBT alone across two clinical sites. 2. Investigate mechanisms of behavior change (e.g., 12-step involvement; social networks, self-efficacy) through which InTEGRA confers benefit. 3. Explore moderators (e.g., age, psychiatric/AOD severity) of InTEGRA’s effects across a one- year follow-up. 4. Explore barriers and facilitators to the intervention’s widespread implementation.

项目摘要/摘要：大约 10% 的青少年被诊断患有酒精或其他药物 (AOD) 滥用 美国每年都会发生这种疾病。此类疾病会增加过早死亡和发病的风险，并带来负面影响 关于社会和神经认知功能、生物行为成熟以及发展里程碑的实现。 尽管青少年 AOD 干预研究取得了进展，1-4 总体而言，科学基础严重落后 5-7 此外，很少有研究测试过可以随着时间的推移维持青少年病情缓解的有效治疗模型，因为 青少年度过了成年初期的高风险期，而针对青少年 AOD 的干预措施有很多。 已经开发出一些疾病并进行了测试，产生了类似的结果，1 缺少一种将青少年与无处不在的、自由的疾病联系起来的疾病。 可用的社区康复资源，例如匿名戒酒协会 (AA) 或匿名戒毒协会 (NA)。 与这些 12 步骤社区资源的临床联系有可能扩大和增强正式干预措施的效果 因为它们已被证明可以调动与正式治疗相同的治疗机制（例如， 通过提高动机/自我效能、改变社交网络），8, 9 但这样做是免费的，而且是长期的 社区.10, 11 支持成年人参与这些组织的证据已大大增加 支持基于临床的十二步促进 (TSF)12-17 干预措施和社区 12 步小组参与12, 18, 19 提高缓解率，同时降低健康成本。20-22 近年来，一些自然主义研究已经检验了 系统地将年轻人与这些普遍资源联系起来的临床和公共卫生效用 23-31 显示 AA/NA8、28、30 以及降低医疗保健成本31 的长期益处与成人相似，而数十项研究表明。 测试了成人 TSF 功效，17, 32, 33 直到最近，还没有测试过青年 TSF 功效，尽管 80% 的青年计划使用 12 步实践和联系。28, 34 在第一项 NIH 资助的研究中，旨在开发和测试可复制的、手动的、青少年的 然而，TSF 发现，青少年被随机分配接受一种新颖的联合治疗（Integrated Treatment for 增强青春期恢复过程中的生长 [InTEGRA]），除 动机增强疗法/认知行为疗法（MET/CBT），临床表现中等至大 与单独接受 MET/CBT 的青少年相比，他们还参加了后续活动，从而获得了有意义的优势。 治疗期间参加 12 步会议的次数是原来的两到三倍，参加 12 步的与会者的表现明显更好 35 鉴于初步功效以及广泛采用和实施的潜力，34, 36, 37 InTEGRA 现在需​​要 在更大的样本中进行测试，并额外强调如何（即机制）以及为谁（即主持人） 使用 I 型混合实施-有效性设计，38 本研究建议： 1. 充分开展 有力的 (N=294) II 期 RCT 来测试 InTEGRA 相对于单独的 MET/CBT 在两个临床中心的疗效 2。 研究行为改变的机制（例如，12步参与；社交网络，自我效能），通过这些机制 InTEGRA 带来益处 3. 探索 InTEGRA 在某一方面的影响的调节因素（例如年龄、精神/AOD 严重程度）。 4. 探索干预措施广泛实施的障碍和促进因素。