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

基本信息

批准号：
10653084
负责人：
CARLA KMETT DANIELSON
金额：
$ 73万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
依托单位国家：
美国
项目类别：
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

项目摘要

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.

童年期间，社会心理创伤事件，尤其是人际暴力经历在青少年和成年期间，强大而一致的物质使用问题（SUP）的预测指标。 PTSD 从此类IPV延伸的经常与SUP共同出现。尽管有一个完善的链接，但标准护理在过去的几十年中，有共同sup和PTSD的青少年是治疗这些问题分别地。这种隔间的治疗方法可在青少年和家庭上创造伯恩，并提高独特对心理健康和成瘾领域的临床医生面临的挑战，并可能导致SUP的高率患有同时发生PTSD的青少年的复发。为了解决这个问题，我们的团队最近完成了严格的NIDA资助的随机对照试验（RCT）支持综合，暴露的效率我们开发的基于治疗，通过家庭疗法（RRFT）降低风险，在更大的长期降低中与大型标准治疗相比青少年样本。拟议的RCT具有有效性 - 实施I型I型设计，实质上建立了在这项先前的研究中提出：1）评估RRFT是否可以降低SUP和 PTSD可以扩展到门诊药物使用治疗环境中的年轻人 - 年轻人为 SUP治疗以及临床医生通常对治疗PTSD的经验较少（AIM 1）； 2）评估成本 - RRFT和探索内部环境变量的有效性（例如，可接受的治疗可接受性，参与性，以及参与的青少年，照顾者，代理商领导者以及治疗师以及障碍实施的促进者）可能会影响潜水员实践环境中的RRFT实施（AIM 2）。拟议的有效性实施试验将招募具有IPV史的青少年（13-18岁）在丹佛的地点呈现用于门诊药物使用障碍治疗的SUP和PTSD符号科罗拉多州与NIDA的临床试验网络相关。参与者将被随机分配给RRFT或治疗照常。多方法，多响应方法将跟踪临床结果（SUP，PTSD和Putative 在基线后3、6和12个月的治疗靶标，例如情绪抑制）。减少科学对实践差距，作为探索性目的，我们将组建并与领导者咨询委员会合作来自科罗拉多州的部门（行为健康和科罗拉多州的刑事/少年司法办公室，致力于参与）和社区心理健康组织，认为海外政策和决策 - 为高风险青少年选择和实施心理社会治疗的目标大规模建筑能力（例如，全州范围）吸收了青少年SUP和PTSD的证据干扰 RRFT，赠款完成后。该提案直接与NIDA最近发布的NOT-DA-20-- 004，特别感兴趣的通知，鼓励对合并症使用的研究，物质使用障碍，和其他精神疾病。