Substance Use Comorbidity Care: Evidence-Based Stepped Strategies for Depression

药物使用合并症护理：基于证据的抑郁症阶梯策略

• 批准号: 7663663
• 负责人: CARLOS BLANCO
• 金额: $ 53.66万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7663663
• 关键词: AIDS prevention; Abstinence; Address; Alcohol or Other Drugs use; Algorithms; Behavior Therapy; Behavioral; Caring; Clinic; Clinical; Cognitive; Comorbidity; Complex; Data; Data Analyses; Development; Disease; Disease remission; Drug usage; Educational workshop; Failure; Focus Groups; Frequencies; Future; Goals; Grant; HIV; Health Status; Human Resources; Individual; Injection of therapeutic agent; Intervention; Intervention Studies; Investigation; Lead; Maintenance; Major Depressive Disorder; Manuals; Manuscripts; Measures; Mediator of activation protein; Mental Health; Mental disorders; Methods; Modality; Modeling; Moods; Motivation; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Preparation; Professional counselor; Research; Risk Behaviors; Severities; Staging; Substance Use Disorder; Substance abuse problem; Symptoms; Techniques; Testing; Texas; Training; Treatment outcome; Writing; addiction; base; cognitive behavior therapy; community based treatment; cost; depression; depressive symptoms; design; effective therapy; evidence base; improved; innovation; methadone maintenance; motivational enhancement therapy; pleasure; programs; psychosocial; therapy development; treatment strategy

Depression is the most common co-occurring psychiatric disorder in individuals with substance use disorders (SUD). Depression has been associated with both severity of addiction and poor treatment outcome. Previous attempts at treating major depressive disorder (MDD) in individuals with SUD have been hampered by at least one of three limitations: 1) Failure to integrate the treatment of MDD and SUD in one intervention, causing untreated mood symptoms to lead to substance use, while the substance use contributed to the maintenance of mood symptoms; 2) Use of single treatment modalities (e.g., medication alone), also leading to small improvement in most patients; and, 3) Use of complex cognitive interventions requiring highly trained personnel that increase the cost of the interventions and limit their future applicability. The goal of the present application is to start to address this problem. The focus of this Stage Ia proposal is the development and initial testing of a stepped-care model to provide integrated treatment for SUD and MDD. The intervention, which we preliminarily call Substance Use Comorbidity Care: Evidence-Based Stepped Strategies for Depression (SUCCESS-D) will overcome prior limitations by: 1) Providing integrated treatment of SUD and MDD; 2) Using behavioral and pharmacological interventions; and, 3) Creating an intervention that is counselor-driven to increase feasibility. The combination of provision of integrated treatment and use of complementary treatment approaches should lead to better mood and substance use outcomes, thus addressing a major unsolved need in the treatment of SUD. The first level of SUCCESS-D, delivered by counselors, will integrate motivational interviewing (MI) and behavioral activation techniques to decrease drug use, promote treatment retention, and reduce depressive symptoms. At the second level, a pharmacological algorithm, the Texas Medication Algorithm for Depression (TMA-D) will be implemented to treat the depressive symptoms of individuals who fail to achieve remission with the first step of SUCCESS-D, while cognitive-behavioral treatment will be offered to those who continue to use substances. It is hoped that this integrated intervention will constitute a more comprehensive and potentially more effective treatment model than currently existing approaches. Data from this study, which will be conducted in a large methadone maintenance clinic and a large drug-free program, will help plan future intervention studies that will use stepped-care models to provide appropriate treatment strategies for substance abuse patients with other co-occurring disorders or in more diverse community-based treatment settings.

抑郁症是药物使用障碍患者中最常见的同时发生精神疾病（SUD）。抑郁症与成瘾的严重程度和治疗结果不佳有关。先前在SUD患者中治疗重度抑郁症（MDD）的尝试受到了至少三个局限性的阻碍：1）未能在一项干预措施中整合MDD和SUD的治疗，从而导致未经处理的情绪症状导致药物使用，而该药物的使用有助于维持情绪症状； 2）使用单一治疗方式（例如，仅药物），大多数患者的改善也很小； 3）使用复杂的认知干预措施，需要训练有素的人员增加干预措施的成本并限制其未来的适用性。本应用程序的目的是开始解决此问题。 IA建议的重点是开发和初始测试，以提供SUD和MDD综合处理的阶梯护理模型。我们将干预措施（我们最初称为使用物质使用合并症护理：基于证据的抑郁策略（Success-D）将通过以下方面克服先前的局限性：1）提供SUD和MDD的综合处理； 2）使用行为和药理干预措施； 3）创建一种由辅导员驱动的干预措施，以提高可行性。提供综合治疗和互补治疗方法的使用的结合应导致更好的情绪和药物使用结果，从而解决SUD治疗的主要未解决需求。 辅导员提供的第一级成功-D将整合动机访谈（MI）和行为激活技术，以减少药物使用，促进治疗保留率并减少抑郁症状。在第二层，将实施一种药理学算法，德克萨斯抑郁症（TMA-D）的药物算法将用于治疗未在成功D的第一步中无法缓解的个体的抑郁症状，而认知 - 行为治疗将提供给继续使用物质的人。希望这种综合干预措施将构成比当前现有方法更全面且可能更有效的治疗模型。 这项研究的数据将在大型美沙酮维护诊所和大型无药物计划中进行，这将有助于计划未来的干预研究，这些研究将使用阶梯护理模型为患有其他共同发生的疾病或更多样化的社区治疗环境提供适当的治疗策略。