Development of a Family-Based Treatment for Adolescent Methamphetamine Abuse

开发针对青少年甲基苯丙胺滥用的家庭治疗方法

• 批准号: 7643215
• 负责人: Holly Barrett Waldron
• 金额: $ 66.23万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7643215
• 关键词: Adherence; Adolescent; Adult; Affect; Amygdaloid structure; Anterior; Area; Behavior; Brain; Brain imaging; Characteristics; Chronic; Clinical; Clinical Trials; Cognitive; Decision Making; Dependence; Development; Drug usage; Effectiveness; Elements; Ensure; Epidemic; Family; Family Relationship; Family psychotherapy; Feedback; Foundations; Functional Magnetic Resonance Imaging; Goals; Holly; Imaging Techniques; Imaging technology; Impulsivity; Individual; Individual Differences; Intervention; Investigation; Laboratories; Lead; Link; Manuals; Measures; Mediating; Mediator of activation protein; Methamphetamine; Modeling; Nucleus Accumbens; Outcome; Participant; Pathway interactions; Play; Population; Procedures; Randomized; Relapse; Relative (related person); Research; Research Personnel; Rewards; Risk; Risk-Taking; Role; Sampling; Solid; Staging; Structure; Substance Use Disorder; System; Testing; Training; Treatment Effectiveness; Treatment Efficacy; Treatment Protocols; Treatment outcome; United States National Institutes of Health; United States Substance Abuse and Mental Health Services Administration; Youth; adolescent substance abuse; adolescent substance use; base; clinically significant; cognitive function; comparative; coping; depression; design; effective therapy; indexing; interdisciplinary approach; intervention effect; methamphetamine abuse; neural circuit; neuroimaging; neurotoxicity; non-drug; nondrug therapy; novel; peer; programs; psychologic; putamen; relating to nervous system; response; social neuroscience; therapy development; treatment adherence; treatment effect; treatment program; treatment response

DESCRIPTION (provided by applicant): Methamphetamine (meth) abuse in the U.S. has reached epidemic proportions, especially in the Western States and has been linked to a host of physical and psychological problems. Even more troubling, meth use during the adolescent period may interfere with normal brain development. These findings suggest that the endemic use of meth will require the development and testing of effective treatments aimed at adolescent abusers to forestall potentially deleterious outcomes. Moreover, combining clinical and neuroscientific approaches in an interdisciplinary model should lead to more prescriptive and efficacious treatments. In the current study, therefore, we merge the development of meth-specific interventions with a more detailed examination of how meth use affects neural systems and how alterations in specific brain areas influence treatment response. The proposed study represents a Stage IA/IB treatment development project, utilizing an interdisciplinary approach, consistent with the NIH Roadmap and designed to develop, refine, and pilot test a theoretically grounded intervention for adolescent meth abuse or dependence. The meth-specific intervention (AMT) will integrate family therapy with core elements of effective adult meth treatment programs, adapted to be developmentally appropriate for adolescents. This will be compared to a stand-alone family therapy intervention (FFT), an efficacious and effective treatment for adolescent substance use disorders. Further, in an effort to inform our treatment approach, a laboratory task will be developed to measure decision-making (i.e., risk-taking and impulsivity) and combined with functional brain imaging procedures (fMRI) to assess the effect of meth and other drug use on the neural circuits underlying these cognitive functions. Our Stage 1A research aim is to develop and test the meth-specific manualized treatment protocol. As well, we will examine the validity of our fMRI procedures in assessing the function of reward-related pathways in the brain known to be affected by meth in a subset of 32 adolescents referred for meth treatment and 16 nondrug-using controls to determine if the brain structures underlying decision-making in the two groups differ significantly. Stage 1B aims following will pilot test the manualized AMT procedure to establish its feasibility and validate its discriminability from FFT, verify the acceptability of the treatment by examining rates of engagement and retention, determine significant clinical outcomes relative to FFT alone, and examine predicted mediators and moderators to determine the core mechanisms of treatment efficacy. fMRI measures will be viewed relative to informing treatment engagement and retention as well as both short-term and long-term treatment outcomes. Stage 1B research will involve 60 adolescent meth abusers randomly assigned to either AMT or FFT who will be assessed at pretreatment, and at 3- months and 6-months following treatment initiation. The ultimate purpose of the research is to evaluate the potential promise of the AMT intervention, as informed by fMRI technology, for further investigation in a formal Stage 2 clinical trial.

描述（由申请人提供）：在美国，甲基苯丙胺（冰毒）滥用已达到流行病的程度，特别是在西部各州，并与许多身体和心理问题有关。更令人不安的是，青少年时期使用冰毒可能会干扰正常的大脑发育。这些发现表明，冰毒的流行使用需要针对青少年滥用者开发和测试有效的治疗方法，以防止潜在的有害后果。此外，在跨学科模型中结合临床和神经科学方法应该会带来更规范和有效的治疗。因此，在当前的研究中，我们将甲基苯丙胺特异性干预措施的发展与对甲基苯丙胺使用如何影响神经系统以及特定大脑区域的变化如何影响治疗反应的更详细检查结合起来。拟议的研究代表了 IA/IB 阶段治疗开发项目，采用跨学科方法，与 NIH 路线图一致，旨在开发、完善和试点测试针对青少年冰毒滥用或依赖的理论干预措施。针对冰毒的干预措施（AMT）将把家庭治疗与有效的成人冰毒治疗计划的核心要素相结合，以适应青少年的发展。这将与独立的家庭治疗干预（FFT）进行比较，这是一种有效且有效的治疗青少年物质使用障碍的方法。此外，为了告知我们的治疗方法，将开发一项实验室任务来衡量决策（即冒险和冲动），并结合功能性脑成像程序（fMRI）来评估冰毒和其他药物的效果对这些认知功能背后的神经回路的使用。我们 1A 阶段的研究目标是开发和测试针对冰毒的手动治疗方案。此外，我们将检查我们的功能磁共振成像程序的有效性，以评估已知受冰毒影响的大脑中奖赏相关通路的功能，其中包括 32 名接受冰毒治疗的青少年和 16 名非吸毒对照者，以确定是否两组人决策时的大脑结构存在显着差异。 1B 阶段的目标是对手动 AMT 程序进行试点测试，以确定其可行性并验证其与 FFT 的区别，通过检查参与率和保留率来验证治疗的可接受性，确定相对于单独 FFT 的显着临床结果，并检查预测的调节因子和主持人确定治疗效果的核心机制。功能磁共振成像测量将被视为与告知治疗参与度和保留以及短期和长期治疗结果有关。 1B 阶段研究将涉及 60 名青少年冰毒滥用者，他们被随机分配到 AMT 或 FFT，他们将在治疗前以及治疗开始后 3 个月和 6 个月时接受评估。该研究的最终目的是评估由功能磁共振成像技术提供的 AMT 干预的潜在前景，以便在正式​​的二期临床试验中进行进一步研究。