Adolescent Substance Abuse: Progressive Treatment

青少年药物滥用：渐进治疗

• 批准号: 7630471
• 负责人: Holly Barrett Waldron
• 金额: $ 63.95万
• 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: 2007-08-15 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7630471
• 关键词: Abstinence; Accounting; Address; Adherence; Adolescent; Adopted; Aftercare; Alcohol or Other Drugs use; Algorithms; Attention; Back; Biological Assay; Caring; Classification; Clinical; Clinical Trials; Clinical Trials Design; Coping Behavior; Cost Allocation; Decision Making; Dependence; Development; Dose; Drug usage; Early treatment; Effectiveness; Empirical Research; Ensure; Evaluation; Experimental Designs; Family; Family Relationship; Family psychotherapy; Foundations; Frequencies; Goals; Guidelines; Health Services Research; Heterogeneity; Individual; Individual Differences; Intervention; Investigation; Judgment; Link; Literature; Maintenance; Measurement; Mediating; Methods; Modeling; Motivation; Movement; Outcome; Participant; Patient Self-Report; Play; Problem behavior; Process; Protocols documentation; Provider; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Relapse; Relative (related person); Research; Research Priority; Research Project Summaries; Resources; Risk; Role; Sampling; Series; Services; Staging; Substance Use Disorder; Substance abuse problem; Testing; Time; Toxicology; Treatment Effectiveness; Treatment Efficacy; Treatment Protocols; Treatment outcome; Urine; Youth; adolescent substance abuse; adolescent substance use; base; clinical practice; clinically significant; cognitive behavior therapy; depression; design; dosage; efficacy research; efficacy testing; follow up assessment; group intervention; meetings; motivational enhancement therapy; peer; pilot trial; programs; rehearsal; research and development; response; skills; standard care; success; treatment effect; treatment response; treatment strategy

DESCRIPTION (provided by applicant): Project Summary: Research on efficacious adolescent substance abuse interventions over the past two decades has consistently demonstrated heterogeneity of response to treatment. Key challenges for the .field include understanding these various response trajectories and establishing strategies to adapt treatments to enhance their effectiveness for those who are not responsive to standard interventions. Such research is critically needed to inform treatment services providers on optimal care strategies. An important advance in treatment services research efforts is the increasing movement away from a "one-size-fits-all" perspective inherent in standardized interventions and a call for the development of adaptive interventions that incorporate treatment algorithms to aid clinical decision-making. The Sequential Multiple Assignment Randomized Trial (SMART) outlines a process whereby a series of randomizations within an individual study is used to create an optimal adaptive intervention. We propose two studies to examine the efficacy of eight potential adaptive treatment strategies using the SMART design. Study 1 goals are twofold (1) to examine which of two distinct sets of criteria for defining early treatment response (abstinence vs. minimal use) is the best guide for subsequent treatment decisions, i.e., how best to determine when response to a minimal treatment intervention is "good enough" for an adolescent to step out of treatment without risking a significant relapse. (2) to determine which of two stepped adaptive interventions result in better outcomes for treatment non-responders and relapsers: an enhanced version of the same treatment or a new treatment? Participants (n=80) will receive an initial dose of treatment consisting of MET/CBT8. At completion, participants will be randomly assigned, in sequential steps, to one of two treatment response criteria and, if needed, one of two stepped interventions. Pre- to post-treatment outcomes will be examined using the SMART protocol framework to identify the specific clinical components comprising the optimal adaptive treatment strategy in response to a particular treatment outcome. Study 2 is a pilot (n=60) test of the efficacy of the optimal adaptive strategy identified in Study 1 vs. a standard MET/CBT 12 group intervention, with follow up assessments at 3 and 6 months post-treatment. Relevance: This research will provide a systematic set of optimal decision rules for treatment agencies on how best to proceed when adolescents receiving an initial course of MET/CBT8 show initial treatment response, persist in their substance use, or demonstrate an initial treatment response followed by later relapse. This type of "practical" clinical trial begins the long overdue process of addressing critical gaps between traditional treatment efficacy research and key questions that emerge in clinical practice such as determining when adolescents have received sufficient treatment, how to proceed when initial treatment efforts are not effective, and how best to address relapse. Mechanisms of change will also be examined in Study 2.

描述（由申请人提供）： 项目摘要：过去二十年对有效的青少年药物滥用干预措施的研究一致证明了治疗反应的异质性。该领域的主要挑战包括了解这些不同的反应轨迹，并制定调整治疗的策略，以提高对标准干预措施无反应的人的有效性。迫切需要此类研究来告知治疗服务提供者最佳护理策略。治疗服务研究工作的一个重要进展是，越来越多地摆脱标准化干预措施固有的“一刀切”观点，并呼吁开发结合治疗算法来辅助临床决策的适应性干预措施。序贯多重分配随机试验 (SMART) 概述了一个过程，通过该过程，在单个研究中使用一系列随机化来创建最佳的适应性干预。我们提出了两项​​研究来检验使用 SMART 设计的八种潜在适应性治疗策略的功效。研究 1 的目标是双重的 (1) 检查用于定义早期治疗反应（戒断与最小限度使用）的两组不同标准中的哪一组是后续治疗决策的最佳指南，即如何最好地确定何时对最小治疗产生反应干预对于青少年来说“足够好”，可以停止治疗，而不会面临严重复发的风险。 (2) 确定两种阶梯式适应性干预措施中的哪一种能够为治疗无反应者和复发者带来更好的结果：相同治疗的增强版本还是新治疗？参与者 (n=80) 将接受由 MET/CBT8 组成的初始治疗剂量。完成后，参与者将按顺序随机分配至两种治疗反应标准之一，如果需要，则分配至两种分步干预措施之一。将使用 SMART 协议框架检查治疗前和治疗后的结果，以确定特定的临床组成部分，包括针对特定治疗结果的最佳适应性治疗策略。研究 2 是对研究 1 中确定的最佳适应策略与标准 MET/CBT 12 小组干预的有效性进行的试点 (n=60) 测试，并在治疗后 3 个月和 6 个月进行后续评估。相关性：这项研究将为治疗机构提供一套系统的最佳决策规则，说明当接受 MET/CBT8 初始疗程的青少年表现出初始治疗反应、坚持其物质使用或表现出初始治疗反应，然后再进行治疗时，如何最好地进行治疗后来复发。这种类型的“实用”临床试验开始了早就该进行的过程，旨在解决传统治疗功效研究与临床实践中出现的关键问题之间的关键差距，例如确定青少年何时接受了足够的治疗，当初始治疗努力无效时如何继续进行，以及如何最好地解决复发问题。研究 2 还将探讨变化机制。