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

基本信息

批准号：
7905074
负责人：
CARLOS BLANCO
金额：
$ 54.41万
依托单位：
NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-01 至 2013-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7905074
关键词：
AIDS prevention Abstinence Address Alcohol or Other Drugs use Algorithms Behavior Therapy Behavioral Caring Clinic Clinical Cognitive Cognitive Therapy Communities Comorbidity Complex Data Development Disease Disease remission Dropout Drug usage Failure Frequencies Future General Population Goals HIV Health Status Human Resources Illicit Drugs Individual Injection of therapeutic agent Intervention Intervention Studies Lead Maintenance Major Depressive Disorder Measures Mediator of activation protein Medical Mental Depression Mental Health Mental disorders Methods Modality Modeling Mood Disorders Moods Motivation Outcome Outpatients Patient Self-Report Patients Pharmaceutical Preparations Professional counselor Public Health Relapse Research Resources Risk Risk Behaviors Sampling Severities Staging Substance Use Disorder Substance abuse problem Symptoms Techniques Testing Texas Time Training Treatment outcome Validation Voice addiction base community based treatment cost depressive symptoms design effective intervention effective therapy evidence base improved innovation meetings methadone maintenance motivational enhancement therapy pleasure programs psychosocial therapy development treatment as usual treatment strategy

项目摘要

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.

抑郁症是物质使用障碍 (SUD) 患者中最常见的并发精神疾病。抑郁症与成瘾的严重程度和治疗结果不佳有关。之前治疗 SUD 患者重度抑郁症 (MDD) 的尝试至少受到以下三个限制之一的阻碍：1) 未能将 MDD 和 SUD 的治疗整合到一项干预措施中，导致未经治疗的情绪症状导致药物滥用，而物质使用有助于维持情绪症状； 2）使用单一治疗方式（例如单独药物治疗），也导致大多数患者的改善较小； 3）使用复杂的认知干预措施需要训练有素的人员，这会增加干预措施的成本并限制其未来的适用性。本申请的目标是开始解决这个问题。这一阶段 Ia 提案的重点是开发和初步测试分级护理模式，为 SUD 和 MDD 提供综合治疗。我们初步将这项干预措施称为药物使用合并症护理：基于证据的抑郁症阶梯式策略 (SUCCESS-D)，将通过以下方式克服先前的局限性： 1) 提供 SUD 和 MDD 的综合治疗； 2）使用行为和药物干预； 3) 制定由辅导员驱动的干预措施以提高可行性。提供综合治疗和使用补充治疗方法相结合应该会带来更好的情绪和物质使用结果，从而解决 SUD 治疗中尚未解决的主要需求。 SUCCESS-D 的第一级由咨询师提供，将整合动机访谈 (MI) 和行为激活技术，以减少药物使用、促进治疗保留并减少抑郁症状。在第二级，将实施药理学算法，即德克萨斯抑郁症药物算法（TMA-D），以治疗在 SUCCESS-D 第一步中未能缓解的个体的抑郁症状，同时认知行为治疗将提供给那些继续使用物质的人。希望这种综合干预措施将构成比目前现有方法更全面且可能更有效的治疗模式。这项研究将在大型美沙酮维持诊所和大型无毒项目中进行，其数据将有助于规划未来的干预研究，这些研究将使用阶梯式护理模式，为同时发生其他疾病的药物滥用患者提供适当的治疗策略疾病或更多样化的基于社区的治疗环境。