Stage II Research on Outpatient Treatment for Adolescents with Comorbidity

青少年合并症门诊治疗的第二阶段研究

• 批准号: 8082620
• 负责人: ASHLI J SHEIDOW
• 金额: $ 61.02万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8082620
• 关键词: Action Research; Address; Adherence; Adolescent; Alcohol or Other Drugs use; Anxiety; Back; Behavior; Behavior Therapy; Behavioral; Build-it; Caregivers; Clinical; Clinical Trials; Cognitive; Communities; Comorbidity; Consumer Satisfaction; Control Groups; Data; Data Collection; Diagnostic; Disease; Drug usage; Evaluation; Exhibits; Family; Family psychotherapy; Funding; Individual; Intervention; Lead; Manuals; Measures; Mediating; Mental Depression; Mental Health; Modeling; Moods; National Institute of Drug Abuse; Outcome; Outpatients; Parenting behavior; Patient Self-Report; Placebos; Preclinical Drug Evaluation; Principal Investigator; Protocols documentation; Psychiatric Diagnosis; Randomized; Randomized Clinical Trials; Relative (related person); Reporting; Research; Research Personnel; Schools; Services; Social Adjustment; Societies; Staging; Symptoms; System; Techniques; Testing; Therapeutic; TimeLine; Training; Treatment Efficacy; Treatment outcome; Urine; Youth; adolescent substance abuse; base; community based treatment; control trial; cost; depressive symptoms; design; deviant; dual diagnosis; experience; follow-up; improved; indexing; peer; pilot trial; programs; psychosocial; public health relevance; quality assurance; satisfaction; therapy development; treatment planning

DESCRIPTION (provided by applicant): Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual diagnosis are more than twice as costly to treat compared to those with no comorbidity. Community-based treatment for these youth most often is disjointed, with youth and families having to navigate separate treatment systems for the disorders or only receiving treatment for a single disorder. Notably, multiple studies have shown that youth with co-occurring problems have worse outcomes and return to pre-treatment levels of substance use more often and more rapidly than those without a psychiatric diagnosis. The applicant principal investigator, a new investigator, recently completed a NIDA-funded Stage I project focused on developing and piloting a psychosocial treatment specifically for youth presenting for outpatient treatment with co-occurring substance use and internalizing (i.e., mood and/or anxiety) problems. Results were promising with the experimental group exhibiting significantly less substance use and more rapid reductions in anxiety and depressive symptoms compared to the control group. In addition, extensive treatment and therapist training manuals were generated. The proposed research is a Stage II randomized clinical trial (RCT) to compare the experimental treatment (OutPatient Treatment for Adolescents; OPT-A) to an "active placebo" on key clinical indices from pre-treatment through 18 months. The proposed RCT (n = 160) employs the treatment manual, quality assurance protocol, and therapist training protocol developed and successfully piloted in the Stage I study, to evaluate the efficacy of OPT-A for youth referred to outpatient treatment of co- occurring substance use and internalizing problems. The following outcomes will be evaluated: drug use; mental health; behavioral, school, peer, and family functioning; and consumer satisfaction. In addition to providing a strong test of treatment efficacy, the proposed project will leverage the data collection of the RCT to provide a preliminary evaluation of putative mechanisms of action. In summary, this study will advance a promising treatment developed through the Stage I behavioral therapies development program to a Stage II controlled trial. It builds on the treatment manual, therapist training materials, and quality assurance system already developed. The intervention addresses one of the more prevalent and most challenging, costly, and understudied presenting problems among adolescent outpatients. If successful, this research could provide a considerable contribution in the treatment field for youth with co-occurring substance use and internalizing disorders. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual diagnosis have worse outcomes and are more than twice as costly to treat than their counterparts with no comorbidity. This project evaluates OPT-A, a treatment that had promising results in NIDA-funded pilot testing, in a rigorous clinical trial.

描述（由申请人提供）：青少年滥用药物滥用会导致年轻人，家庭，社区和社会的显着负面结果和非凡的成本。此外，与没有合并症的年轻人相比，滥用青少年的物质的精神病率从25％到82％的滥用率从25％到82％不等，而双重诊断的年轻人则是昂贵的两倍以上。最常对这些年轻人的社区治疗是脱节的，青年和家庭不得不为疾病提供单独的治疗系统，或者仅接受单个疾病的治疗。值得注意的是，多项研究表明，与没有精神病诊断的患者相比，患有同时发生问题的青年的预后较差，并且更频繁，更快地恢复了药物使用的预处理水平。申请人首席研究员是一名新研究人员，最近完成了一项由NIDA资助的I阶段项目，重点旨在开发和试行一种专门针对青年人的社会心理治疗，用于与同时发生的药物使用和内在化（即情绪和/或焦虑）的问题。与对照组相比，实验组表现出明显较少的物质使用和焦虑和抑郁症状的快速减少，结果有望得到明显降低。此外，还生成了广泛的治疗和治疗师培训手册。拟议的研究是一项II期随机临床试验（RCT），以比较实验治疗（青少年的门诊治疗； OPT-A）与从预处理到18个月的关键临床指数上的“活跃安慰剂”。拟议的RCT（n = 160）采用了治疗手册，质量保证方案以及在我研究的阶段开发并成功试行的治疗师培训方案，以评估Opt-A对青年的疗效，指的是对同事治疗的现场药物使用和内化问题的门诊治疗。将评估以下结果：吸毒；心理健康；行为，学校，同伴和家庭功能；和消费者满意度。除了提供对治疗疗效的强有力测试外，该提议的项目还将利用RCT的数据收集来提供对假定作用机制的初步评估。总而言之，这项研究将推进通过I阶段行为疗法开发计划开发出的有希望的治疗方法，以进行II期对照试验。它建立在治疗手册，治疗师培训材料和质量保证系统的基础上。该干预措施解决了青少年门诊患者中更为普遍，最具挑战性，昂贵且研究的提出问题之一。如果成功的话，这项研究可以为治疗领域提供相当大的贡献，这些贡献与同时发生的药物使用和内在疾病。 公共卫生相关性：青少年滥用药物滥用导致年轻人，家庭，社区和社会的显着负面结果和非凡的成本。此外，滥用青年的物质的精神病合并症率从25％到82％不等，并且具有双重诊断的年轻人的预后较差，并且比没有合并症的同龄人的治疗成本是两倍以上。该项目评估了一项严格的临床试验，该项目评估了OPT-A，该治疗方法在NIDA资助的试点测试中具有有希望的结果。