Integrating Combined Therapies for Persons with Co-occurring Disorders

对患有并发疾病的人进行综合治疗

基本信息

批准号：
9415334
负责人：
Mark P McGovern
金额：
$ 17.31万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-01-30 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9415334
关键词：
Integrating Combined Therapies Persons Co

项目摘要

DESCRIPTION (provided by applicant): Persons with alcohol use disorders are three times more likely to have a co-occurring psychiatric disorder than those without alcohol use diagnoses. Co-occurring alcohol and psychiatric disorders are highly prevalent in clinical settings and, relative to those with a single disorder alone, these patients have more challenging treatment and recovery experiences. Integrated treatments result in more favorable outcomes, yet these services are not widely available. This is a revised R21 application, "Integrating combined therapies for persons with co-occurring disorders." We propose to evaluate an integrated adaptation of the Combined Behavioral Intervention (CBI) from NIAAA Project COMBINE. CBI features three evidence-based behavioral therapies: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT) and Twelve Step Facilitation Therapy (TSF). We adapted CBI into a novel manual-guided intervention for co-occurring psychiatric and substance-related problems. Integrating Combined Therapies (ICT) is an individual-format treatment designed to be transferable to routine care settings and for delivery by the existing workforce. A small pilot study supported the clinical promise of ICT as well as its safety and practicality. In the research now proposed, we will randomly assign 76 eligible patients in community outpatient addiction treatment to ICT adapted standard care versus standard care only. Primary outcomes will be assessed at baseline, 3-, and 6- month follow-up periods. We hypothesize that ICT adapted standard care will demonstrate improved alcohol, drug and psychiatric outcomes, and that ICT participants will have better retention in treatment services. As found in our preliminary research, we also expect typical program counselors to be able to deliver ICT with satisfactory adherence and competence. The gap between the discovery and routine delivery of evidence-based treatments for alcohol use disorders is substantial. This problem is compounded when one considers the disparity in public access to efficacious integrated services for persons with co-occurring substance use and psychiatric disorders. The present research stands to address this issue, by rigorously evaluating a promising and community- friendly option for a broad spectrum psychosocial therapy. If found to be effective in this trial, the next logical research steps would be further efficacy study of ICT in a larger randomized controlled trial, as well as in dismantling and fractional factorial designs. The overarching goal of this research is to contribute to better treatment and recovery outcomes for individuals with co-occurring disorders.

描述（由申请人提供）：患有酒精使用障碍的人同时患有精神疾病的可能性是没有酒精使用诊断的人的三倍。酒精和精神疾病同时发生在临床环境中非常普遍，相对于单独患有单一疾病的患者，这些患者的治疗和康复经历更具挑战性。综合治疗可以带来更有利的结果，但这些服务尚未广泛提供。这是修订后的 R21 申请，“对患有并发疾病的人进行综合治疗”。我们建议评估 NIAAA 项目 COMBINE 的联合行为干预 (CBI) 的综合适应。 CBI 具有三种循证行为疗法：动机增强疗法 (MET)、认知行为疗法 (CBT) 和十二步促进疗法 (TSF)。我们将 CBI 改编为一种新颖的手动引导干预措施，用于治疗同时发生的精神和物质相关问题。整合联合疗法 (ICT) 是一种个体化治疗方法，旨在可转移到常规护理环境中并由现有劳动力提供。一项小型试点研究支持了 ICT 的临床前景及其安全性和实用性。在现在提出的研究中，我们将随机分配 76 名符合条件的社区门诊成瘾治疗患者接受 ICT 适应的标准护理与仅标准护理。主要结局将在基线、3 个月和 6 个月的随访期进行评估。我们假设采用 ICT 的标准护理将改善酒精、药物和精神疾病的结果，并且 ICT 参与者将更好地保留治疗服务。正如我们的初步研究所示，我们还期望典型的项目顾问能够以令人满意的依从性和能力提供 ICT。针对酒精使用障碍的循证治疗的发现与常规实施之间存在巨大差距。当人们考虑到公众在为同时患有药物滥用和精神疾病的人提供有效的综合服务方面存在差异时，这一问题就变得更加复杂。目前的研究旨在通过严格评估一种有前途且对社区友好的广谱心理社会治疗选择来解决这个问题。如果在这项试验中发现有效，下一个合乎逻辑的研究步骤将是在更大的随机对照试验以及拆解和部分因子设计中进一步研究 ICT 的有效性。这项研究的总体目标是为患有并发疾病的个体提供更好的治疗和康复结果。