A comprehensive intervention to treat emerging drug-using populations

2.1简介：鉴于药物使用可能改变大脑发育，儿童是一个重要的研究人群。物质使用障碍是一种儿科疾病，儿童应该得到与青少年和成年人同样的关注。该项目将前瞻性地检查从接受药物治疗的儿童收集的去识别数据，以告知提供者如何在美国治疗儿童。2011年，美国国务院国际麻醉品和执法事务局（INL）支持联合国毒品和犯罪问题办公室（UNODC）制定和实施了一项干预措施，重点是减少药物使用和改善儿童的结果。PI Hendree Jones博士制定了治疗儿童（4-17岁）药物使用的方案。700多名儿童接受了早期版本的停止使用麻醉品：儿童干预促进发展（SUN CHild）干预的结果表明，从基线到治疗后评估，儿童表现出一致的显著（所有ps<.001）下降模式，在精神障碍、焦虑相关情绪障碍、社会问题和生活质量的提高方面，随访中保持了增长。设计：nida支持的部分研究将在美国接收和分析一项平行、两组、随机对照试验的去识别数据，该试验中，使用物质（大麻、溶剂或阿片类药物作为主要使用药物）的7-12岁儿童进入住院治疗，随机接受SUN CHILD干预（n=272: 204名男孩和68名女孩）或常规护理（n=272: 68）。204名男孩和68名女孩)，分配治疗的男女比例为3:1，代表了这一人群中药物使用的大致流行程度。结果评估工具将在基线、治疗后以及治疗后1、3、6和12个月的随访中使用。直接比较干预条件将开始回答有关减少大麻、溶剂和阿片类药物使用以及其他物质使用和改善儿童福祉的功效的关键问题。目的：主要目的是确定SUN儿童状况相对于常规护理状况的程度，显示出两个主要结果，(a)较长的平均治疗持续时间，(b)在治疗后和治疗后1、3、6和12个月随访期间平均精神活性物质使用的更大减少；对于六个次要结果，(c)艾滋病毒风险行为、(d)精神障碍、(e)焦虑相关情绪障碍、(f)社会问题、(g)创伤后应激症状的平均减少幅度更大，(h)治疗后和治疗后1个月、3个月、6个月和12个月随访期间的生活质量平均增加幅度更大。辅助目的包括了解SUN CHILD对(1)女孩和男孩的不同疗效程度，(2)年幼的儿童与年龄较大的儿童，以及(3)检查SUN CHILD对大麻，溶剂或阿片类药物为主要药物选择的儿童的相对疗效。目的：近端：根据上述结果确定SUN CHILD干预的有效性。远端：开发一种有效的干预措施，以阻止儿童的物质使用。

2.1 Introduction: Children are a critical population to study given the potential for changed brain development due to substance use. Substance use disorders are a pediatric disease and children deserve the same attention as adolescents and adults. This project will examine prospectively collected de-identified data from children receiving drug treatment to inform providers how children can be treated in the USA. In 2011, the Bureau of International Narcotics and Law Enforcement Affairs (INL) of the US Department of State supported the United Nations Office on Drugs and Crime (UNODC) in the development and implementation of an intervention focused on reducing substance use and improving outcomes for children. Dr. Hendree Jones, PI developed the protocols to treat substance use in children (ages 4-17). Results from the 700+ children treated with this early version of our Stopping Use of Narcotics: CHild Intervention to Lift Development (SUN CHILD) intervention indicated that children showed a consistent pattern of significant (all ps<.001) decreases from baseline to post-treatment assessment, with gains maintaining at follow-up in psychiatric disturbance, anxiety-related emotional disorders, social problems, and increases in quality of life. Design: The NIDA-supported part of this study will be to receive and analyze in the USA, the de-identified data from a parallel, two-group, randomized controlled trial in which substance-using (cannabis, solvents, or opioids as the primary drug of use) children 7-12 years of age entering residential treatment randomized to receive either the SUN CHILD intervention (n=272: 204 boys and 68 girls), or usual care (n=272: 204 boys and 68 girls), with the 3:1 male:female ratio of assignment to treatment representing the approximate prevalence of substance use in this population. Outcome assessment instruments will be administered at baseline, post-treatment, and 1-, 3-, 6-, and 12-month post-treatment follow-up. Directly comparing intervention conditions will begin to answer critical questions about the efficacy of reducing cannabis, solvent, and opioid use as well as other substance use and improving the well-being of children. Aims: The main aim is to determine the extent to which the SUN CHILD condition, relative to the usual care condition, shows for the two primary outcomes, (a) longer mean duration of treatment, and (b) greater reductions in mean use of psychoactive substances over the course of post-treatment and 1-, 3-, 6-, and 12-months post-treatment follow-up; and, for the six secondary outcomes, greater reductions in mean (c) HIV risk behaviors, (d) psychiatric disturbance, (e) anxiety-related emotional disorders, (f) social problems, (g) post-traumatic stress symptoms, and larger increases in mean (h) quality of life at post-treatment and 1-, 3-, 6-, and 12-months post-treatment follow-up. The ancillary aim includes understanding the extent to which SUN CHILD is differentially efficacious for (1) girls and boys, (2) younger children v. older children, and (3) examining the relative efficacy of SUN CHILD in children for whom cannabis, solvents, or opioids is the primary drug of choice. Goals: Proximal: To determine the efficacy of the SUN CHILD intervention in terms of the above noted outcomes. Distal: To develop an efficacious intervention to stop substance use among children.