Improving Treatment Engagement in Individuals with Co-occurring Substance Use and Psychosis: A Telemedicine Family-Based Approach

摘要治疗投入是首发精神病(FEP)患者的一个重要问题。 同时存在物质使用障碍是治疗依从性低和 治疗中断，超过50%的FEP患者有终生物质使用障碍史。尽管 对于有药物使用和FEP的个人来说，综合治疗是可用的，如果客户 没有从事治疗。同时使用药物和FEP的客户在以下方面的减少有限 物质使用，因为20%的人成功地进行了推荐的物质使用治疗。这些结果要求我们 为这一弱势群体增加药物使用障碍治疗参与度的新战略。 社区强化方法和家庭培训(CREAT)是一种循证治疗方法， 显著增加对跨诊断物质使用障碍的治疗参与度。工艺 承认有物质使用障碍的人可能还没有准备好改变他们的物质使用，以及 它利用家庭成员作为变革推动者的动机。调整工艺以适应共同发生的 物质使用障碍和FEP人群有可能通过增加客户的 物质使用、治疗参与和减少其使用。因为高涨的家庭痛苦与 物质使用和精神病，减少家庭痛苦可能是手艺的一个潜在机制 改善这一人群的治疗参与度。许多FEP患者与家人有频繁的联系， 但时间、交通、资金和育儿都是家庭成员获得额外服务的障碍。 利用远程医疗(视频会议)可以减轻这些障碍，这些工具可以实现类似的治疗 面对面心理治疗的结果。为了扩大我在横截面物质使用方面的背景 精神障碍研究到心理社会治疗研究，我建议1)发展和完善一门手艺 通过远程医疗(CRECURE-FT)和面对面(CRECURE-F)提供FEP的协议，以及2)进行试点 随机对照试验在慢性阻塞性肺疾病患者家庭成员中测试CREATE-FT的初步疗效 物质使用障碍和FEP与常规治疗(TAU)和CRICATE-F的比较。确定变化 在治疗投入、物质使用和家庭痛苦方面，将为较大的R01提供效应大小估计 学习和高级培训。我的导师团队(DostÖngür博士、Roger Weiss博士、Kim Mueser博士、Robert博士 迈耶斯、珍妮特·沃兹尼亚克和吉姆·哈德森)将提供全面指导，以弥补我的培训空白：1) 治疗发展，2)远程医疗，3)临床干预研究，4)先进的统计方法，以及 5)职业发展(科学交流/领导力)，因为我成为一名独立的调查员。通过 实现我的K23研究和培训目标，我将获得必要的专业知识，以实现我的长期职业目标 在确定治疗预测因素的同时，开发和实施新的可获得的干预措施 同时患有药物使用和精神障碍的人及其家人的结局。

ABSTRACT Treatment engagement is a significant concern for individuals with first episode psychosis (FEP). Having a co-occurring substance use disorder is a primary predictor of low treatment adherence and risk for treatment dropout, and over 50% of people with FEP have a lifetime history of substance use disorder. Though integrated treatments are available for individuals with substance use and FEP, they cannot be effective if clients are not engaged in treatment. Clients with co-occurring substance use and FEP have limited reductions in their substance use, as <20% successfully engage in recommended substance use treatment. These results call for novel strategies that increase substance use disorder treatment engagement for this vulnerable population. Community Reinforcement Approach and Family Training (CRAFT) is an evidence-based treatment that significantly increases treatment engagement for transdiagnostic substance use disorders. CRAFT acknowledges that people with substance use disorders may not be ready to change their substance use, and it capitalizes on the motivation of family members as agents of change. Adapting CRAFT to a co-occurring substance use disorder and FEP population has the potential to make a significant impact by increasing clients’ substance use treatment engagement and reducing their use. Since elevated family distress is associated with both substance use and psychosis, reducing family distress may be a potential mechanism by which CRAFT improves treatment engagement for this population. Many individuals with FEP have frequent contact with family, but time, transportation, finances, and childcare are barriers to family members accessing additional services. Utilizing telemedicine (video conferencing) mitigates these barriers, and such tools can achieve similar treatment outcomes to in-person psychotherapy. To expand my background in cross-sectional substance use and psychotic disorders research to psychosocial treatment research, I propose to 1) develop and refine a CRAFT protocol for FEP delivered via telemedicine (CRAFT-FT) and in-person (CRAFT-F), and 2) conduct a pilot randomized controlled trial to test preliminary efficacy of CRAFT-FT with family members of people with substance use disorders and FEP compared to treatment as usual (TAU) and CRAFT-F. Determining changes in treatment engagement, substance use, and family distress will provide effect size estimation for larger R01 studies and advanced training. My mentorship team (Drs. Dost Öngür, Roger Weiss, Kim Mueser, Robert Meyers, Janet Wozniak, and Jim Hudson) will provide comprehensive guidance to address my training gaps: 1) treatment development, 2) telemedicine, 3) clinical intervention research, 4) advanced statistical methods, and 5) professional development (scientific communication/leadership) as I become an independent investigator. By achieving my K23 research and training aims, I will gain the necessary expertise for my long-term career goal of developing and implementing novel and accessible interventions while identifying predictors of treatment outcomes for people with co-occurring substance use and psychiatric disorders and their families.