Increasing Treatment Adherence in Co-Occurring Disorders

描述：（申请人提供）： 此应用程序是一个“指导病人为导向的研究生涯 发展奖”（K23），以研究治疗依从性， 精神病和药物使用障碍（COD），指导下的布鲁斯J。 Rounsaville，医学博士理查德S。Schottenfeld，医学博士不遵守是一个关键的 COD的问题，特别是那些患有抑郁症的人， 常常限制了有效治疗所获得的最大益处， 特别是具有改善两种情况的潜力的那些（例如， 抗抑郁药）。因此，COD的粘附增强干预可以 优化治疗效果。它们也能适应新的治疗方法 正在开发中。虽然初步研究表明， 增强依从性的干预对非COD患者有效， 对COD的系统评价很少。与开发新的 治疗内容，研究简短的策略，以提高坚持 现有的治疗方法是一种高成本效益的方法， 快速的回报。K23应用的研究计划包括：1） 评价9项正在进行的研究中的依从性问题，2）完成一项新的 临床试验评估创新的粘附增强方法COD在一个 双重诊断门诊。这项新的临床试验将采用 拆除设计，其中75例门诊合并抑郁症 疾病和药物滥用/依赖（CODDA）将被随机分配到：1） 作为治疗（TAU），一种提供药物管理的对照条件， 关于诊断和依从性重要性的标准教育，以及 团体咨询，2）TAU+依从性反馈（TAU+AF），其中患者接受 TAU加上关于药物治疗和咨询依从性的计算机化反馈，基于 用药事件监测系统（MEMS; Aprex Corporation，Fremont，CA）数据 和出勤记录，或3）TAU+动机增强反馈（TAU+MEF）， TAU加上动机增强疗法和应急管理 将添加到AF中。主要结局指标为：1） 抗抑郁药物，通过MEMS帽和自我报告测量，2）比率 咨询出席率，以及3）减少非法药物使用，包括 通过每周两次的尿液毒理学测试评估是否实现禁欲 自我报告。次要结果包括抑郁症的减少， 再住院率和再住院率。

DESCRIPTION: (Provided by Applicant): This application is for a "Mentored Patient-Oriented Research Career Development Award" (K23) to study treatment adherence in co-occurring psychiatric and drug use disorders (COD), under the mentorship of Bruce J. Rounsaville, M.D. and Richard S. Schottenfeld, M.D. Nonadherence is a critical issue in COD, especially among those with depressive disorders, as it occurs frequently and limits the maximal benefit achieved by efficacious treatments, particularly those with the potential to improve both conditions (e.g., antidepressants). Therefore, adherence-enhancing interventions for COD can optimize the efficacy of treatments. They are also adaptable to new treatments that are being developed. While preliminary studies indicate that adherence-enhancing interventions are efficacious for patients with non-COD, little systematic evaluation has occurred in COD. Compared to developing new contents for treatment, studying brief strategies to improve adherence to existing treatments is a highly cost-efficient approach that can have a large and rapid payoff. The research plan for this K23 application entails: 1) the evaluation of adherence issues in 9 ongoing studies and 2) completion of a new clinical trial evaluating innovative adherence-enhancing methods for COD in a dual-diagnosis outpatient clinic. This new clinical trial will employ a dismantling design, within which 75 outpatients with co-occurring depressive disorders and drug abuse/dependence (CODDA) will be randomly assigned to: 1) Treatment-as-Usual (TAU), a control condition offering medication management, standard education regarding diagnosis and the importance of adherence, and group counseling, 2) TAU+Adherence Feedback (TAU+AF), in which patients receive TAU plus computerized feedback on medication and counseling adherence, based on Medication Event Monitoring System (MEMS; Aprex Corporation, Fremont, CA) data and attendance records, or 3) TAU+Motivationally Enhanced Feedback (TAU+MEF), in which TAU plus Motivational Enhancement Therapy and Contingency Management will be added to AF. Primary outcome measures are: 1) rates of adherence to antidepressant medication, as measured by MEMS caps and self-report, 2) rates of counseling attendance, and 3) reductions in illicit drug use, including achievement of abstinence, as assessed by twice-weekly urine toxicology tests and self-report. Secondary outcomes include reductions in depressive symptomatology and rates of re-hospitalization.