Family-Based Drug Services for Young Disaster Victims

描述(申请人提供)：卡特里娜飓风对新奥尔良及其周边社区造成的破坏震惊了世界。对于青少年来说，其后果可能尤其严重，他们在极端压力、家庭解体和生活中断的条件下，容易受到共生创伤和药物滥用的影响。这项提案是针对NOT-DA-05-013号文件“时间敏感型研究机会机制的通知：PAR-05-150，扩大纳入与卡特里娜飓风有关的酒精和药物滥用研究”而提出的，这将是在一场全社区灾难之后对青少年药物滥用和创伤之间联系的第一次审查。利用这一快速审查和资助机会，这项研究将探索以家庭为基础的干预措施的潜力，即多维家庭疗法(MDFT；利德尔，2002a)，以解决受卡特里娜飓风影响的青少年中的共病创伤和药物滥用问题。MDFT在青少年药物滥用和共病问题方面显示出很强的效果，但尚未在受到创伤的青少年及其家庭中进行充分测试。调查人员将与路易斯安那州圣查尔斯教区的临床提供商合作，在现实服务环境中严格测试MDFT与Group CBT。圣查尔斯教区是新奥尔良地区的一个社区，受到风暴的严重影响。这项随机对照试验有四个目的：1)探索飓风相关压力和创伤与青少年药物滥用之间的联系；2)在社区随机对照试验中，调查受卡特里娜飓风影响的青少年药物滥用者家庭干预(MDFT)和团体CBT的有效性；3)检查青少年和父母应对方式作为治疗效果的中介；以及4)根据卡特里娜飓风后的压力和创伤症状，探索治疗效果的调节因素。150名13至17岁的青少年被临床转诊到门诊接受药物滥用治疗，并经历了与飓风有关的创伤症状，他们将被随机分为MDFT组或CBT组。这两种治疗都将纳入以创伤为重点的干预措施，并将由同一社区机构的治疗提供者提供。多时间点(摄入量、2、4、6和12个月)、多领域和方法评估方法将评估MDFT的能力：(1)减少青少年使用药物、创伤、犯罪和学校问题；(2)减少青少年被诊断为创伤后应激障碍；以及(3)减少父母压力和家庭冲突。潜在增长曲线模型(LGC)和平行过程LGC将被用来测试关于治疗结果、青年和父母应对作为治疗中介以及卡特里娜飓风后应激和创伤作为治疗效果调节因素的研究假设。这项研究通过阐明青少年滥用药物与创伤之间的联系，并验证了在美国代价最高的自然灾害之后，对遭受创伤的青少年药物滥用者进行的基于家庭的干预，具有推动该领域发展的巨大潜力。

DESCRIPTION (provided by applicant): The devastation that Hurricane Katrina wrought on New Orleans and its surrounding communities stunned the world. Its consequences are likely to be particularly acute for adolescents, who are vulnerable for co-occurring trauma and substance abuse under conditions of extreme stress, family disorganization, and life disruption. This proposal, submitted in response to NOT-DA-05-013, "Notice of Mechanism for Time- Sensitive Research Opportunities: PAR-05-150, Expansion to Include Alcohol and Drug Abuse Research Pertaining to Hurricane Katrina," would be the first examination of the links between adolescent substance abuse and trauma following a community-wide disaster. Using this rapid review and funding opportunity, the study would explore the potential of a family-based intervention, Multidimensional Family therapy (MDFT; Liddle, 2002a), to address comorbid trauma and substance abuse among teens impacted by Hurricane Katrina. MDFT has demonstrated strong effects on adolescent substance abuse and comorbid problems, yet has not been fully tested with traumatized teens and their families. The investigators will partner with clinical providers in St. Charles Parish, Louisiana, a New Orleans area community that was heavily impacted by the storm, to rigorously test MDFT vs. group CBT in a real-world service setting. This randomized controlled trial has four aims: 1) To explore links between hurricane-related stress and trauma and youths' substance abuse; 2) To investigate in a community-based randomized controlled trial the effectiveness of a family-based intervention (MDFT) vs. group CBT for teen substance abusers impacted by Hurricane Katrina; 3) To examine teen and parent coping as mediators of treatment effects; and 4) To explore moderators of treatment effects based on post-Katrina stress and trauma symptoms. 150 youth ages 13 to 17 who are clinically referred for outpatient substance abuse treatment and experiencing trauma symptoms related to the hurricane will be randomized to either MDFT or group CBT. Both treatments will incorporate trauma-focused interventions and will be delivered by treatment providers in the same community-based agency. A multiple time point (intake, 2, 4, 6, and 12 months), multiple-domain and method assessment approach will evaluate MDFT's capacity to: (1) decrease youths' substance use, trauma, delinquency, and school problems; (2) reduce youths' diagnoses of PTSD; and (3) reduce parental stress and family conflict. Latent growth curve modeling (LGC) and parallel process LGC will be used to test study hypotheses regarding treatment outcomes, youth and parent coping as treatment mediators, and post-Katrina stress and trauma as moderators of treatment effects. The study has significant potential to advance the field by elucidating links between teen substance abuse and trauma, and validating a family-based intervention for traumatized adolescent substance abusers in the wake of the nation's most costly natural disaster.