Family-Based Drug Services for Young Disaster Victims

描述（由申请人提供）：卡特里娜飓风给新奥尔良及其周边社区造成的破坏震惊了世界。其后果可能对青少年特别严重，在极端压力、家庭解体和生活中断的情况下，他们很容易同时发生创伤和药物滥用。该提案是为响应NOT-DA-05-013，“时间敏感研究机会机制通知：PAR-05-150，扩展包括与卡特里娜飓风有关的酒精和药物滥用研究”而提交的，将是对社区范围灾难后青少年药物滥用与创伤之间联系的第一次审查。利用这种快速审查和资助机会，该研究将探索以家庭为基础的干预的潜力，多维家庭治疗（MDFT; Liddle, 2002a），以解决受卡特里娜飓风影响的青少年的共病创伤和药物滥用问题。MDFT已证明对青少年药物滥用和共病问题有很强的影响，但尚未对受创伤的青少年及其家人进行充分的测试。研究人员将与路易斯安那州圣查尔斯教区的临床提供者合作，新奥尔良地区社区受到风暴的严重影响，在现实世界的服务环境中严格测试MDFT与群体CBT。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)在一项基于社区的随机对照试验中，调查基于家庭的干预（MDFT）与团体CBT对受卡特里娜飓风影响的青少年药物滥用者的有效性；3)考察青少年和父母应对作为治疗效果的中介；4)探讨基于卡特里娜飓风后应激和创伤症状的治疗效果调节因子。150名年龄在13到17岁的青少年被临床转诊接受门诊药物滥用治疗，并经历与飓风相关的创伤症状，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。采用多个时间点（入院、2、4、6和12个月）、多领域和方法评估方法来评估MDFT的能力：(1)减少青少年药物使用、创伤、犯罪和学校问题；(2)降低青少年PTSD诊断率；(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将用于检验关于治疗结果的研究假设，青年和父母应对作为治疗中介，卡特里娜飓风后的压力和创伤作为治疗效果的调节因子。这项研究通过阐明青少年药物滥用与创伤之间的联系，并在国家最昂贵的自然灾害之后，验证了对受创伤的青少年药物滥用者进行基于家庭的干预，具有重大的推动该领域发展的潜力。

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.