Mechanisms of Change in Alcohol Treatment for Dually Diagnosed Youth

描述（由申请人提供）：为了响应RFA-AA-07-005，酒精使用障碍治疗中的行为改变机制，本项目检查了改变物质使用的准备情况，作为酒精和其他药物使用变化的关键近端，高度可塑性的认知因素。这项研究的重点是准备改变物质使用，因为它是假设提前和预测物质使用的变化，并作为治疗效果的敏感标志物。将使用强化评估时间表来确定治疗（特异性和非特异性效应）如何影响接受强化门诊（IOP）治疗的双重诊断（同时发生物质使用和精神疾病）青少年改变物质使用的准备程度。青少年将在初始治疗评价后立即开始评估，在参加第一次IOP治疗前，每次IOP治疗后，以及治疗开始后每月一次，直至6个月随访。将使用强化评估来确定手动、基于组的IOP治疗和其他因素（例如，共同发生的精神病理学，缓刑状态）影响年轻人改变物质使用的准备。我们将前瞻性研究50名青少年（14-18岁）从青少年双重诊断诊所招募。每个青少年都会有一个父母间接线人。临床医生将在每次IOP会议后提供青少年参与的评级。该项目有三个具体目标：（1）跟踪青少年改变药物使用意愿的变化（例如，戒烟动机），一种建议的物质使用行为改变的中介，从青少年双重诊断诊所的治疗初始评估开始，在每次密集门诊（IOP）治疗后立即参加，并在IOP开始后每月一次，直至6个月随访;（2）检查改变物质使用行为的准备程度，作为治疗效果和物质参与的中介，并识别患者特征和影响在治疗开始后的前、期间和6个月内改变物质使用的准备程度的额外治疗因素;以及（3）确定在治疗期间和治疗后在一个功能领域（例如，物质使用行为）与另一个领域的功能（例如共同发生的精神病理学）有关。研究结果对改善向双重诊断青年提供的治疗内容和服务具有重要意义。成瘾治疗的一个重要目标是增加和保持患者改变物质使用的准备。该项目将研究治疗如何影响青少年双重诊断（物质使用和共同发生的精神疾病）门诊患者的改变准备。结果有重要的意义，为改善设计和提供双重诊断的青少年治疗。

DESCRIPTION (provided by applicant): In response to RFA-AA-07-005, Mechanisms of behavior change in treatment of alcohol use disorders, this project examines readiness to change substance use as a key proximal, highly malleable cognitive factor underlying change in alcohol and other drug use. This study focuses on readiness to change substance use because it is hypothesized to precede and predict changes in substance use, and serves as a sensitive marker of treatment effect. An intensive assessment schedule will be used to determine how treatment (specific and non-specific effects) impacts readiness to change substance use among dually diagnosed (co-occurring substance use and psychiatric illness) adolescents admitted to intensive outpatient (IOP) treatment. Adolescents will be assessed starting immediately after the initial evaluation for treatment, prior to attending the first IOP session, after each IOP session, and monthly after the start of treatment through 6-month follow-up. Intensive assessment will be used to determine how manualized, group-based IOP treatment and other factors (e.g., co-occurring psychopathology, probation status) impact youths' readiness to change substance use. We will prospectively study 50 adolescents (age 14-18) recruited from an Adolescent Dual Diagnosis Clinic. Each adolescent will have a parent collateral informant. Clinicians will provide ratings of youth participation after each IOP session. The project addresses three specific aims: (1) track changes in adolescents' readiness to change substance use (e.g., motivation to abstain), a proposed mediator of change in substance use behavior, starting at the initial evaluation for treatment at an adolescent dual diagnosis clinic, immediately after each intensive outpatient (IOP) session attended, and monthly after the start of IOP through 6-month follow-up; (2) examine readiness to change substance use behavior as a mediator of treatment effects and substance involvement, and to identify patient characteristics and extra-treatment factors that influence readiness to change substance use pre-, during, and through 6-months after treatment entry; and (3) determine how change during and post treatment in one area of functioning (e.g., substance use behavior) is associated with functioning in another domain (e.g. co-occurring psychopathology). Results have important implications for improving the content and delivery of treatment provided to dually diagnosed youth. An important goal of addictions treatment is to increase and maintain patients' readiness to change substance use. This project will examine how treatment impacts readiness to change in adolescent dual diagnosis (substance use and co-occurring psychiatric illness) outpatients. Results have important implications for improving the design and delivery of treatment provided to dually diagnosed adolescents.