Adolescents with Major Depression and AUD: Community-based Integrated Treatment

描述（由申请人提供）：研究一致表明青春期精神健康障碍与酒精使用障碍（AUD）之间存在关联。特别是，AUD与重度抑郁症（MDD）的共病性已得到充分证实，并与一系列负面结局相关，包括更长时间和更严重的疾病发作以及更大的心理社会损害（包括行为障碍）。这一人群的治疗可能比成年人更具挑战性，因为患有MDD/AUD的青少年除了AUD外还经常患有其他外化疾病。针对这一人群的治疗研究相当有限，健康人2020目标MHMD HP 2020-14直接解决了这一领域：“增加同时患有药物滥用和精神障碍并接受这两种疾病治疗的人的比例”。本申请的目的是进行一项随机临床试验，比较MDD和AUD青少年的综合认知行为治疗（CBT- I）与标准治疗（SC），即治疗技术的折衷组合。将使用两组随机设计来检验主要假设，即与标准治疗相比，设计用于治疗12至18岁患有AUD/ MDD的青少年的综合CBT-I方案将在以下方面产生更好的治疗结局：1）大量饮酒/酒精问题，这可能导致抑郁和外化行为，其中最严重的导致昂贵的住院安置和逮捕/监禁;和2）抑郁症和自杀事件，后者可能需要昂贵的急诊室就诊和住院精神病住院治疗。综合CBT-I和SC条件都将由社区心理健康诊所的持牌心理健康顾问提供，该诊所使用强化门诊计划模式来治疗患有AUD和心理健康障碍的青少年，这些青少年先前的门诊治疗失败，需要更强化的服务。在CBT-I条件的临床医生将接受每周监督，重点是使用CBT-I协议。南卡罗来纳州的临床医生将接受标准的诊所监督，这种监督本质上更加不拘一格，与典型的社区护理一致。将在治疗后一年收集结果数据。成功完成项目目标可能会改变向这一高风险群体提供服务的方式。其临床意义在于解决了该领域的一个关键障碍：如何治疗MDD/AUD青少年。 公共卫生相关性：同时患有酒精使用障碍和精神障碍的青少年通常有影响其功能多个方面的重大障碍。用于治疗这些个体的改进方法具有降低与这两种病症相关的发病率的潜力。这一问题的相关性反映在《健康人群2020年目标》MHMD HP 2020-14中，其中写道：“增加同时患有药物滥用和精神障碍并接受这两种疾病治疗的人的比例。"

DESCRIPTION (provided by applicant): Studies have consistently shown an association between mental health disorders and alcohol use disorders (AUD) during adolescence. In particular, the comorbidity of AUD with Major Depressive Disorder (MDD) is well established and associated with a range of negative outcomes including longer and more severe episodes of illness and greater psychosocial impairment including behavior disturbance. This population may be even more challenging to treat than their adult counterparts because adolescents with MDD/AUD so often have other externalizing disorders besides AUD. Treatment research for this population is quite limited and Healthy People 2020 Objective MHMD HP 2020-14 directly addresses this area: "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders". The purpose of this application is to conduct a randomized clinical trial comparing Cognitive Behavioral Therapy - Integrated (CBT- I) for adolescents with MDD and AUD to standard care (SC), i.e. an eclectic mix of therapy techniques. A two group randomized design will be used to test the primary hypothesis that the integrated CBT- I protocol designed to treat adolescents aged 12 to 18 years with AUD/ MDD will produce better treatment outcomes compared to standard care with respect to 1) heavy volume alcohol use/ alcohol problems which can contribute to both depression and externalizing behaviors, the most severe of which result in costly residential placements and arrests/incarceration; and 2) depression and suicidal events, the latter potentially requiring expensive Emergency Department visits and inpatient psychiatric hospitalizations. Both the integrated CBT-I and SC condition will be delivered by licensed mental health counselors at a community mental health clinic that uses an Intensive Outpatient Program model to treat adolescents with AUD and mental health disorders who have failed prior outpatient therapy and require more intensive services. Clinicians in the CBT-I condition will receive weekly supervision that focuses on use of the CBT-I protocol. Clinicians in SC will be provided standard clinic supervision that is more eclectic in nature, consistent with typical community care. Outcome data will be collected at one year post treatment. Successful completion of the project aims could change how services are delivered to this high risk group. Its clinical significance lies in ts addressing a critical barrier to the field: how to treat MDD/AUD adolescents. PUBLIC HEALTH RELEVANCE: Adolescents who have both alcohol use disorders and psychiatric disorders typically have major impairment that affects multiple aspects of their functioning. Improved methods for treating these individuals have the potential to decrease the morbidity associated with both conditions. The relevance of this problem is reflected in Healthy People 2020 Objective MHMD HP 2020-14 which reads: "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders."