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

患有重度抑郁症和 AUD 的青少年：基于社区的综合治疗

• 批准号: 8296799
• 负责人: Anthony Spirito
• 金额: $ 67.31万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-20 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296799
• 关键词: Accident and Emergency department; Address; Admission activity; Adolescence; Adolescent; Adult; Affect; Aftercare; Alcohol abuse; Alcohol consumption; Anxiety Disorders; Area; Behavior; Caring; Clinic; Cognitive; Cognitive Therapy; Communities; Comorbidity; Data; Depressed mood; Diagnosis; Disease; Disease remission; Early treatment; Event; Goals; Healthy People 2020; Home environment; Hospitalization; Hospitals; Impairment; Imprisonment; Individual; Inpatients; Intervention; Licensing; Major Depressive Disorder; Marijuana Smoking; Mediating; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; National Institute of Mental Health; National Institute on Alcohol Abuse and Alcoholism; Nature; Outcome; Outpatients; Parents; Persons; Population; Population Research; Problem Solving; Procedures; Professional counselor; Protocols documentation; Psychopathology; Randomized; Randomized Clinical Trials; Reading; Recording of previous events; Regulation; Services; Severities; Strategic Planning; Substance abuse problem; Suicide attempt; Supervision; Techniques; Teenagers; Testing; Trauma; Treatment outcome; Visit; Work; addiction; adolescents with alcohol use disorders; aged; alcohol use disorder; base; clinically significant; community intervention; depressive symptoms; design; drinking; drinking behavior; efficacy testing; externalizing behavior; follow-up; high risk; improved; intervention effect; parental monitoring; programs; psychosocial; reduced alcohol use; response; social; standard care; suicidal; suicidal risk; trial comparing

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."

描述(由申请者提供)：研究一直表明青春期精神健康障碍和酒精使用障碍(AUD)之间存在联系。特别是，AUD和严重抑郁障碍(MDD)的共病是公认的，并与一系列负面后果相关，包括更长和更严重的疾病发作和包括行为障碍在内的更严重的心理社会损害。这一群体的治疗可能比他们的成年同行更具挑战性，因为患有MDD/AUD的青少年除了AUD外，还经常有其他外在障碍。针对这一人群的治疗研究相当有限，健康人2020年目标MHMD HP 2020-14直接针对这一领域：“增加同时接受两种疾病治疗的药物滥用和精神障碍患者的比例”。本申请的目的是进行一项随机临床试验，比较综合认知行为疗法(CBT-I)与标准护理(SC)治疗MDD和AUD青少年的效果，标准护理是一种折中的治疗技术组合。将使用两组随机设计来检验主要假设，即设计用于治疗患有AUD/MDD的12至18岁青少年的综合CBT-I方案将在以下方面产生比标准护理更好的治疗结果：1)大量饮酒/酗酒问题，可导致抑郁和外在行为，其中最严重的导致昂贵的住宿安置和逮捕/监禁；2)抑郁症和自杀事件，后者可能需要昂贵的急诊科就诊和住院精神科住院治疗。综合CBT-I和SC条件将由社区精神健康诊所的有执照的精神健康顾问提供，该诊所使用强化门诊计划模式治疗患有AUD和精神健康障碍的青少年，这些青少年之前的门诊治疗失败，需要更多的强化服务。CBT-I条件下的临床医生将接受每周监督，重点是CBT-I方案的使用。SC的临床医生将被提供标准的诊所监督，本质上更具折衷性质，与典型的社区护理一致。结果数据将在治疗后一年收集。项目目标的成功完成可能会改变向这一高风险群体提供服务的方式。它的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严重的损害，影响其功能的多个方面。改进的治疗这些人的方法有可能降低与这两种疾病相关的发病率。这一问题的相关性反映在《健康人2020年MHMD惠普2020-14年目标》中，内容为：“增加同时患有药物滥用和精神障碍的人接受这两种疾病治疗的比例。”