Computer Based Training in CBT for Spanish-Speaking Substance Users

描述（由申请人提供）：药物滥用是西班牙裔美国人的一个重要问题，他们代表了美国最大的少数民族群体。拉丁美洲人/作为往往是不太可能接受心理健康和药物滥用治疗服务比欧洲和非洲裔美国人，经验不成比例的药物使用的不良后果的水平，但在临床和研究样本的代表性很低。为了解决改善获得经验验证疗法的问题，我们开发了一种计算机辅助的认知行为疗法（认知行为疗法的计算机辅助培训，CBT 4CBT），并证明了其作为标准门诊药物滥用治疗的辅助手段的有效性和持久性。我们现在建议调整CBT 4CBT计划，用于广泛的药物滥用者，其主要/首选语言是西班牙语，并评估其在这一人群中的疗效。如果西班牙语版的CBT 4CBT被发现是一种有效的治疗辅助手段，那么在广泛的项目中传播和实施它将是相对便宜和直接的。因此，这也将是一个重要的步骤，使循证疗法更广泛地提供给这一重要和服务不足的人群，从而解决美国和美国国立卫生研究院优先考虑的关键健康差距。我们建议，首先，调整我们的个性化，互动，基于网络的培训计划（CBT 4CBT）为讲西班牙语的物质使用者。第二，我们建议进行一项初步的随机试验，评估在100名符合目前药物滥用依赖标准的西班牙语人群中，在基于社区的治疗计划中，将CBT 4CBT-Spanish添加到治疗中的可行性和有效性。参与者将被随机分配到以下两种情况之一：（1）在康涅狄格州精神卫生中心的西班牙裔诊所接受标准治疗（ST），或（2）接受CBT 4CBT-Spanish计划作为辅助治疗的ST。将通过6个月随访评价治疗效果的长期持久性和/或延迟出现。主要结局指标将是物质使用的减少，可操作为通过尿液毒理学筛查确认的每周物质使用频率的减少。次要结果将包括艾滋病毒风险降低，心理社会功能，以及参与者展示CBT 4CBT干预措施中作为结果中介的技能的能力。

DESCRIPTION (provided by applicant): Substance abuse is a significant problem among Hispanic Americans, who represent the largest ethnic minority group in the United States. Latino/as tend to be less likely to receive mental health and substance abuse treatment services than European and African Americans, experience disproportionate levels of adverse consequences of drug use, and yet are highly underrepresented in clinical and research samples. To address the issue of improving access to empirically validated therapies, we have developed a computer-assisted version of cognitive behavioral therapy (Computer Based Training for Cognitive Behavioral Therapy, CBT4CBT) and have demonstrated its efficacy and durability as an adjunct to standard outpatient substance abuse treatment. We now propose to adapt the CBT4CBT program for use with a broad range of substance abusers whose principal/preferred language is Spanish and to evaluate its efficacy in this population. If this Spanish version of CBT4CBT is found to be an effective adjunct to treatment, it would be comparatively inexpensive and straightforward to disseminate and implement in a wide range of programs. It would thus also represent a significant step in making evidence-based therapies more broadly available to this important and underserved population and hence to address a critical health disparity in the US and an NIH priority. We propose to, first, adapt our individualized, interactive, web-based training program (CBT4CBT) for Spanish- speaking substance users. Second, we propose to conduct an initial randomized trial evaluating the feasibility and efficacy of adding CBT4CBT-Spanish to treatment as usual in a community based treatment program in a population of 100 Spanish-speaking individuals who meet current criteria for substance abuse dependence. Participants will be randomized to one of two conditions: (1) standard treatment (ST) at the Hispanic Clinic of the Connecticut Mental Health Center, or (2) ST with access to the CBT4CBT-Spanish program as an adjunct to treatment. The long-term durability and/or delayed emergence of treatment effects will be evaluated through a six month follow-up. The primary outcome measures will be reduction in substance use, operationalized as reduction in the frequency of substance use by week confirmed by urine toxicology screens. Secondary outcomes will include HIV risk reduction, psychosocial functioning, and the participants' ability to demonstrate the skills targeted in the CBT4CBT intervention as a mediator of outcome.