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: 8676331
• 负责人: Anthony Spirito
• 金额: $ 5.51万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8676331
• 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.

描述（由申请人提供）：研究一致表明青春期期间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) 的共病已得到充分证实，并与一系列负面结果相关，包括更长、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患者更具挑战性，因为患有 MDD/AUD 的青少年通常还患有除 AUD 之外的其他外在疾病。针对这一人群的治疗研究相当有限，健康人群 2020 年目标 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的人接受这两种疾病治疗的比例”。本申请的目的是进行一项随机临床试验，将针对患有 MDD 和 AUD 的青少年的认知行为综合疗法 (CBT-I) 与标准护理 (SC)（即不拘一格的治疗技术组合）进行比较。将使用两组随机设计来检验主要假设，即与标准护理相比，旨在治疗患有 AUD/MDD 的 12 至 18 岁青少年的综合 CBT-I 方案将产生更好的治疗结果：1）大量饮酒/酒精问题可能导致抑郁和外化行为，其中最严重的会导致昂贵的住院安置和逮捕/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 状况将由社区心理健康诊所的持证心理健康咨询师提供，该诊所使用强化门诊计划模式来治疗患有 AUD 和心理健康障碍且之前门诊治疗失败并需要更强化服务的青少年。处于 CBT-I 状态的临床医生将每周接受监督，重点关注 CBT-I 方案的使用。南卡罗莱纳州的临床医生将获得标准的诊所监督，这种监督本质上更加不拘一格，与典型的社区护理一致。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该领域的一个关键障碍：如何治疗 MDD/AUD 青少年。