Family Intervention for Teen Drinking and Alcohol-related Crises in the ER

描述（由申请人提供）：酒精仍然是美国年轻人的首选毒品，青少年饮酒仍然是美国最严重的公共卫生问题之一。然而，在美国卫生部长最近发布的《预防和减少未成年人饮酒的行动呼吁》（USDHHS, 2007）中，他断言：“未成年人饮酒并非不可避免，学校、家长和其他成年人并非无力阻止它。”因此，根据科学建议和NIAAA（2006）的研究重点，我们建议进一步开发和严格测试两种针对青少年酒精问题的家庭干预措施，多维家庭治疗（MDFT）和家庭动机访谈干预（FMII）。家庭干预在治疗成人酒精中毒和青少年药物滥用方面有很强的研究和临床传统，但很少有研究集中在家庭干预青少年饮酒方面。在这项对照试验中，250名年龄在12岁至18岁之间的青少年在急诊室或创伤中心接受与酒精相关的危机治疗，他们将被随机分为两组，一组接受家庭干预，另一组接受标准治疗。家庭干预，MDFT和FMII，都旨在增强家庭的影响，以激励和帮助青少年改变，但它们依赖于不同的理论基础和临床技术。两种家庭干预都在急诊室就诊的72小时内在参与者家中提供2次初始参与会议。然后，MDFT的青少年将参加以家庭为中心的完整疗程（3个月），FMII的青少年将参加为期3个月的行为导向的12步小组治疗。标准治疗参与者将与FMII中的青少年进行相同的小组治疗，但不参加任何活动或家庭会议。我们提出了一项随机对照试验，有五个目的：1。探讨以家庭为中心的干预（MDFT）和家庭动机访谈干预(FMII)/小组对青少年酒精相关危机的参与潜力和有效性；2. 探讨青少年合并症的差异治疗效果；3. 研究动机和家庭因素作为治疗中介的作用；4. 在18个月的随访中检查长期戒断、模式和复发的预测因素；和5。比较MDFT、FMII/组和标准治疗对社会的总货币效益和净货币效益。采用多个时间点（入组、3个月、6个月、9个月、12个月和18个月的随访）、多领域和方法评估方法来比较干预措施的参与度和保留率、临床结果以及对社会的总和净货币效益。潜在增长曲线模型和其他最先进的统计技术将用于测试关于青少年和家庭随时间变化的研究假设，干预对共病青年的不同影响，治疗实现其效果的机制，复发模式和预测因素。这项研究具有重大的潜力，通过为提供者和政策制定者提供关于在急诊室和最终在其他卫生保健机构中对有酒精问题的青少年进行有效和成本效益的家庭干预的新知识，促进青少年酒精治疗。

DESCRIPTION (provided by applicant): Alcohol continues to be the drug of choice among American youth and teen drinking remains one of the nation's most serious public health problems. Yet in the Surgeon General's recent "Call to Action to Prevent and Reduce Underage Drinking" (USDHHS, 2007), he asserted that "underage drinking is not inevitable, and schools, parents, and other adults are not powerless to stop it." Accordingly, in line with scientific recommendations and NIAAA's (2006) research priorities, we propose to further develop and rigorously test two family interventions for adolescent alcohol problems, Multidimensional Family Therapy (MDFT) and a Family Motivational Interviewing Intervention (FMII). Family interventions have strong research and clinical traditions in the treatment of adult alcoholism and adolescent drug abuse, but little research has focused on family interventions for teen drinking. In this controlled trial, 250 youth ages 12 to 18 with alcohol-related crises in the ER or trauma center will be randomized to one of these two family interventions or to standard care. Both family interventions, MDFT and FMII, aim to potentiate the influence of the family to motivate and help youth to change, but they rely on different theoretical foundations and clinical techniques. Both family interventions provide 2 initial engagement sessions in the homes of participants within 72 hours of the ER visit. Youth in MDFT will then be engaged into a full course (3 months) of this family-centered treatment, and FMII youth will be enrolled into 3 months of behaviorally oriented 12-step group treatment. Standard care participants will be referred to the same group treatment as youth in FMII, but will receive no engagement or family sessions. We propose a randomized controlled trial with five aims: 1. To investigate the engagement potential and effectiveness of a family-centered intervention (MDFT) and Family Motivational Interviewing Intervention (FMII)/group for teens with alcohol-related crises; 2. To explore differential treatment effects with comorbid adolescents; 3. To examine the role of motivation and family factors as treatment mediators; 4. To examine long-term abstinence, patterns and predictors of relapse up to 18 months follow-up; and 5. To compare the total and net monetary benefits to society of MDFT, FMII/group, and standard care. A multiple time point (intake, 3, 6, 9, 12, and 18 month follow-up), multiple domain and method assessment approach will be used to compare the interventions on their engagement and retention rates, clinical outcomes, and total and net monetary benefits to society. Latent growth curve modeling and other state-of-the-art statistical techniques will be used to test study hypotheses regarding adolescent and family change over time, differential effects of the interventions on comorbid youth, the mechanisms by which the treatments achieve their effects, and relapse patterns and predictors. The study has significant potential to advance adolescent alcohol treatment by providing new knowledge to providers and policy makers about effective and cost-beneficial family interventions for youth identified with alcohol problems in the ER and ultimately in other health care settings.