Integrative Risk Reduction and Treatment for Teen Substance Use Problems and PTSD

儿童性虐待（CSA）是青少年问题的最强和最一致的预测因素之一。 经历过CSA的青少年有早期开始，使用和滥用物质的重大风险。 比如研究表明，青少年CSA受害者有超过3.5倍的可能性报告， 与非CSA受害者相比，大麻滥用/依赖。其他负面后遗症，如 创伤后应激障碍（PTSD）和艾滋病毒性风险行为，也已明确与 CSA。值得注意的是，没有行为干预措施已经开发和严格评估这一点 （a）采取综合办法，通过利用现有的经验性方法， 支持性干预措施;和B）为症状较轻的青年减少风险。减少风险和 为青少年CSA受害者量身定制的治疗，解决个人、家庭和社区风险， 青少年物质使用问题的弹性因素，并纳入了基于安全的治疗， 创伤后应激障碍症状，以及针对艾滋病毒相关性行为的循证预防干预措施，并且是 有正当理由通过家庭治疗降低风险（RRFT）由PI开发，NIDA-K获奖者 （K23 DA 018686）和早期研究者。第1a阶段可行性研究的初步结果 试验和阶段1b试点随机对照试验（RCT）是有希望的，表明RRFT可以很容易地 它可以导致药物使用和药物使用相关的改善， 风险和保护因素、PTSD症状和HIV性风险行为（Danielson等，2010年）。在 根据NIDA推荐的行为治疗发展阶段模型， 应用的目的是进行II期RCT，以更严格地评价RRFT（与治疗A相比）的疗效 从治疗前到18个月，拟议研究的第一个具体目标是评估 RFT在减少CSA患者物质使用问题和预后因素中的有效性 创伤相关症状第二个具体目标是评估RFT在减少PTSD和 这一人群中的艾滋病危险性行为。为了更好地利用这些数据， 拟定的疗效试验，并告知该治疗研究的潜在后续步骤（根据NOT-DA-019）， 对RRFT作用机制的初步研究也将作为探索性目标。 具体来说，RFFT的中间目标，如父母的做法和情绪反应，作为假定的 改善物质使用、创伤后应激障碍和危险性行为的行动机制将是 探讨了拟议研究的结果将对公共卫生产生重大影响， 针对青少年CSA受害者的多方面临床需求的干预工作，这些受害者处于药物的高风险中 使用，艾滋病毒感染，青少年和成年期的其他问题。为了证明这种有前途的 风险减少和治疗方法可以为社区治疗师提供一个有价值的临床工具。

Child Sexual Abuse (CSA) is one of the strongest and most consistent predictors of adolescent problems. Youth who have experienced CSA are at significant risk for early initiation, use, and abuse of substances. For example. research has indicated that adolescent CSA victims are over 3.5 times more likely to report marijuana abuse/dependence compared to non-CSA victims. Other negative sequelae, such as posttraumatic stress disorder (PTSD) and HIV sexual risk behaviors, also have been clearly linked with CSA. Remarkably, no behavioral interventions have been developed and rigorously evaluated for this population that: a) take an integrated approach to targeting such sequelae through use of existing empirically supported interventions; and b) incorporate risk reduction for less symptomatic youth. Risk reduction and treatment tailored to adolescent CSA victims, which addresses the individual, family, and community risk and resiliency factors for adolescent substance use problems and incorporates exposure-based treatment for PTSD symptoms, as well as evidence based prevention interventions for HIV-related sexual behaviors, and is warranted. Risk Reduction through Family Therapy (RRFT) has been developed by the PI, a NIDA-K awardee (K23DA018686) and Early Stage Investigator, for this purpose. Preliminary findings from a Stage 1a feasibility trial and a Stage 1b pilot randomized controlled trial (RCT) are promising, indicating that RRFT can be readily learned and implemented with fidelity, and that it can lead to improvements in drug use and drug use-related risk and protective factors, PTSD symptoms, and HIV sexual risk behaviors (Danielson et al., 2010). In following NIDA's recommended stage model of behavioral therapy development, the overall goal of this application is to conduct a Stage II RCT to more rigorously evaluate the efficacy of RRFT (vs. Treatment As Usual) from pre-treatment through 18 months. The first specific aim of the proposed study is to evaluate the efficacy of RRFT in reducing substance use problems and prognostic factors among CSA victims experiencing trauma-related symptoms. The second specific aim is to evaluate the efficacy of RRFT in reducing PTSD and HIV sexual risk behaviors among this population. In order to better make maximum use of the data from this proposed efficacy trial and to inform potential next steps in this line of treatment research (per NOT-DA-019), preliminary investigation on mechanisms of action in RRFT also will be pursued as an exploratory aim. Specifically, intermediate targets of RRFT, such as parenting practices and emotional reactivity, as putative mechanisms of action for improvements in substance use and PTSD and risky sexual behaviors will be explored. The results of the proposed study will have a significant impact on public health by informing intervention efforts for the multifaceted clinical needs of adolescent CSA victims, who are at high risk for drug use, HIV infection, other problems in adolescence and adulthood. Demonstrating the efficacy of this promising risk reduction and treatment approach could provide a valuable clinical tool for community-based therapists.