Family and Adolescent Motivational Incentives for Leveraging Youth

描述（由申请人提供）：研究为青少年物质使用障碍（SUD），HIV风险行为和相关问题的认知行为和家庭干预的有效性提供了支持。尽管支持这些干预措施，但在各研究中一致发现治疗结局和高复发率的实质性异质性。这种差异突出表明，需要采取创新战略，扩大青少年药物滥用治疗的影响，并加强其效果的持久性。研究表明，应急管理（CM）方法对减少物质使用，主要是成年人的物质使用有积极影响。CM已被证明可以改善结果时，结合以证据为基础的做法和研究正在出现的建议，这种整合也可能是有效的青少年药物滥用者。拟议的II期疗效试验检查了CM与两种经验支持的干预措施的整合：MET/CBT组和FFT组。通过比较两种干预方式（组与家庭），该研究提供了一个独特的机会，以检查CM在社区环境中广泛实施的既定青少年治疗中的效果的稳健性，并比较可能导致治疗结果的变化机制。在拟议的研究中，物质滥用青少年（n = 160）将被随机分配到四个干预条件之一，两个与综合CM干预（MET/CBT-CM，FFT-CM）和两个没有CM（MET/CBT，FFT）。本研究将采用2（激励：CM、noncom）x 2（模态：MET/CBT、FFT）x 5（时间：基线、随机化后2、4、8和12个月）析因设计。本研究的主要目的是检查综合CM干预、FFT-CM和MET/CBT-CM组与这些不含CM的治疗相比对药物滥用戒断的疗效（a）治疗期间（即，作用速度）和（B）治疗后随访评估（即，效果的持久性）。第二个目标是研究干预措施对青少年性风险行为和行为问题的影响。第三个目的是评估CM对干预效果的假设介质的影响。我们预计，CM条件相比，noncom条件，更有可能加速青少年的动机，以实现禁欲，参加和参与治疗，并完成家庭作业。额外的探索性分析将检查模式（MET/CBT与FFT）之间的差异对假定的介质：MET/CBT将产生更大的改善青少年药物回避自我效能和FFT将产生更大的改善家庭关系（由FES测量）。药物回避自我效能和家庭关系的改善将分别介导MET/CBT和FFT的改善。最后，我们将进行非正式的成本效益分析，以得出每种治疗方式的相对成本的初步估计，特别是在治疗参与/出勤率和青少年安置到限制环境。

DESCRIPTION (provided by applicant): Research has provided support for the efficacy of cognitive-behavioral and family interventions for adolescent substance use disorders (SUD), HIV-risk behaviors, and related problems. Despite support for these interventions, substantial heterogeneity in treatment outcomes and high relapse rates has been consistently found across studies. Such variability highlights the need for innovative strategies to broaden the impact and strengthen the durability of effects of adolescent substance abuse treatments. Research has demonstrated the positive effects of contingency management (CM) methods on reductions in substance use, primarily with adults. CM has been shown to improve outcomes when combined with evidence-based practices and research is emerging to suggest that such integrations may also be effective for adolescent substance abusers. The proposed Stage II efficacy trial examines the integration of CM with two empirically- supported interventions: group MET/CBT and FFT. By comparing two intervention modalities (group vs. family), the study provides a unique opportunity to examine the robustness of the effects of CM across established adolescent treatments that are widely implemented in community settings, and to compare change mechanisms that may account for treatment outcomes. In the proposed research, substance abusing adolescents (n = 160) will be randomly assigned one of four intervention conditions, two with an integrated CM intervention (MET/CBT-CM, FFT-CM) and two without CM (MET/CBT, FFT). The study will employ a 2 (Incentives: CM, noncom) x 2 (Modality: MET/CBT, FFT) x 5 (Time: Baseline, 2-, 4-, 8-, and 12-months post- randomization) factorial design. The primary aim of the study is to examine the efficacy of an integrated CM intervention, FFT-CM and group MET/CBT-CM, compared to these treatments without CM on drug abuse abstinence (a) during treatment (i.e., speed of effects) and (b) at post-treatment follow-up assessments (i.e., durability of effects). A second aims is to examine the impact of interventions on adolescent sexually risky behavior and conduct problems. A third aim is to evaluate the effects of CM on hypothesized mediators of intervention effects. We anticipate that the CM conditions, compared to the noncom conditions, are more likely to accelerate the adolescent's motivation to achieve abstinence, to attend and participate in treatment, and to complete homework assignments. Additional exploratory analyses will examine differences between modalities (MET/CBT vs. FFT) on the presumed mediators: MET/CBT will produce greater improvements in adolescents drug avoidance self-efficacy and FFT will produce greater improvements in family relationships (as measured by the FES). Improvements in drug avoidance self-efficacy and family relationships will mediate improvements in MET/CBT and FFT, respectively. Finally, we will conduct an informal cost-effectiveness analysis to derive preliminary estimates of the relative costs of each treatment modality, particularly with respect t treatment engagement/attendance and youth outplacement to restricted settings.