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，但在研究中一致发现治疗结果和高复发率存在实质性异质性。这种可变性突出表明需要创新战略，以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）方法对减少药物使用的积极影响，主要是对成年人。当与循证实践相结合时，CM已被证明可以改善结果，并且正在出现的研究表明，这种结合也可能对青少年药物滥用者有效。拟议的II期疗效试验考察了CM与两种经验支持的干预措施的整合：MET/CBT组和FFT。通过比较两种干预方式（团体与家庭），该研究提供了一个独特的机会来检验在社区环境中广泛实施的已建立的青少年治疗中CM效果的稳健性，并比较可能解释治疗结果的变化机制。在拟议的研究中，药物滥用青少年（n = 160）将被随机分配到四种干预条件中的一种，两种是综合CM干预（MET/CBT-CM, FFT-CM），两种是不进行CM干预（MET/CBT， FFT）。该研究将采用2（激励：CM，非com） x 2（方式：MET/CBT， FFT） x 5（时间：基线，随机化后2、4、8和12个月）析因设计。该研究的主要目的是检查综合CM干预，FFT-CM和MET/CBT-CM组的疗效，与没有CM的治疗相比，在药物滥用戒断方面(a)治疗期间（即效果速度）和(b)治疗后随访评估（即效果持久性）。第二个目的是检查干预措施对青少年性危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，与非性行为条件相比，性行为条件更有可能加速青少年实现禁欲的动机，参加和参与治疗，完成家庭作业。额外的探索性分析将检查不同的模式（MET/CBT vs. FFT）在假定的介质上的差异：MET/CBT将在青少年药物回避自我效能方面产生更大的改善，FFT将在家庭关系方面产生更大的改善（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，对每种治疗方式的相对成本进行初步估计，特别是在治疗参与/出勤和青少年再安置方面。

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.