Intervention for Teens with ADHD and Substance Use

对患有多动症和药物滥用的青少年进行干预

• 批准号: 8631364
• 负责人: WILLIAM E PELHAM
• 金额: $ 58.8万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-09 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8631364
• 关键词: Abate; Abstinence; Achievement; Acute; Address; Adolescent; Adult; Affect; Alcohol or Other Drugs use; Alcohols; Attention deficit hyperactivity disorder; Behavior Disorders; Cigarette; Cognitive; Cognitive Therapy; Conflict (Psychology); Control Groups; Development; Disease; Early Intervention; Effectiveness; Enrollment; Evaluation; Family; Florida; Future; Goals; Guidelines; Illicit Drugs; Impairment; Individual; Intervention; Intervention Studies; Literature; Maintenance; Minority; Monitor; Motivation; Outcome; Parents; Participant; Pharmaceutical Preparations; Population; Preventive Intervention; Psychiatric Diagnosis; Randomized; Recruitment Activity; Relative (related person); Research; Risk; Risk Factors; Self Efficacy; Substance Addiction; Substance Use Disorder; Substance abuse problem; Teenagers; Testing; Time; Training; adolescent substance use; brief intervention; deviant; early onset substance use; evidence base; high risk; high risk sexual behavior; improved; meetings; parental monitoring; peer; primary outcome; psychosocial; public health relevance; response; secondary outcome; therapy development; treatment adherence; treatment effect; treatment response

DESCRIPTION (provided by applicant): Individuals with ADHD are at markedly high risk for increased substance use and Substance Use Disorder (SUD; Barkley et al., 2004; Charach et al, 2011; Derefinko & Pelham, in press; Lee et al., 2011; Molina & Pelham, 2003; Sibley et al., 2011). They have high rates of substance use across a wide range of substances, including illicit drugs, alcohol, and cigarettes (Arias et al., 2008; Molina & Pelham, 2003; Szobot et al., 2007), and are at risk for early onset of substance use behaviors and disorders (Arias et al., 2008; Milberger et al.,1997; Molina & Pelham, 2003). Importantly, these substance use problems do not abate over time; among individuals with adult ADHD, rates of substance use disorders approach 40% (Kalbag & Levin, 2005; Biederman et al., 1995), suggesting the need for early intervention. However, treatment of ADHD and substance use concurrently presents a number of problems for clinicians, including poor treatment adherence, lack of treatment progress, and impaired achievement of treatment goals, (Carroll & Rounsaville, 1993; Levin et al., 2004; Wise et al., 2001). Given these barriers, it is clear that future prevention and intervention development should follow the guidelines provided by the current literature on both ADHD and substance use treatment. Several psychosocial interventions for teens with SUD are well-established (Waldron & Turner, 2008; Winters & Leitten, 2007). However, typical studies that have examined efficacy of substance use interventions have conducted only secondary analyses to see if comorbid psychiatric diagnoses moderate outcome. There have been no controlled evaluations of how comorbid ADHD affects the efficacy of early intervention for early substance use. Given the strong evidence for the negative trajectory for individuals with co-occurring ADHD and substance use initiation, our goal is to conduct a controlled examination of a brief, early intervention for substance use (BEI; Teen Intervene, Winters & Leitten, 2007) modified for adolescents with ADHD by using the evidence from both treatment literatures. Importantly, this intervention will address individuals who have initiated substance use, but do not yet meet criteria for an SUD. Although brief interventions have been found to be effective in other populations, their efficacy in an ADHD population with emerging substance use remains uninvestigated. We expect BEI to be effective for some but not all ADHD teens, with lower rates of response than have been obtained with nonADHD populations. To better understand why some adolescents with ADHD and substance use initiation respond to BEI and others do not, we investigate the contributions of several cognitive, proximal and situational factors to treatment response. Finally, we will randomize non-responders to the BEI to three secondary treatment conditions (monitor only, parent training/adolescent cognitive behavioral therapy, and medication plus parent training/adolescent cognitive behavioral therapy) to determine the relative efficacy of these more intensive interventions for insufficient responders to brief treatment.

描述（由申请人提供）：患有多动症的人有明显增加药物使用和吸毒障碍的风险（SUD； Barkley等，2004； Charach等，2011； Derefinko＆Pelham，Press; Lee等，2011; Molina＆Pelham＆Pelham，2003; Sibley等，2003; Sibley等，2011）。它们在各种物质中具有较高的物质使用率，包括非法药物，酒精和香烟（Arias等，2008; Molina＆Pelham，2003; Szobot等，2007），并且有可能早期使用毒品使用行为和疾病的风险（Arias and and; Milberger et al。，1997; Molina; Molina; Molina; y Morina; Molina; 1997；重要的是，这些物质使用问题不会随着时间的流逝而减轻。在患有成人多动症的个体中，物质使用障碍率接近40％（Kalbag＆Levin，2005； Biederman等，1995），这表明需要早期干预。然而，多动症和药物使用的治疗同时为临床医生带来了许多问题，包括治疗依从性不佳，缺乏治疗进展以及治疗目标的实现受损（Carroll＆Rounsaville，1993; Levin等，2004; Wise等，2001）。鉴于这些障碍，很明显，未来的预防和干预开发应遵循当前有关多动症和药物使用治疗的文献提供的准则。针对SUD的青少年的几种社会心理干预措施已建立了良好的公认（Waldron＆Turner，2008； Winter＆Leitten，2007）。但是，研究了使用药物使用干预措施的典型研究仅进行了次要分析，以查看合并症的精神病诊断是否适中结果。没有对合并症如何影响早期干预效力的早期使用效力的控制评估。鉴于对同时发生多动症和药物使用启动的个体具有负轨迹的有力证据，我们的目标是对对药物使用的简短干预进行对照检查（Bei;青少年干预，Winters＆Leitten，2007年，2007年），通过使用两种治疗文献的证据为ADHD进行了修改。重要的是，这种干预措施将针对已发起药物使用但尚未符合SUD标准的个人。尽管已经发现短暂的干预措施在其他人群中有效，但它们在具有新兴药物使用的ADHD人群中的疗效仍未得到评估。我们希望BEI对某些但不是全部ADHD青少年有效，其响应率低于非ADHD人群的响应率。为了更好地理解为什么一些患有多动症和药物使用启动的青少年对BEI做出反应，而其他一些青少年则研究了几种认知，近端和情境因素对治疗反应的贡献。最后，我们将对BEI的非反应器随机到三种次要治疗条件（仅监测父母培训/青少年认知行为疗法，药物以及父母培训/青少年认知行为疗法），以确定这些更密集的干预措施的相对有效性，以使反应者不足以进行简短治疗。