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 ADHD 的个体物质使用增加和物质使用障碍的风险明显较高（SUD；Barkley 等人，2004 年；Charach 等人，2011 年；Derefinko & Pelham，出版中；Lee 等人，2011 年；Molina & Pelham，2003 年；Sibley 等人，2011 年）。他们对各种物质的滥用率很高，包括非法药物、酒精和香烟（Arias 等人，2008 年；Molina 和 Pelham，2003 年；Szobot 等人，2007 年），并且有早期发生物质使用行为和疾病的风险（Arias 等人，2008 年；Milberger 等人，1997 年；Molina 和 Pelham， 2003）。重要的是，这些物质使用问题不会随着时间的推移而减轻；在患有成人 ADHD 的个体中，物质使用障碍的发生率接近 40%（Kalbag & Levin，2005；Biederman 等，1995），这表明需要早期干预。然而，ADHD 的治疗和药物滥用同时给临床医生带来了许多问题，包括治疗依从性差、治疗进展缓慢以及治疗目标的实现受损（Carroll & Rouunsaville，1993；Levin 等，2004；Wise 等，2001）。考虑到这些障碍，很明显，未来的预防和干预措施的发展应遵循当前关于多动症和药物滥用治疗的文献提供的指南。针对 SUD 青少年的几种心理社会干预措施已经成熟（Waldron & Turner，2008；Winters & Leitten，2007）。然而，检查物质使用干预措施功效的典型研究仅进行了二次分析，以确定共病精神疾病诊断是否会影响结果。对于共病 ADHD 如何影响早期药物使用的早期干预效果，尚未进行对照评估。鉴于有强有力的证据表明同时发生 ADHD 和物质使用开始的个体的负面轨迹，我们的目标是利用两种治疗文献中的证据，对针对 ADHD 青少年进行的简短的早期物质使用干预（BEI；Teen Intervene，Winters & Leitten，2007）进行对照检查。重要的是，这项干预措施将针对那些已经开始使用药物但尚未达到 SUD 标准的个人。尽管已发现简短的干预措施对其他人群有效，但其对新出现药物滥用的 ADHD 人群的功效仍未得到研究。我们预计 BEI 对部分但不是所有 ADHD 青少年有效，其反应率低于非 ADHD 人群的反应率。为了更好地理解为什么一些患有 ADHD 和物质使用开始的青少年对 BEI 有反应而其他人则没有，我们调查了几种认知、近端和情境因素对治疗反应的贡献。最后，我们将 BEI 的无反应者随机分为三种次要治疗条件（仅监测、家长培训/青少年认知行为治疗、药物加家长培训/青少年认知行为治疗），以确定这些更强化的干预措施对短暂治疗反应不足的人的相对疗效。