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)：ADHD患者有明显增加的药物使用和物质使用障碍的风险(Sud；Barkley等人，2004；Charach等人，2011；Derefinko&Pelham出版社；Lee等人，2011；Molina&Pelham等人，2003；Sibley等人，2011)。他们在包括非法药物、酒精和香烟在内的各种物质中的药物使用率很高(Arias等人，2008年；Molina和Pelham等人，2003年；Szobot等人，2007年)，并有过早出现药物使用行为和障碍的风险(Arias等人，2008年；Milberger等人，1997年；Molina和Pelham等人，2003年)。重要的是，这些物质使用问题不会随着时间的推移而减少；在成人ADHD患者中，物质使用障碍的发生率接近40%(KalBag&Levin，2005；Biederman等人，1995)，这表明需要早期干预。然而，ADHD的治疗和药物使用同时给临床医生带来了许多问题，包括治疗依从性差，治疗缺乏进展，以及治疗目标的实现受阻(Carroll&Rounaville，1993；Levin等人，2004；Wise等人，2001)。鉴于这些障碍，很明显，未来的预防和干预发展应该遵循目前关于ADHD和药物使用治疗的文献提供的指导方针。有几种针对青少年SUD的心理社会干预措施是行之有效的(Waldron&Turner，2008；Wters&Leitten，2007)。然而，检验药物使用干预措施有效性的典型研究只进行了二次分析，以确定合并精神疾病诊断是否会产生适度的结果。对于共病的ADHD如何影响早期药物使用的早期干预效果，目前还没有对照评估。鉴于同时患有ADHD和药物使用开始的个体的负面轨迹有强有力的证据，我们的目标是通过使用这两个治疗文献中的证据，对针对ADHD青少年修改的短暂的、早期的物质使用干预(BEI；Teen Interaction，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，但还不符合SUD标准的个人。尽管简单的干预措施已被发现在其他人群中有效，但其在ADHD人群中的有效性仍未得到调查。我们预计BEI对部分但不是所有ADHD青少年有效，与非ADHD人群相比，反应率更低。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，而另一些不是，我们调查了几个认知、近端和情景因素对治疗反应的贡献。最后，我们将BEI的无反应者随机分成三种二级治疗条件(仅监测、家长培训/青少年认知行为疗法和药物加家长培训/青少年认知行为疗法)，以确定这些更密集的干预措施对反应不足的人进行简单治疗的相对疗效。