Treating Co-Occurring PTSD and Substance Abuse in High-Risk Transition Age Youth

该指导以患者为导向的研究职业发展奖（K23）的目标是将申请人发展成为一名独立的研究人员，准备领导大规模严格设计的治疗结果研究，重点是高危青年。具体而言，申请人将专注于针对高风险过渡年龄青年的物质使用障碍（SUD）和创伤后应激障碍（PTSD）的综合治疗。拟议的职业发展和研究计划建立在申请人在临床心理学，创伤人群和创伤后应激障碍治疗方面的先前培训基础上。研究目标与NIDA战略计划的目标2一致，即“开发成功的药物滥用和成瘾治疗方法，改善治疗的可及性和实施”，特别是目标2.2，“开发与共病相关的药物滥用和成瘾治疗方法。“通过拟议的培训计划，申请人将：（1）发展循证SUD治疗方面的专业知识;（2）发展进行临床试验的技能;（3）精通SUD和PTSD综合干预方法;（4）获得过渡年龄青年研究和治疗方面的专业知识。培训活动将包括 来自SUD治疗、临床试验和过渡领域专家团队的指导 年龄青年; SUD治疗的强化培训; [关于纵向统计方法的专家咨询和培训;]关于开展临床试验和保护人类受试者的课程和讲座;以及参加科学讲习班和会议。申请人将应用这些技能进行试点研究，旨在通过整合和调整现有的经验支持的SUD（应急管理）和PTSD（长期暴露）干预措施，开发和评估针对高危过渡年龄青少年的综合SUD/PTSD治疗。）。该项目将分[三个阶段]进行：1）使用迭代方法整合和调整治疗方案; [2]申请人对方案进行初步试点和修订B;]和3）一项试点可行性研究的综合治疗与样本[30]司法参与过渡年龄的青年，以检查可接受性，安全性，主要结果（物质使用的自我报告和生物学测量，PTSD的自我报告和访谈测量）和次要结果（刑事司法参与的自我报告和档案记录，适应功能的自我报告）的症状减轻。拟议的研究计划将遵循行为疗法阶段模型（卡罗尔和Nuro，2002）的治疗开发建议，重点是阶段1a和1b研究。考虑到过渡年龄青年中SUD/PTSD共病的高发病率和特别有害的影响，本申请的目标有可能解决一个重要而昂贵的公共卫生问题。由于共病PTSD的存在极大地干扰了有效的SUD治疗，因此为这一人群开发综合循证治疗至关重要。

DESCRIPTION (provided by applicant): The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to develop the applicant into an independent investigator prepared to lead large-scale rigorously designed treatment outcome research focused on high-risk youth. Specifically, the applicant will focus on integrated treatments for substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) targeting high-risk transition age youth. The proposed career development and research plan builds on the applicant's prior training in clinical psychology, trauma populations, and PTSD treatments. The research aims are consistent with Goal 2 of the NIDA Strategic Plan, "to develop successful treatments for drug abuse and addiction and improve treatment accessibility and implementation" and specifically, Objective 2.2, "to develop treatments for drug abuse and addiction in association with comorbid conditions." Through the proposed training plan, the applicant will: (1) develop expertise in evidence-based SUD treatments; (2) develop the skill set to conduct clinical trials; (3) become proficient in approaches for integrating interventions for SUDs and PTSD; and (4) gain expertise in the study and treatment of transition age youth. Training activities will include mentorship from a team of experts in the fields of SUDs treatments, clinical trials, and transition age youth; intensive training in SUDs treatment; [expert consultation and training on longitudinal statistical methods;] coursework and lectures on conducting clinical trials and protection of human subjects; and participation in scientific workshops and conferences. The applicant will apply these skills to pilot research aimed at developing and evaluating an integrated SUD/PTSD treatment for high-risk transition age youth through the integration and adaptation of existing empirically supported interventions for SUDs (Contingency Management) and PTSD (Prolonged Exposure). The project will be conducted in [three phases]: 1) integration and adaptation of the treatment protocol using an iterative approach; [2) initial piloting and revision of the protocol b the applicant;] and 3) a pilot feasibility study of the integrated treatment with a sample of [30] justice-involved transition age youth to examine acceptability, safety, and symptom reduction in both primary (self-report and biological measures of substance use, self-report and interview measures of PTSD) and secondary outcomes (self-report and archival records of criminal justice involvement, self-report of adaptive functioning). The proposed research plan will adhere to the treatment development recommendations of the Stage Model of Behavioral Therapies (Carroll & Nuro, 2002), with a focus on Stage 1a and 1b research. Given the high rates and particularly detrimental effects of comorbid SUD/PTSD among transition age youth, the goals of this application have the potential to address an important and costly public health problem. As the presence of comorbid PTSD greatly interferes with effective SUDs treatment, development of an integrated evidence-based treatment for this population is critical.