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

描述(由申请者提供)：这项以患者为导向的研究职业发展奖(K23)的目标是将申请者培养成一名独立的调查者，准备领导以高危青年为重点的大规模、严格设计的治疗结果研究。具体地说，申请者将专注于针对高危过渡年龄青年的物质使用障碍(SUDS)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先前在临床心理学、创伤人群和创伤后应激障碍治疗方面的培训基础上。这项研究的目标与NIDA战略计划的目标2“开发成功的药物滥用和成瘾治疗方法，并改善治疗的可及性和实施”是一致的，具体地说，目标2.2“开发与共病有关的药物滥用和成瘾的治疗方法”。通过拟议的培训计划，申请者将：(1)发展循证SUD治疗方面的专门知识；(2)发展进行临床试验的技能；(3)熟练掌握整合SUDS和创伤后应激障碍干预措施的方法；以及(4)获得过渡年龄青年研究和治疗方面的专门知识。培训活动将包括 肥皂水治疗、临床试验和过渡领域专家团队的指导 青少年；肥皂泡治疗方面的强化培训；[关于纵向统计方法的专家咨询和培训；]关于进行临床试验和保护人体受试者的课程作业和讲座；以及参加科学讲习班和会议。申请者将把这些技能应用于试验性研究，旨在通过整合和适应现有的经经验支持的SUDS(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年的SUD/PTSD综合治疗。该项目将分[三个阶段]进行：1)采用迭代方法整合和调整治疗方案；[2)初步试行和修订方案；b)对申请者进行初步试验和修订；3)对[30]涉及司法的过渡年龄青年进行一项综合治疗的试点可行性研究，以检查初级结果(药物使用情况的自我报告和生物措施、创伤后应激障碍的自我报告和面谈措施)和次要结果(刑事司法介入的自我报告和档案记录、适应功能的自我报告)的可接受性、安全性和症状减轻情况。拟议的研究计划将遵循行为疗法阶段模式(Carroll&Nuro，2002)的治疗发展建议，重点放在1a和1b阶段研究上。考虑到在过渡年龄的年轻人中，SUD/PTSD的高发病率和特别有害的影响，这项应用的目标有可能解决一个重要的和昂贵的公共卫生问题。由于合并创伤后应激障碍的存在极大地干扰了有效的肥胖症治疗，为这一人群开发一种综合的循证治疗是至关重要的。

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.