Behavioral Activation to Reduce Problem Alcohol Use in College Students with ADHD

描述(由申请者提供)：患有注意力缺陷/多动障碍(ADHD)的大学生特别容易受到有问题的酒精使用的影响，因为他们的注意力不集中、多动和冲动的发育水平，加上与大学校园生活相关的生活方式(包括接触酒精的机会增加、结构减少和父母监督)。我们之前的研究表明，患有ADHD的大学生中与酒精相关的问题和障碍(AUD)的发生率较高；47%的ADHD大学生符合酗酒的终生标准，23%的大学生符合依赖标准，而普通大学生的这一比例分别为12%和6%。目前还没有已发表的针对ADHD大学生的心理社会干预的随机对照研究，也没有专门针对这一人群中任何年龄段的AUD的研究，尽管新出现的研究明确表明需要这种干预。此外，简单的基于动机的酒精干预(BMI)在大学生中通常是成功的，但在冲动增强和自我调节能力差的个人中，益处有限，这两个特征都是ADHD的特征，这呼吁需要为这一弱势群体修改BMI。因此，确定对治疗AUDS有效的核心治疗成分是至关重要的，这些核心治疗成分适合患有ADHD的大学生的发育，并以促进可移植到大学咨询中心的方式设计。行为激活(BA)是一种简短的行为方法，旨在通过系统性的努力增加个人与有价值的环境的接触，以增加奖励体验、日常活动的乐趣和目标导向的行为。我们已经成功地将BA应用于一系列环境中的物质使用者，包括有问题饮酒模式的大学生。重要的是，BA在解决与ADHD相关的执行功能缺陷方面具有明显的相关性，这可能与参与问题酒精使用的倾向增加有关。此外，BA还教导个人参与健康的、以目标为导向的奖励行为，而不是依赖饮酒来提供即时奖励。最后，BA是一种适应性很强的干预方法。在目前的研究中，我们将开发一种基于BA的治疗方法，旨在减少患有ADHD的大学生的问题饮酒行为。这项治疗将与大学咨询中心合作开发，以确保其在这一背景下的适用性，并利用中心工作人员的重点小组方法。根据焦点小组的反馈修改了最终的治疗手册，将在I阶段RCT中对80名大学生进行测试，他们被随机分为BMI+BA或BMI+支持性咨询(SC)三个疗程。我们预计，与BMI+SC相比，BMI+BA在减少问题酒精使用行为升级方面将在患有ADHD的大学生中取得成功。这项治疗发展研究将为更大规模的随机对照试验(R01)奠定基础。

DESCRIPTION (provided by applicant): College students with Attention-Deficit/Hyperactivity Disorder (ADHD) are particularly vulnerable to problematic alcohol use, given their developmentally-inappropriate levels of inattention, hyperactivity and impulsivity, combined with the lifestyle associated with life on a college campus (including increased access to alcohol, decreased structure and parental supervision). Our prior research demonstrates elevated rates of alcohol- related problems and disorders (AUDs) among college students with ADHD; 47% of college students with ADHD meet lifetime criteria for alcohol abuse and 23% meet criteria for dependence, as compared to 12% and 6% of college students from the general population, respectively. There are currently no published randomized controlled studies examining psychosocial interventions for college students with ADHD, and none specifically targeting AUDs in this population at any age, despite the clear indication from emerging research of the need for such interventions. Moreover, brief motivation-based alcohol interventions (BMIs) that generally have been successful for college students show limited benefits among individuals with elevated impulsivity and poor self- regulation, both hallmarks of ADHD, calling for the need to modify BMIs for this vulnerable group. Thus, it is crucial to determine core treatment components that are efficacious for treating AUDs and that are developmentally-appropriate for college students with ADHD and designed in a manner which promotes transportability to the university counseling center setting. Behavioral activation (BA) is a brief behavioral approach that aims to increase individuals' contact with valued environments through systematic efforts to increase rewarding experiences, enjoyment of daily activities, and goal-directed behaviors. We have successfully applied BA to substance users in a range of settings, including college students with problematic drinking patterns. Importantly, BA has clear relevance for addressing ADHD-related executive functioning deficits, which may be associated with an increased propensity for engagement in problematic alcohol use. Further, BA teaches individuals to engage in healthy, goal-directed rewarding behaviors, rather than relying on drinking to provide immediate rewards. Finally, BA is a highly adaptable intervention approach. In the current study, we will develop a BA-based treatment intended to reduce problematic drinking behaviors among college students with ADHD. This treatment will be developed in collaboration with the University Counseling Center, to ensure its applicability within this setting, utilizing focus grou methodology with Center staff. Finalized treatment manuals, altered based on focus group feedback, will be tested in a stage I RCT among 80 college students randomized to 3 sessions of BMI + BA or BMI + supportive counseling (SC). We expect that BMI + BA will be successful with college students with ADHD, in terms of decreasing the escalation of problematic alcohol use behaviors, as compared to BMI + SC. This treatment development study will set the stage for larger-scale RCTs (R01).