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

描述（由申请人提供）：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，多动和冲动的发展水平不合适，再加上与大学校园生活相关的生活方式（包括酒精的增加，结构和父母监督的减少）。我们先前的研究表明，患有ADHD的大学生中与酒精相关的问题和障碍（AUD）的发生率升高; 47%患有ADHD的大学生符合酒精滥用的终身标准，23%符合依赖标准，而普通人群中的大学生分别为12%和6%。目前还没有发表的随机对照研究，研究ADHD大学生的心理社会干预措施，也没有专门针对任何年龄段人群的AUD，尽管新兴研究明确表明需要这种干预措施。此外，基于动机的简短酒精干预（BMI）通常对大学生是成功的，但在冲动性和自我调节能力差的个体中效果有限，这两种症状都是ADHD的标志，因此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，这些治疗成分对患有ADHD的大学生来说是适合发展的，并且以促进大学咨询中心设置的可移植性的方式设计。行为激活（BA）是一种简单的行为方法，旨在通过系统的努力增加个体与有价值的环境的接触，以增加有益的体验，日常活动的享受和目标导向的行为。我们已经成功地将BA应用于一系列环境中的物质使用者，包括有问题的饮酒模式的大学生。重要的是，BA对于解决ADHD相关的执行功能缺陷具有明确的相关性，这可能与参与有问题的酒精使用的倾向增加有关。此外，BA教导个人参与健康，目标导向的奖励行为，而不是依靠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ADHD大学生的问题饮酒行为。这种治疗将与大学咨询中心合作开发，以确保其在这种环境中的适用性，利用中心工作人员的焦点格鲁方法。根据焦点小组反馈修改的最终治疗手册将在80名大学生中进行I期RCT测试，这些大学生被随机分配到3个BMI + BA或BMI +支持性咨询（SC）阶段。我们预计，BMI + BA将是成功的，与BMI + SC相比，在减少有问题的酒精使用行为的升级方面，ADHD的大学生。这项治疗开发研究将为更大规模的RCT（R 01）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).