Cost-Effectiveness & Efficacy of Computerized Therapy for Depression and Drug Use

成本效益

• 批准号: 8910848
• 负责人: Suzette V Glasner-Edwards
• 金额: $ 30万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8910848
• 关键词: Abstinence; Address; Adherence; Adult; Aftercare; Alcohol or Other Drugs use; Behavior Therapy; Behavioral; Cannabis; Clinical; Cognitive Therapy; Communities; Computer Assisted; Computers; Coping Skills; Coupled; Data; Depressed mood; Dimensions; Disease; Drug abuse; Drug usage; Effectiveness; Ensure; Evaluation; Frequencies; Future; Health; Healthcare; Impulsivity; Individual; Intervention; Intervention Studies; Investigation; K-Series Research Career Programs; Knowledge; Length; Major Depressive Disorder; Marijuana Dependence; Marijuana Smoking; Mediating; Medication Management; Mental Depression; Mental Health; Modality; Modeling; National Institute of Drug Abuse; Neurobiology; Outcome; Participant; Pharmaceutical Preparations; Pharmacotherapy; Phase; Protocols documentation; Psychiatric therapeutic procedure; Psychotherapy; Public Health; Relapse; Relative (related person); Research; Research Design; Sampling; Self Efficacy; Techniques; Technology; Testing; Therapeutic Effect; Therapeutic Studies; Treatment Protocols; Treatment Step; Treatment outcome; addiction; alternative treatment; base; computerized; cost; cost effective; cost effectiveness; depressive symptoms; discounting; disorder later incidence prevention; evidence base; health care service utilization; health related quality of life; improved; innovation; intervention effect; motivational enhancement therapy; neurobehavioral; prevent; programs; psychologic; psychosocial; reduced substance use; skills; social; treatment adherence; treatment as usual; treatment duration; treatment response; treatment strategy

DESCRIPTION (provided by applicant): The objective of this research is to improve treatment for cannabis dependent adults with comorbid major depression by augmenting depression pharmacotherapy with an innovative, integrated computer-assisted strategy combining the techniques of cognitive behavioral therapy and motivational enhancement therapy (CBT/MET) to promote relapse prevention skills, reduce cannabis use and depressive symptoms, and improve psychiatric treatment adherence. In 2007 the applicant received a Career Development Award to study an integrated CBT/MET intervention for the treatment of substance users with comorbid major depression in a primary mental health care setting. Results show that (a) cannabis dependence is among the most frequently observed addictive disorders among depressed adults in this setting; (b) integrating CBT/MET with psychiatric treatment for depression produces significant reductions in depressive symptoms and facilitates reductions in cannabis use that are comparable to those observed in psychosocial intervention studies targeting cannabis dependence. To extend this model of evidence-based psychotherapy implementation for depressed cannabis users receiving usual care (TAU) in a primary psychiatric care setting to a computer-based platform, the specific aims of this research are: 1) To conduct an RCT among 195 depressed, cannabis dependent adults receiving TAU, comparing computer-assisted, integrated CBT/MET (cICBT/MET) addressing cannabis use and depression, relative to therapist-delivered integrated CBT/MET (tICBT/MET) and TAU alone in improving cannabis use, depression, psychiatric treatment adherence, and healthcare outcomes; 2) To determine the cost-effectiveness of cICBT/MET; and 3) To examine neurobehavioral predictors and mechanisms of action of cICBT/MET, including impulsivity, operationalized by delay discounting, and self-efficacy. We hypothesize that cICBT/MET will yield superior clinical outcomes relative to TAU in reducing substance use, improving depressive symptoms and psychiatric treatment adherence, and reducing health service utilization during and after treatment. Moreover, we expect that cICBT/MET will be less costly and at least as effective as cICBT/MET. Further, we expect that cICBT/MET will have a direct effect on psychological variables that are recognized mechanisms of change in CBT and MET, and these changes will be associated with cannabis use and depression outcomes. By providing support to maximize psychiatric treatment adherence, coupled with coping skills to prevent relapse, cICBT/MET may provide a promising, cost-effective, and easily deployable strategy for the treatment of depressed cannabis users.

描述（由申请人提供）：本研究的目的是通过结合认知行为疗法和动机增强疗法（CBT / MET）技术的创新、综合计算机辅助策略来增强抑郁症药物治疗，以改善复发预防技能，减少大麻使用和抑郁症状，并提高精神科治疗依从性，从而改善患有共病重度抑郁症的大麻依赖成人的治疗。 2007 年，申请人获得了职业发展奖，以研究综合 CBT/MET 干预措施，以治疗初级精神卫生保健机构中患有共病重度抑郁症的物质使用者。结果表明，(a) 大麻依赖是这种情况下抑郁成年人中最常见的成瘾性疾病之一； (b) 将 CBT/MET 与抑郁症精神治疗相结合，可显着减少抑郁症状，并有助于减少大麻使用，这与针对大麻依赖的心理社会干预研究中观察到的结果相当。为了将这种在初级精神科护理机构中接受常规护理 (TAU) 的抑郁症大麻使用者的循证心理治疗实施模式扩展到基于计算机的平台，本研究的具体目标是：1) 在 195 名接受 TAU 的抑郁症、大麻依赖成年人中进行随机对照试验，比较解决大麻使用和抑郁症的计算机辅助综合 CBT/MET (cICBT/MET) 与治疗师提供的治疗方案 整合 CBT/MET (tICBT/MET) 和单独 TAU 来改善大麻使用、抑郁症、精神治疗依从性和医疗保健结果； 2) 确定cICBT/MET的成本效益； 3) 检查 cICBT/MET 的神经行为预测因素和作用机制，包括冲动、延迟折扣操作和自我效能。我们假设，与 TAU 相比，cICBT/MET 将在减少物质使用、改善抑郁症状和精神科治疗依从性以及减少治疗期间和治疗后的医疗服务利用率方面产生更好的临床结果。此外，我们预计 cICBT/MET 将成本更低，并且至少与 cICBT/MET 一样有效。此外，我们预计 cICBT/MET 将对心理变量产生直接影响，这些变量是 CBT 和 MET 变化的公认机制，并且这些变化将与大麻使用和抑郁结果相关。通过提供支持以最大限度地提高精神科治疗的依从性，再加上应对技巧以防止复发，cICBT/MET 可以为抑郁症大麻使用者的治疗提供一种有前景、具有成本效益且易于部署的策略。