Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity

项目摘要 许多患有物质使用障碍（SUD）的人也会经历严重的心理困扰或 符合常见情绪和焦虑障碍的标准，对SUD具有潜在的重要意义 结果和SUD治疗效果。研究这些影响对于确定最佳的 治疗患有共病的患者。过去关于此类合并症影响的研究 结果喜忧参半，主要是由于样本量小或依赖于观察性研究。在这 提案，一项关于1）情绪和焦虑症以及2）心理困扰的影响的大规模研究 使用来自5,000多名患者的数据，提出了SUD结局和SUD治疗效果的协方差分析 来自20项SUD药物和心理社会治疗的随机对照试验（RCT） 由国家药物滥用研究所赞助。我们的目标包括使用现代个人参与者 荟萃分析方法，结合联合收割机的个人水平的数据，并检查是否和在多大程度上SUD 结果和SUD治疗效果在有和没有合并症的患者中不同。成果将包括 保留治疗至试验结束，继续使用经尿液毒理学和自我检查确定的药物， 报告和社会成果（包括职业成果和刑事司法参与）。在目标1中，数据 来自随机对照试验的研究将被结合起来，以检查精神病合并症的影响（即，情绪和焦虑症 以及心理困扰）对SUD结局的影响，不考虑治疗组， 使用混合效应回归模型。RCT样本将在社会人口统计学方面保持平衡 以及使用倾向评分方法在研究中可能不同的临床因素。Aim 2将使用类似的 通过检查合并症对SUD治疗效果的调节作用的方法 混合回归模型中SUD治疗与共病的相互作用项。在目标3中，我们将研究 伴随药物治疗情绪和焦虑障碍是否会改变这些影响， 疾病对SUD结局和SUD治疗效果的影响。在目标4中，我们将对RCT样本重新加权， 类似于普通人群中接受治疗的SUD个体的目标样本，以解决 从SUD RCT中排除（可能代表性不足）重度精神疾病患者。 将重新称重样品的结果与原始未称重样品的结果进行比较。的 该项目显著推进了关于这些合并症对SUD结局和SUD影响的研究 使用来自一个前所未有的大组严格进行的个人参与者数据的治疗效果 使用一套核心标准化评估和一致的结局指标的试验。

Project Summary Many individuals with substance use disorders (SUDs) also experience significant psychological distress or meet the criteria for common mood and anxiety disorders with potentially significant implications for SUD outcomes and SUD treatment effects. Examining these implications is important for identifying optimal treatments for patients with comorbid conditions. Past research on the impact of such comorbidities has produced mixed results, mainly due to small sample sizes or reliance on observational studies. In this proposal, a large-scale study of the impact of 1) mood and anxiety disorder as well as 2) psychological distress comorbidity on SUD outcomes and SUD treatment effects is proposed using data from over 5,000 patients from 20 randomized controlled trials (RCTs) of pharmacological and psychosocial treatments of SUDs sponsored by the National Institute on Drug Abuse. Our aims include the use of modern individual participant meta-analytic methods to combine the individual level data and to examine whether and to what extent SUD outcomes and SUD treatment effects vary among patients with and without comorbidity. Outcomes will include retention in treatment to the end of the trial, continued use of drugs ascertained by urine toxicology and self- report, and social outcomes (including occupational outcomes and criminal justice involvement). In Aim 1, data from RCTs will be combined to examine the impact of psychiatric comorbidity (i.e., mood and anxiety disorders as well as psychological distress, jointly and separately) on the SUD outcomes, irrespective of treatment arm, using mixed effect regression models. The RCT samples will be balanced with regards to socio-demographic and clinical factors that may vary across studies using propensity score methods. Aim 2 will use a similar methodology to examine the moderating effect of comorbidity on SUD treatment effects by examining interaction terms of SUD treatment by comorbidity in mixed regression models. In Aim 3, we will examine whether concomitant medication treatment of mood and anxiety disorders will change the impact of these disorders on the SUD outcomes and SUD treatment effects. In Aim 4, we will reweight the RCT samples to resemble target samples of individuals with SUDs receiving treatment in the general population to address exclusion (and possible under-representation) of patients with severe psychiatric conditions from SUD RCTs. The results from reweighted samples will be compared with the results of the original unweighted samples. The project significantly advances research on the impact of these comorbidities on SUD outcomes and SUD treatment effects using individual participant data from an unprecedentedly large group of rigorously conducted trials that have used a core set of standardized assessments and consistent outcome measures.