Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity

药物使用治疗结果：精神共病的影响

• 批准号: 10634124
• 负责人: Rosa M. Crum
• 金额: $ 36.03万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-15 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634124
• 关键词: Abstinence; Address; Anxiety Disorders; Behavior Therapy; Caring; Characteristics; Clinical; Clinical Trials; Cocaine; Communities; Criminal Justice; Data; Disease; Drug usage; Effectiveness; Exclusion; Family; Future; General Population; Health; Health Services; Heterogeneity; Individual; Investments; Legal; Measures; Medical; Mental Health Services; Mental disorders; Meta-Analysis; Metadata; Methamphetamine; Methodology; Methods; Modeling; Modernization; Mood Disorders; National Institute of Drug Abuse; Observational Study; Occupational; Outcome; Outcome Measure; Participant; Patient Care; Patient Self-Report; Patients; Pharmaceutical Preparations; Placebos; Psychiatric Diagnosis; Psychiatric therapeutic procedure; Randomized, Controlled Trials; Research; Sample Size; Sampling; Scoring Method; Services; Site; Social Justice; Social outcome; Standardization; Stimulant; Substance Use Disorder; Target Populations; Techniques; Toxicology; Treatment outcome; Urine; Variant; Weight; Work; analytical method; comorbidity; data harmonization; experience; improved; multidisciplinary; optimal treatments; pharmacologic; psychiatric comorbidity; psychological distress; psychosocial; reduced substance use; screening; severe mental illness; social; sociodemographics; substance use treatment; treatment adherence; treatment arm; treatment as usual; treatment effect; treatment program; trial design

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.

项目摘要 许多患有药物使用障碍（SUD）的人也经历了严重的心理困扰或 符合常见情绪和焦虑症的标准，对SUD具有重要意义 结果和SUD治疗效果。检查这些含义对于确定最佳 对患有合并症的患者的治疗。过去关于这种合并症影响的研究 产生的结果混合了，主要是由于样本量较小或依赖观察性研究。在这个 提案，一项关于1）情绪和焦虑症的影响的大规模研究以及2）心理困扰 使用5,000多名患者的数据提出了对SUD结果和SUD治疗效果的合并症 来自SUD的20种随机对照试验（RCT） 由美国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 荟萃分析方法结合了单个级别数据并检查是否以及在何种程度上SUD 与合并症有或没有合并症患者的结果和SUD治疗效果各不相同。结果将包括 在试验结束时保留治疗，继续使用尿液毒理学和自我确定的药物 报告和社会成果（包括职业成果和刑事司法参与）。在AIM 1中，数据 从RCT中将合并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，共同和分别）在SUD结果上，无论治疗部门如何 使用混合效应回归模型。 RCT样本将与社会人口统计学平衡 以及使用倾向评分方法在研究中可能有所不同的临床因素。 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论 混合回归模型中合并症的SUD治疗的相互作用术语。在AIM 3中，我们将检查 情绪和焦虑症的伴随药物治疗是否会改变这些影响 SUD结果和SUD治疗效果的疾病。在AIM 4中，我们将将RCT样品重新持续到 类似于在普通人群接受治疗的泡沫的个体的目标样本以解决 SUD RCT严重精神病患者的排除（可能不足的代表性不足）。 将重新加权样品的结果与原始未加权样品的结果进行比较。这 项目对这些合并症对SUD结果和SUD的影响的研究大大提高了研究 使用来自前所未有的大型严格进行的个人参与者数据的治疗效果 使用了一系列标准化评估和一致的结果指标的试验。