Computer-Delivered Psychosocial Treatment for Adolescent Substance Use Disorders

计算机提供的针对青少年药物使用障碍的心理社会治疗

• 批准号: 7507017
• 负责人: Lisa A. Marsch
• 金额: $ 59.91万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-01 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7507017
• 关键词: Abstinence; Accident and Emergency department; Address; Adolescent; Adolescent Behavior; Adoption; Adult; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Behavior Therapy; Behavioral; Behavioral Model; Caring; Client; Clinical; Communities; Complex; Computers; Data; Dependence; Development; Drug usage; Economics; Effectiveness; Ensure; Evidence based intervention; Evidence based practice; Evidence based treatment; Feedback; Financial cost; Focus Groups; Future; HIV; HIV Infections; Health Personnel; Home environment; Illicit Drugs; Internet; Intervention; Intranet; Knowledge; Learning; Link; Medical; Methods; Modeling; Nature; Opioid; Outcome; Outcome Measure; Outpatients; Parents; Participant; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Process; Professional counselor; Psychological reinforcement; Public Health; Quality-Adjusted Life Years; Randomized; Relative (related person); Reporting; Research; Research Design; Resources; Rewards; Risk; Risk Behaviors; Schools; Science; Series; Staging; Substance Use Disorder; Substance abuse problem; System; Technology; Testing; Text; Therapeutic; Therapeutic Intervention; Time; Toxicology; Training; Translations; Treatment Cost; Treatment Efficacy; Urine; Work; Youth; adolescent substance use; age group; animation; base; community organizations; computer program; computerized; control trial; cost; cost effectiveness; effective therapy; effectiveness measure; evidence base; experience; improved; meetings; novel therapeutic intervention; novel therapeutics; primary outcome; programs; psychologic; psychosocial; public health relevance; secondary outcome; skills; social; standard care; therapy development; tool; treatment program; young adult

DESCRIPTION (provided by applicant): Substance use among youth remains a major public health problem. About half of all 12th graders have tried an illicit drug and over 72% of this same age group has used alcohol. Rates of abuse of prescription opioids among youth are estimated to have increased about 542% in the past decade. Although effective substance abuse treatment programs for youth exist, they are currently of limited reach. Only 1 in 10 adolescents who need substance abuse treatment receive any care. The limited compatibility of research-based interventions with treatment agency realities may present numerous operational barriers to the transfer of evidence-based practice into community-based settings. An interactive, computer-delivered psychosocial intervention has the potential to address these challenges, as it allows for complex interventions to be delivered at a low cost, without increasing demands on staff time or training needs. It may also be highly acceptable to youth and enable widespread dissemination of science- based treatment in a manner that ensures fidelity. In this application, we propose to develop and evaluate the efficacy and cost-effectiveness of an evidence-based, computer-delivered, psychosocial intervention for adolescents in treatment for substance use disorders. To our knowledge, the planned program will be the first interactive program to provide comprehensive, psychosocial substance abuse treatment to adolescents via computer-based technology. AIM 1: Develop an interactive, computer-delivered, psychosocial treatment for adolescent substance use disorders, which will be grounded in the Adolescent Community Reinforcement Approach (A-CRA), a behavioral treatment for adolescents of demonstrated effectiveness and cost-effectiveness. AIM 2: Evaluate the efficacy of the computer-delivered intervention with adolescents in outpatient treatment for substance use disorders. Adolescent participants in a controlled trial will be randomized to (1) therapist-delivered A-CRA, (2) computer-delivered A-CRA or (3) standard treatment. We will evaluate the relative efficacy of these interventions on the primary outcome of objective substance use and secondary outcomes of treatment retention, self-reported drug use, HIV risk behavior, therapeutic alliance, psychosocial functioning, and the extent to which participants report their treatment needs are adequately met. AIM 3: Perform a comprehensive economic analysis to provide necessary information to inform a decision regarding adoption of this new therapeutic tool. We will estimate a societal incremental cost- effectiveness ratio (ICER) to inform an adoption decision from a societal perspective, as well as the cost- effectiveness to inform an adoption decision at the program level. These detailed cost data will be vital to future translational projects to disseminate effective computer-based behavioral models to community systems. PUBLIC HEALTH RELEVANCE: To our knowledge, the program we propose to develop will be the first interactive program to provide comprehensive, science-based psychosocial substance abuse treatment to adolescents via computer-based technology. The planned program will be browser-based and can be delivered via Internet, intranet or CD- ROM, allowing for its use in a wide variety of settings, including treatment programs, home, community organizations, schools, emergency rooms, and health care providers' offices. The proposed research will contribute new empirical information relevant to increasing the delivery of evidence-based psychosocial treatment to adolescents with substance use disorders in a manner that is cost-effective and will promote the adoption of effective treatment.

描述（由申请人提供）：青少年使用药物仍然是一个主要的公共卫生问题。大约一半的12年级学生尝试过非法药物，超过72%的同龄人使用过酒精。据估计，在过去十年中，青年人滥用处方阿片类药物的比例增加了约542%。虽然存在针对青年的有效药物滥用治疗方案，但目前这些方案的覆盖面有限。只有十分之一需要药物滥用治疗的青少年得到任何照顾。以研究为基础的干预措施与治疗机构的现实情况的兼容性有限，这可能会给循证实践向社区环境的转移带来许多业务障碍。一个互动的、由计算机提供的心理社会干预措施有可能应对这些挑战，因为它可以以低成本提供复杂的干预措施，而不增加对工作人员时间或培训需求的要求。它也可能是青年高度接受的，并能够以确保忠实的方式广泛传播以科学为基础的治疗。在这个应用程序中，我们建议开发和评估的有效性和成本效益的循证，计算机交付，心理社会干预青少年在治疗物质使用障碍。据我们所知，计划中的方案将是第一个通过计算机技术向青少年提供全面的社会心理药物滥用治疗的互动方案。目标1：为青少年药物使用障碍制定一种互动的、计算机提供的心理社会治疗方法，该方法将以青少年社区强化方法为基础，这是一种经证明有效和具有成本效益的青少年行为治疗方法。目的2：评价青少年物质使用障碍门诊治疗中计算机提供的干预的有效性。对照试验中的青少年受试者将随机接受（1）治疗师提供的A-CRA，（2）计算机提供的A-CRA或（3）标准治疗。我们将评估这些干预措施对客观物质使用的主要结局和治疗保留、自我报告的药物使用、HIV风险行为、治疗联盟、心理社会功能的次要结局的相对有效性，以及参与者报告其治疗需求得到充分满足的程度。目标3：进行全面的经济分析，以提供必要的信息，为采用这种新的治疗工具的决定提供信息。我们将估计社会增量成本效益比（ICER），以从社会角度为采用决策提供信息，以及在项目层面为采用决策提供信息的成本效益。这些详细的成本数据对于未来的翻译项目至关重要，这些项目将有效的基于计算机的行为模型传播到社区系统。公共卫生相关性：据我们所知，我们建议开发的项目将是第一个通过计算机技术为青少年提供全面的、以科学为基础的心理社会药物滥用治疗的互动项目。计划中的程序将基于浏览器，可以通过互联网、内联网或CD-ROM提供，允许其在各种环境中使用，包括治疗程序、家庭、社区组织、学校、急诊室和卫生保健提供者的办公室。拟议的研究将有助于新的经验信息，以增加提供以证据为基础的心理治疗，以具有成本效益的方式与物质使用障碍的青少年，并将促进采用有效的治疗。