Computer-Delivered Psychosocial Treatment for Adolescent Substance Use Disorders

描述(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年级学生尝试过违禁药物，这个年龄段的学生中超过72%的人使用过酒精。据估计，在过去十年中，年轻人滥用处方阿片类药物的比率增加了约542%。尽管存在针对青少年的有效的药物滥用治疗方案，但这些方案目前影响有限。需要药物滥用治疗的青少年中只有十分之一得到任何护理。以研究为基础的干预措施与治疗机构的实际情况相容有限，这可能对将循证做法转移到社区环境造成许多操作障碍。计算机提供的交互式心理社会干预有可能应对这些挑战，因为它能够以低成本提供复杂的干预，而不会增加对工作人员时间或培训需求的要求。它也可能被年轻人高度接受，并能够以确保忠诚的方式广泛传播以科学为基础的治疗方法。在这项应用中，我们建议开发和评估一种基于证据的、计算机提供的、针对青少年治疗物质使用障碍的心理社会干预的有效性和成本效益。据我们所知，计划中的计划将是第一个通过基于计算机的技术为青少年提供全面的、心理社会药物滥用治疗的互动计划。目标1：开发一种针对青少年物质使用障碍的交互式、计算机交付的心理社会治疗方法，该方法将以青少年社区强化方法(A-CRA)为基础，这是一种针对青少年的行为治疗方法，证明了其有效性和成本效益。目的：评价计算机辅助干预在青少年药物使用障碍门诊治疗中的效果。在对照试验中，青少年参与者将被随机分为(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在客观物质使用的主要结果和治疗保留、自我报告的药物使用、艾滋病毒危险行为、治疗联盟、心理社会功能以及参与者报告他们的治疗需求得到充分满足的程度上的相对效果。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参考。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参考，以及为计划层面的采用决策提供参考的成本效益。这些详细的成本数据将对未来向社区系统传播有效的基于计算机的行为模型的翻译项目至关重要。公共卫生相关性：据我们所知，我们计划开发的计划将是第一个互动计划，通过基于计算机的技术为青少年提供全面的、基于科学的心理社会药物滥用治疗。计划中的计划将是基于浏览器的，可以通过互联网、内联网或CD-ROM提供，允许在各种环境中使用，包括治疗计划、家庭、社区组织、学校、急诊室和医疗保健提供者办公室。拟议的研究将提供新的经验性信息，以符合成本效益的方式增加对患有药物使用障碍的青少年的循证心理社会治疗，并将促进采用有效的治疗方法。

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.