Stage II Research on Outpatient Treatment for Adolescents with Comorbidity

描述（由申请人提供）：青少年药物滥用会给青少年、他们的家庭、社区和社会带来显著的负面结果和巨大的成本。此外，在滥用药物的青少年中，精神疾病的共病率从25%到82%不等，患有双重诊断的青少年的治疗费用是没有共病的青少年的两倍多。以社区为基础的对这些青年的治疗往往是脱节的，青年和家庭不得不面对不同的疾病治疗系统，或者只接受一种疾病的治疗。值得注意的是，多项研究表明，与没有精神病诊断的年轻人相比，同时出现问题的年轻人的结果更糟糕，而且更频繁、更快地恢复到治疗前的药物使用水平。申请人的首席研究员，一名新研究员，最近完成了nida资助的第一阶段项目，重点是开发和试点一种心理社会治疗方法，专门针对在门诊治疗中同时出现药物使用和内化（即情绪和/或焦虑）问题的青少年。与对照组相比，实验组的药物使用明显减少，焦虑和抑郁症状减轻得更快，结果令人鼓舞。此外，还编制了广泛的治疗和治疗师培训手册。拟议的研究是一项II期随机临床试验（RCT），比较实验治疗（青少年门诊治疗；OPT-A）和“活性安慰剂”从治疗前到18个月的关键临床指标。拟议的RCT （n = 160）采用治疗手册、质量保证协议和治疗师培训协议，并在I期研究中成功试点，以评估OPT-A对青少年门诊治疗共同发生的物质使用和内化问题的疗效。将评估以下结果：药物使用；心理健康;行为、学校、同伴和家庭功能；以及消费者满意度。除了对治疗效果进行强有力的测试外，拟议的项目还将利用随机对照试验收集的数据对假定的作用机制进行初步评估。综上所述，这项研究将把一种有希望的治疗方法从第一阶段的行为治疗发展计划推进到第二阶段的对照试验。它建立在治疗手册、治疗师培训材料和已经开发的质量保证系统的基础上。该干预措施解决了青少年门诊患者中最普遍、最具挑战性、成本高、研究不足的问题之一。如果成功，这项研究可以提供相当大的贡献在治疗领域的青少年同时发生的物质使用和内化障碍。

DESCRIPTION (provided by applicant): Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual diagnosis are more than twice as costly to treat compared to those with no comorbidity. Community-based treatment for these youth most often is disjointed, with youth and families having to navigate separate treatment systems for the disorders or only receiving treatment for a single disorder. Notably, multiple studies have shown that youth with co-occurring problems have worse outcomes and return to pre-treatment levels of substance use more often and more rapidly than those without a psychiatric diagnosis. The applicant principal investigator, a new investigator, recently completed a NIDA-funded Stage I project focused on developing and piloting a psychosocial treatment specifically for youth presenting for outpatient treatment with co-occurring substance use and internalizing (i.e., mood and/or anxiety) problems. Results were promising with the experimental group exhibiting significantly less substance use and more rapid reductions in anxiety and depressive symptoms compared to the control group. In addition, extensive treatment and therapist training manuals were generated. The proposed research is a Stage II randomized clinical trial (RCT) to compare the experimental treatment (OutPatient Treatment for Adolescents; OPT-A) to an "active placebo" on key clinical indices from pre-treatment through 18 months. The proposed RCT (n = 160) employs the treatment manual, quality assurance protocol, and therapist training protocol developed and successfully piloted in the Stage I study, to evaluate the efficacy of OPT-A for youth referred to outpatient treatment of co- occurring substance use and internalizing problems. The following outcomes will be evaluated: drug use; mental health; behavioral, school, peer, and family functioning; and consumer satisfaction. In addition to providing a strong test of treatment efficacy, the proposed project will leverage the data collection of the RCT to provide a preliminary evaluation of putative mechanisms of action. In summary, this study will advance a promising treatment developed through the Stage I behavioral therapies development program to a Stage II controlled trial. It builds on the treatment manual, therapist training materials, and quality assurance system already developed. The intervention addresses one of the more prevalent and most challenging, costly, and understudied presenting problems among adolescent outpatients. If successful, this research could provide a considerable contribution in the treatment field for youth with co-occurring substance use and internalizing disorders. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual diagnosis have worse outcomes and are more than twice as costly to treat than their counterparts with no comorbidity. This project evaluates OPT-A, a treatment that had promising results in NIDA-funded pilot testing, in a rigorous clinical trial.