Stage II Research on Outpatient Treatment for Adolescents with Comorbidity

描述(由申请者提供)：青少年滥用药物会给青少年、他们的家庭、社区和社会带来严重的负面后果和额外的代价。此外，在滥用药物的青少年中，精神疾病的共患率从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青少年的两倍多。对这些青少年的社区治疗往往是脱节的，青少年和家庭不得不通过不同的治疗系统来治疗这些疾病，或者只接受单一疾病的治疗。值得注意的是，多项研究表明，与没有精神疾病诊断的青少年相比，患有共生问题的青少年结局更差，恢复到治疗前的药物使用水平更频繁、更快。申请的首席调查员是一名新的调查员，最近完成了NIDA资助的第一阶段项目，重点是开发和试行一种专门针对青少年的心理社会治疗，这些青少年在门诊接受药物使用和内化(即情绪和/或焦虑)问题的治疗。结果是令人振奋的，与对照组相比，实验组显示出明显减少的药物使用，并更快地减少焦虑和抑郁症状。此外，还编写了广泛的治疗和治疗师培训手册。这项拟议的研究是一项第二阶段随机临床试验(RCT)，旨在比较试验性治疗(青少年门诊治疗；OPT-A)和“活性安慰剂”在治疗前至18个月期间的关键临床指标。拟议的随机对照试验(n=160)采用在第一阶段研究中开发并成功试行的治疗手册、质量保证方案和治疗师培训方案，以评估针对青少年的OPT-A的疗效，该OPT-A涉及门诊治疗共生物质使用和内化问题。将评估以下结果：药物使用；精神健康；行为、学校、同伴和家庭功能；以及消费者满意度。除了提供强有力的治疗效果测试外，拟议的项目还将利用随机对照试验的数据收集，对假定的行动机制进行初步评估。总而言之，这项研究将把通过第一阶段行为疗法开发计划开发的有前景的治疗推进到第二阶段对照试验。它建立在已经开发的治疗手册、治疗师培训材料和质量保证体系的基础上。该干预措施解决了青少年门诊患者中更普遍、最具挑战性、成本最高、研究较少的问题之一。如果成功，这项研究可能会在治疗患有物质使用和内在性障碍的青少年领域做出相当大的贡献。 与公共健康相关：青少年滥用药物会给青少年、他们的家庭、社区和社会带来严重的负面后果和额外的代价。此外，在滥用药物的青少年中，精神疾病的共患率从25%到82%不等，患有双重诊断的青少年的结果更差，治疗费用是没有共病青少年的两倍以上。该项目在一项严格的临床试验中评估了OPT-A，这是一种在NIDA资助的中试测试中取得了有希望的结果的治疗方法。

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.