Stage II Research on Outpatient Treatment for Adolescents with Comorbidity

描述（由申请人提供）：青少年药物滥用导致显着的负面结果和非凡的成本为青年，他们的家庭，社区和社会。此外，药物滥用青少年中精神科合并症的比例从25%到82%不等，与没有合并症的青少年相比，有双重诊断的青少年治疗费用是没有合并症的青少年的两倍多。对这些青年的社区治疗往往是脱节的，青年和家庭不得不为这些疾病导航单独的治疗系统，或者只接受单一疾病的治疗。值得注意的是，多项研究表明，与没有精神病诊断的青少年相比，患有并发症的青少年的结果更差，并且更经常和更快地恢复到治疗前的药物使用水平。申请人的主要研究者，一个新的研究者，最近完成了一个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，这种治疗是门诊治疗中同时发生的物质使用和内化（即，情绪和/或焦虑）问题。结果是有希望的，与对照组相比，实验组表现出显着减少物质使用和更快地减少焦虑和抑郁症状。此外，还编写了大量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），旨在比较实验性治疗（青少年门诊治疗; OPT-A）与“活性安慰剂”从治疗前到18个月的关键临床指标。拟定的RCT（n = 160）采用治疗手册、质量保证方案和治疗师培训方案，在第I阶段研究中开发并成功试点，以评价OPT-A对因同时发生的物质使用和内化问题而转诊门诊治疗的青少年的疗效。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;和消费者满意度。除了提供强有力的治疗效果测试外，拟议的项目将利用RCT的数据收集，对假定的作用机制进行初步评估。总之，这项研究将通过第一阶段行为疗法开发计划将一种有前途的治疗方法推进到第二阶段对照试验。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。干预措施解决了青少年门诊患者中最普遍和最具挑战性，成本高和研究不足的问题之一。如果成功的话，这项研究可以在治疗领域为青少年提供相当大的贡献与共同发生的物质使用和内化障碍。 公共卫生相关性：青少年药物滥用会给青少年、他们的家庭、社区和社会带来重大的负面后果和巨大的代价。此外，药物滥用青少年的精神病合并症发生率从25%到82%不等，患有双重诊断的青少年的结果更糟，治疗费用是没有合并症的青少年的两倍多。该项目在严格的临床试验中评估OPT-A，这是一种在NIDA资助的试点测试中取得有希望结果的治疗方法。

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.