Family Intervention for Teen Drinking and Alcohol-related Crises in the ER

急诊室青少年饮酒和酒精相关危机的家庭干预

• 批准号: 7788004
• 负责人: CYNTHIA Lyn ROWE
• 金额: $ 68.25万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7788004
• 关键词: Abstinence; Accident and Emergency department; Acute; Address; Adolescence; Adolescent; Adult; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohol dependence; Alcohol or Other Drugs use; Alcoholism; Alcohols; American; Area; Arts; Behavior; Behavior Therapy; Caring; Chronic; Clinical; Communities; Continuity of Patient Care; Costs and Benefits; Development; Diagnostic; Distress; Drug abuse; Drug usage; Drunk driving; Effectiveness; Emergency Situation; Enrollment; Etiology; Family; Family Relationship; Family Research; Family member; Family psychotherapy; Foundations; Functional disorder; Growth; Health; Healthcare; Home environment; Hospitals; Hour; Injury; Intake; Intervention; Knowledge; Link; Mediator of activation protein; Medical; Mental Health; Mental disorders; Methods; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Outcome; Parenting behavior; Parents; Participant; Pattern; Pediatric Hospitals; Pharmaceutical Preparations; Policy Maker; Preventive Intervention; Provider; Public Health; Randomized; Randomized Controlled Trials; Recommendation; Relapse; Relative (related person); Reporting; Research; Research Personnel; Research Priority; Risk; Risk Behaviors; Risk Factors; Risk-Taking; Role; Sampling; Schools; Services; Societies; Surgeon; System; Techniques; Teenagers; Testing; Therapeutic; Time; United States Substance Abuse and Mental Health Services Administration; Universities; Visit; Vulnerable Populations; Youth; adolescent alcohol; adolescent alcohol abuse; adolescent drug abuse; adolescent substance abuse; alcohol abuse therapy; alcohol expectancy; alcohol intervention; alcohol measurement; alcohol relapse; alcohol research; alcohol services; base; binge drinking; control trial; coping; cost; design; drinking; effective intervention; effective therapy; family influence; follow-up; group intervention; improved; innovation; intervention effect; medical specialties; meetings; motivational enhancement therapy; parental influence; peer; prevent; problem drinker; public health relevance; reduced alcohol use; response; standard care; substance abuse treatment; trauma centers; trauma units; treatment center; treatment duration; treatment effect; treatment program; underage drinker; underage drinking; underage drinking reduction

DESCRIPTION (provided by applicant): Alcohol continues to be the drug of choice among American youth and teen drinking remains one of the nation's most serious public health problems. Yet in the Surgeon General's recent "Call to Action to Prevent and Reduce Underage Drinking" (USDHHS, 2007), he asserted that "underage drinking is not inevitable, and schools, parents, and other adults are not powerless to stop it." Accordingly, in line with scientific recommendations and NIAAA's (2006) research priorities, we propose to further develop and rigorously test two family interventions for adolescent alcohol problems, Multidimensional Family Therapy (MDFT) and a Family Motivational Interviewing Intervention (FMII). Family interventions have strong research and clinical traditions in the treatment of adult alcoholism and adolescent drug abuse, but little research has focused on family interventions for teen drinking. In this controlled trial, 250 youth ages 12 to 18 with alcohol-related crises in the ER or trauma center will be randomized to one of these two family interventions or to standard care. Both family interventions, MDFT and FMII, aim to potentiate the influence of the family to motivate and help youth to change, but they rely on different theoretical foundations and clinical techniques. Both family interventions provide 2 initial engagement sessions in the homes of participants within 72 hours of the ER visit. Youth in MDFT will then be engaged into a full course (3 months) of this family-centered treatment, and FMII youth will be enrolled into 3 months of behaviorally oriented 12-step group treatment. Standard care participants will be referred to the same group treatment as youth in FMII, but will receive no engagement or family sessions. We propose a randomized controlled trial with five aims: 1. To investigate the engagement potential and effectiveness of a family-centered intervention (MDFT) and Family Motivational Interviewing Intervention (FMII)/group for teens with alcohol-related crises; 2. To explore differential treatment effects with comorbid adolescents; 3. To examine the role of motivation and family factors as treatment mediators; 4. To examine long-term abstinence, patterns and predictors of relapse up to 18 months follow-up; and 5. To compare the total and net monetary benefits to society of MDFT, FMII/group, and standard care. A multiple time point (intake, 3, 6, 9, 12, and 18 month follow-up), multiple domain and method assessment approach will be used to compare the interventions on their engagement and retention rates, clinical outcomes, and total and net monetary benefits to society. Latent growth curve modeling and other state-of-the-art statistical techniques will be used to test study hypotheses regarding adolescent and family change over time, differential effects of the interventions on comorbid youth, the mechanisms by which the treatments achieve their effects, and relapse patterns and predictors. The study has significant potential to advance adolescent alcohol treatment by providing new knowledge to providers and policy makers about effective and cost-beneficial family interventions for youth identified with alcohol problems in the ER and ultimately in other health care settings. PUBLIC HEALTH RELEVANCE: Adolescent alcohol abuse is one of the nation's most serious public health problems, and youth presenting for alcohol-related crises in the emergency room (ER) represent a particularly vulnerable group (Maio et al 2000). Findings from the proposed study have the potential to yield new knowledge for providers and policy makers to guide decisions about implementing the most effective and cost-beneficial alcohol interventions for youth in the ER and other public health care settings. Further, better understanding of the treatments' mechanisms of action and effects on comorbid problems, as well as youths' relapse patterns and predictors following these interventions, may guide further development of family-based interventions to halt the progression of alcohol problems among highly susceptible adolescents.

描述（由申请人提供）：酒精仍然是美国青年和青少年饮酒的首选药物仍然是国家最严重的公共卫生问题之一。然而，在卫生局局长最近的“预防和减少未成年人饮酒的行动呼吁”（USDHHS，2007年）中，他断言“未成年人饮酒并非不可避免，学校、家长和其他成年人并非无力阻止。“因此，根据科学建议和NIAAA（2006）的研究重点，我们建议进一步开发和严格测试两种针对青少年酒精问题的家庭干预措施，多维家庭治疗（MDFT）和家庭动机访谈干预（FMII）。家庭干预在成人酗酒和青少年药物滥用的治疗方面有很强的研究和临床传统，但很少有研究关注青少年饮酒的家庭干预。在这项对照试验中，250名年龄在12岁至18岁之间在急诊室或创伤中心患有酒精相关危机的青少年将被随机分配到这两种家庭干预措施之一或标准护理。家庭干预，MDFT和FMII，目的是加强家庭的影响，以激励和帮助青年改变，但它们依赖于不同的理论基础和临床技术。两种家庭干预措施均在急诊室访视后72小时内在参与者家中提供2次初始参与会议。然后，MDFT中的青少年将参与这种以家庭为中心的治疗的整个疗程（3个月），FMII青少年将参加3个月的行为导向12步组治疗。标准护理参与者将被转介到与FMII中的青少年相同的团体治疗，但不会接受任何参与或家庭会议。我们提出了一个随机对照试验，有五个目的：1。探讨以家庭为中心的干预（MDFT）和家庭动机访谈干预（FMII）对青少年酒精相关危机的参与潜力和有效性。探讨青少年共病的差异治疗效果; 3.探讨动机和家庭因素作为治疗中介的作用; 4.检查长期禁欲，模式和复发的预测因素长达18个月的随访;和5。比较MDFT、FMII/组和标准治疗对社会的总货币效益和净货币效益。将采用多时间点（入组、3、6、9、12和18个月随访）、多领域和方法评估方法，比较干预措施的参与率和保留率、临床结局以及对社会的总和净货币效益。潜在生长曲线建模和其他最先进的统计技术将用于测试研究假设，关于青少年和家庭随时间的变化，干预措施对共病青年的差异影响，治疗达到其效果的机制，复发模式和预测因素。这项研究具有重大的潜力，以推进青少年酒精治疗提供新的知识，提供者和政策制定者对有效的和成本效益的家庭干预措施，为青年确定酒精问题在急诊室，并最终在其他卫生保健机构。 公共卫生相关性：青少年酒精滥用是美国最严重的公共卫生问题之一，在急诊室（ER）出现酒精相关危机的青少年是一个特别脆弱的群体（Maio等人，2000年）。拟议研究的结果有可能为供应商和政策制定者提供新的知识，以指导在急诊室和其他公共卫生保健环境中为青年实施最有效和最具成本效益的酒精干预措施的决策。此外，更好地了解治疗的作用机制和对共病问题的影响，以及这些干预措施后青少年的复发模式和预测因素，可以指导进一步发展以家庭为基础的干预措施，以阻止高度易感青少年酒精问题的进展。