Evaluation of Clinical Effectiveness, Cost, and Implementation Factors to Optimize Scalability of Treatment for Co-Occurring SUD and PTSD Among Teens

童年期间的心理社会创伤事件，特别是人际暴力经历，是 强烈和一致的预测物质使用问题(SUP)在青春期和成年期。创伤后应激障碍 这从这种IPV经常与SUP并存延伸而来。尽管这一联系已经确立，但标准护理对 在过去的几十年里，患有SUP和PTSD的青少年一直在治疗这些问题 分开的。这种区分治疗的方法给青少年和家庭带来了负担，提出了独特的 对临床医生在心理健康和成瘾领域的挑战，并可能导致高SUP率 与创伤后应激障碍共同发生的青少年的复发。为了解决这个问题，我们的团队最近完成了一个 由NIDA资助的严格的随机对照试验(RCT)支持综合、暴露- 基于我们开发的治疗方法，通过家庭治疗降低风险(RRFT)，长期降幅更大 在SUP中，以及PTSD回避和高度觉醒症状，与标准治疗相比 青少年样本。拟议的RCT，采用有效性-实施混合型I类设计，基本上建立了 在先前的研究基础上，建议：1)评估RRFT在降低SUP和 创伤后应激障碍可以扩展到门诊药物使用治疗环境中的年轻人-那里的年轻人正在为 超级治疗，以及临床医生通常没有治疗创伤后应激障碍经验的地方(目标1)；2)评估成本- RRFT的有效性，并探索内部背景变量(例如，感知的治疗可接受性，态度， 参与的青少年、照顾者、机构领导人和治疗师的满意度和障碍 和执行的促进者)，这可能会影响在不同的实践环境中实施RRFT(目标2)。 拟议的有效性-实施试验将招募有肺炎病史的青少年(13-18岁)。 在丹佛，因门诊药物使用障碍治疗而出现SUP和PTSD症状， 科罗拉多州隶属于NIDA的临床试验网络。参与者将被随机分配到RRFT或接受治疗 像往常一样。多方法、多响应方法将跟踪临床结果(SUP、PTSD和推定 治疗目标，如情绪压抑)在基线后3、6和12个月。以减少 科学与实践之间的差距，作为一项探索性目标，我们将组建并聘用一个领导人顾问委员会 来自科罗拉多州各部门(科罗拉多州行为健康和刑事/少年司法办公室， 已承诺参与)和社区精神卫生组织，负责监督政策和决策- 为高危青少年选择和实施心理社会治疗，目标是 建设大规模(例如，全州)获取证据的能力--对青少年SUP和创伤后应激障碍的干预，如 RRFT，在完成拨款后。这一提议与NIDA最近发布的Not-DA-20- 004，一份特别关注的通知，鼓励对共病药物使用、药物使用障碍、 以及其他精神疾病。

Psychosocial traumatic events, and interpersonal violence experiences in particular, during childhood serve as strong and consistent predictors of substance use problems (SUP) during adolescence and adulthood. PTSD that extends from such IPV often co-occurs with SUP. Despite this well-established link, standard care for adolescents with co-occurring SUP and PTSD for the last several decades has been to treat these problems separately. This compartmentalized approach to treatment creates burden on teens and families, raises unique challenges to clinicians in both mental health and addiction domains, and may contribute to high rates of SUP relapse among adolescents with co-occurring PTSD. To address this problem, our team recently completed a rigorous NIDA-funded randomized controlled trial (RCT) supporting the efficacy of an integrative, exposure- based treatment we developed, Risk Reduction through Family Therapy (RRFT), in greater long term reductions in SUP, as well as PTSD avoidance and hyperarousal symptoms, in comparison to standard treatment in a large teen sample. The proposed RCT, with an effectiveness-implementation Hybrid Type I design, substantially builds on that prior research by proposing to: 1) evaluate whether RRFT's clinical effectiveness for reducing SUP and PTSD can be extended to youth in outpatient substance use treatment settings—where youth are presenting for SUP treatment and where clinicians often have less experience treating PTSD (Aim 1); 2) evaluate the cost- effectiveness of RRFT and to explore inner context variables (e.g., perceived treatment acceptability, attitudes, and satisfaction among the participating adolescents, caregivers, agency leaders, and therapists and barriers to and facilitators of implementation) that might affect RRFT implementation in diverse practice settings (Aim 2). The proposed effectiveness-implementation trial will recruit adolescents (13-18 years) with a history of IPV presenting with SUP and PTSD symptoms for outpatient substance use disorder treatment at sites in Denver, Colorado affiliated with NIDA's Clinical Trials Network. Participants will be urn randomized to RRFT or Treatment as Usual. A multi-method, multi-respondent approach will track clinical outcomes (SUP, PTSD, and putative targets of treatment, such as emotional suppression) at 3, 6, and 12 months post-baseline. To reduce the science-to-practice gap, as an Exploratory Aim, we will assemble and engage an Advisory Board of leaders from Colorado state departments (Offices of Behavioral Health and Criminal/Juvenile Justice for Colorado, which have committed to participate) and community mental health organizations that oversee policy and decision- making in selection and implementation of psychosocial treatments for high-risk adolescents, with the goal of building capacity for large scale (e.g., state-wide) uptake of evidence-interventions for teen SUP and PTSD, like RRFT, upon completion of the grant. This proposal is directly in line with NIDA's recent release of NOT-DA-20- 004, a Notice of Special Interest encouraging research on comorbid substance use, substance use disorders, and other psychiatric disorders.