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

童年时期的心理创伤事件，特别是人际暴力经历， 在青春期和成年期的物质使用问题的强有力的和一致的预测。PTSD 从这种IPV延伸出来的，经常与IPV同时出现。尽管这种良好的联系，标准的护理， 在过去的几十年里，青少年与共同发生的创伤后应激障碍一直是治疗这些问题 分开这种分割的治疗方法给青少年和家庭造成了负担， 对心理健康和成瘾领域的临床医生提出了挑战，并可能导致高风险 在患有创伤后应激障碍的青少年中复发。为了解决这个问题，我们的团队最近完成了一个 严格的NIDA资助的随机对照试验（RCT）支持一个综合的，暴露- 基于我们开发的治疗，通过家庭治疗降低风险（RFT），在更大的长期减少 与标准治疗相比， 青少年样本。建议的RCT采用有效性-实施混合I型设计， 在先前的研究中，建议：1）评估RRFT是否具有减少糖尿病的临床有效性， 创伤后应激障碍可以扩展到青少年在门诊物质使用治疗设置-其中青年提出， 创伤后应激障碍的治疗和临床医生治疗创伤后应激障碍的经验往往较少（目标1）; 2）评估成本- RFT的有效性和探索内部上下文变量（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， 和实施的促进者），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IPV病史的青少年（13-18岁） 在丹佛的门诊药物使用障碍治疗中出现了抑郁症和创伤后应激障碍症状， 科罗拉多附属于NIDA的临床试验网络。受试者将被随机分配至RFT或治疗组 作为一个整体。多方法、多应答方法将跟踪临床结果（创伤后应激障碍、创伤后应激障碍和假定的 治疗目标，如情绪抑制）在基线后3、6和12个月。减少 作为一个探索性目标，我们将召集并聘请一个由领导人组成的咨询委员会， 来自科罗拉多州政府部门（科罗拉多行为健康和刑事/少年司法办公室， 承诺参与）和社区精神卫生组织，监督政策和决定- 为高危青少年选择和实施社会心理治疗，目标是 构建大规模的能力（例如，全州范围内）对青少年抑郁症和创伤后应激障碍的证据干预措施的吸收，如 RRFT，在赠款完成后。这一建议直接符合NIDA最近发布的NOT-DA-20- 004，一个特别关注的通知，鼓励对共病物质使用，物质使用障碍， 和其他精神疾病。

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.