Treatment of Justice-Involved Emerging Adults with Substance Use Disorders

 描述（由申请人提供）：酒精和其他药物（AOD）滥用和犯罪活动的流行率是最高的，在成年期相比，任何其他发展阶段，并导致社会的非凡成本。他们也经常发生在一起;新兴的成年人（EAs;年龄17-21）与AOD滥用有更大的监禁率比没有AOD滥用的EAs，和AOD滥用罪犯有显着更多的累犯，严重犯罪，监禁比其他罪犯。这种严重的行为干扰了成功地过渡到成年-完成学业，就业，住房。因此，有一个强大的公共卫生需要有效的治疗，以减少滥用AOD和司法参与EA。令人惊讶的是，有没有既定的有效性，以减少EA之间的犯罪活动的干预措施，有或没有滥用AOD。在年轻的青少年中，反社会行为的综合原因通过有效的干预措施得到解决（例如，多系统治疗;多维治疗寄养[MTFC]），目前的调查小组已经开发和评估了一个定义明确的年龄定制的干预与犯罪行为的EA。制定的干预措施是对少年司法措施的改编，并纳入了来自少年司法工作队的技能辅导部分，这两项措施都是行之有效的少年司法干预措施。最初的MST-EA研究集中在有精神健康问题的年轻人，这是一个高风险的罪犯亚群，但AOD滥用很快成为MST-EA团队治疗的主要问题。作为一种单一来源的干预，MST-EA针对犯罪活动和AOD滥用的EA相关性，包括有收益的EA活动（积极的关系，学校，工作和住房）和减少AOD滥用-部分通过针对不良自我调节的近端机制。在一项成功完成的以社区为基础的开放试验中，确立了干预的安全性、可行性和初步疗效。 拟议的研究将评估MST-EA在减少司法介入和滥用AOD方面的有效性。滥用AOD和司法介入（最近被捕或从司法机构释放）的EA（n = 240）将随机接受MST-EA或治疗作为药物（TAU）。在第0、2、4、6、8、12和16个月，将完成评估，并使用系统记录和并行报告对所有结局数据进行三角测量。目的是评估MST-EA随着时间的推移对减少AOD滥用和犯罪活动的影响，以及评估MST-EA对治疗（自我调节）的关键近端目标和治疗（有收益的活动）的中间结果的影响。本研究的最后一个目的是调查治疗对犯罪活动的直接影响是否通过其对自我调节、滥用AOD和有收益活动的影响来介导。在这个特定的年龄组，有一个完全没有的AOD滥用和累犯减少治疗证明有效。拟议研究的最终效果将是减少AOD滥用和司法参与高风险人群，以及改善具有重大社会影响的结果（例如，减少无家可归和失业）。

 DESCRIPTION (provided by applicant): Prevalence of alcohol and other drug (AOD) abuse and criminal activity is highest during emerging adulthood compared to any other developmental period, and causes extraordinary costs to society. They also frequently occur together; Emerging Adults (EAs; ages 17-21) with AOD abuse have greater incarceration rates than EAs without AOD abuse, and AOD-abusing offenders have significantly more recidivism, severe offending, and incarceration than other offenders. Such serious behavior interferes with successful transition into adulthood - school completion, employment, housing. Thus, there is a strong public health need for effective treatment to reduce AOD abuse and justice involvement in EAs. Surprisingly, there are no interventions with established efficacy to reduce criminal activity among EAs, with or without AOD abuse. Among younger adolescents, the comprehensive causes of antisocial behavior are addressed by effective interventions (e.g., Multisystemic Therapy [MST]; Multidimensional Treatment Foster Care [MTFC]), and the present investigative team has developed and evaluated a well-defined age-tailored intervention for EAs with criminal behavior. The developed intervention is an adaptation of MST and integrates a skills coaching component from MTFC, both well-established effective juvenile justice interventions. Initial MST-EA research focused on justice-involved young adults who had mental health problems, a high-risk subpopulation of offenders, but AOD abuse quickly became a primary problem the MST-EA team treated. As a single-source intervention, MST-EA targets the EA correlates of criminal activity and AOD abuse, including gainful EA activities (positive relationships, school, work, and housing) and reduced AOD abuse-in part by targeting the proximal mechanism of poor self- regulation. In a successfully completed community-based open trial, the safety, feasibility, and preliminary efficacy of the intervention were established. The proposed study will evaluate the effectiveness of MST-EA for reducing justice involvement and AOD abuse. EAs (n = 240) with AOD abuse and justice involvement (recent arrests or release from justice facilities) will be randomized to receive MST-EA or Treatment as Usual (TAU). At months 0, 2, 4, 6, 8, 12, and 16, assessments will be completed, with triangulation of all outcome data using system records and collateral reports. Aims will be to evaluate the effect over time of MST-EA for reducing AOD abuse and criminal activity, as well as to evaluate the effect of MST-EA on the key proximal target of treatment (self-regulation) and intermediate outcomes of treatment (gainful activities). A final aim of the study will be to investigate if the direct effect of treatment on criminal activity is mediated by its effect on self- regulation, AOD abuse, and gainful activities. In this specific age group, there is a complete absence of AOD abuse and recidivism reduction treatments with demonstrated effectiveness. The ultimate effect of the proposed research would be decreased AOD abuse and justice involvement in a high-risk population, as well as improved outcomes that have significant societal impact (e.g., reduced homelessness and unemployment).