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

描述(申请人提供)：酒精仍然是美国年轻人的首选药物，青少年饮酒仍然是美国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)中，他断言，“未成年人饮酒并非不可避免，学校、家长和其他成年人也并非无力阻止。”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，即多维度家庭治疗(MDFT)和家庭动机访谈干预(FMII)。家庭干预在治疗成人酗酒和青少年药物滥用方面有很强的研究和临床传统，但很少有研究侧重于青少年饮酒的家庭干预。在这项对照试验中，250名在急诊室或创伤中心患有酒精相关危机的12岁至18岁的青年将随机接受这两种家庭干预之一或接受标准护理。MDFT和FMII这两种家庭干预措施的目的都是增强家庭的影响力，以激励和帮助年轻人改变，但它们依赖于不同的理论基础和临床技术。这两种家庭干预措施都在急诊室就诊后72小时内在参与者家中提供两次初始参与会议。MDFT的青少年随后将参加这种以家庭为中心的完整疗程(3个月)，FMII青少年将参加为期3个月的以行为为导向的12步团体治疗。标准护理参与者将被转介到FMII中与青年相同的团体治疗，但不会得到参与或家庭会议。我们提出了一项随机对照试验，有五个目标：1.调查以家庭为中心的干预(MDFT)和家庭动机访谈干预(FMII)/组在青少年酒精相关危机中的参与潜力和有效性；2.探索与共病青少年的不同治疗效果；3.考察动机和家庭因素作为治疗中介的作用；4.检验长期禁欲、复发的模式和预测因素；5.比较MDFT、FMII/组和标准护理对社会的总和净经济利益。将使用多时间点(入院、3、6、9、12和18个月随访)、多领域和方法评估方法来比较干预措施对其参与率和保留率、临床结果以及社会总和净经济利益的影响。潜伏期生长曲线建模和其他最先进的统计技术将用于测试有关青少年和家庭随时间变化的研究假设，干预措施对患有共病青年的不同影响，治疗实现其效果的机制，以及复发模式和预测因素。这项研究通过向提供者和政策制定者提供新的知识，向急诊室和最终在其他医疗保健环境中被发现存在酒精问题的青少年提供有效和成本效益高的家庭干预，具有推动青少年酒精治疗的巨大潜力。 公共卫生相关性：青少年酗酒是该国最严重的公共卫生问题之一，青少年在急诊室出现与酒精有关的危机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提供者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定。此外，更好地了解治疗的作用机制和对共病问题的影响，以及青少年在这些干预措施后的复发模式和预测因素，可能会指导进一步发展以家庭为基础的干预措施，以阻止高度敏感青少年中酒精问题的进展。

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.