Treatment for Teens with Alcohol Abuse and Depression

青少年酗酒和抑郁症的治疗

• 批准号: 8577440
• 负责人: JOHN F CURRY
• 金额: $ 28.26万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-20 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8577440
• 关键词: Address; Adolescent; Adult; Aftercare; Age; Alcohol abuse; Alcohol consumption; Alcohols; American; Characteristics; Clinical; Cognitive Therapy; Communities; Comorbidity; Connecticut; Consensus; Depressed mood; Depressive disorder; Disease; Disease remission; Drug abuse; Early treatment; Effectiveness; Ethnic Origin; Evidence based intervention; Feeling suicidal; Frequencies; Gender; Heavy Drinking; High Prevalence; Impairment; Intervention; Lead; Maintenance; Mental Depression; Mental disorders; Minority; Modeling; Mono-S; Motivation; NIH Program Announcements; National Institute on Alcohol Abuse and Alcoholism; Outcome; Participant; Public Health; Race; Randomized; Randomized Controlled Trials; Recruitment Activity; Relapse; Risk Factors; Severities; Site; Socioeconomic Status; Substance abuse problem; Suicide attempt; Teenagers; Testing; Time; Universities; Work; Youth; adolescent alcohol abuse; adolescents with alcohol use disorders; alcohol abuse therapy; alcohol related problem; alcohol use disorder; clinical practice; clinically significant; depressive symptoms; drinking; effective intervention; emergency service responder; evidence base; follow-up; functional disability; high risk; psychosocial; public health relevance; response; single episode major depressive disorder; suicidal behavior; suicidal risk; treatment as usual

DESCRIPTION (provided by applicant): Alcohol use disorders (AUDs) continue to be a significant public health concern among American adolescents. AUDs are commonly accompanied by co-occurring psychiatric disorders including depression. This co morbidity has been associated with increased severity of AUD, earlier treatment termination, poorer outcomes, and increased suicidal risk. Presently there is neither a consensus nor a standard, evidence-based intervention to address the need for an effective and feasible treatment for both disorders. However, cognitive behavior therapy (CBT) has been found to be effective for each of these disorders, separately. In addition, in some, but not all, adolescents with both disorders, depression appears to respond rapidly to CBT that targets only alcohol or substance abuse. This suggests that early depression responders (EDRs) may not need additional treatment that targets depression directly, unlike their non-early responding NEDR counterparts. However, no studies have compared longer term outcomes of adolescent EDRs to NEDRs. Moreover, no randomized, controlled studies have tested the hypothesis that an integrated CBT intervention for co-occurring AUD and depression will be effective for both disorders, in NEDR adolescents. In this two-site study, submitted in response to PA: PAS-10-251, we will recruit 170 eligible adolescents (102 at the University of Connecticut and 68 at Duke University), ages 13 to 18, with AUD and clinically significant depression. All subjects will receive 12-weeks of Motivation Enhancement Therapy/Cognitive Behavior Therapy (MET/CBT-12), a standard, evidence-based intervention for alcohol or drug abuse. After four weeks, NEDR adolescents will be randomized to depression treatment augmentation, either with seven sessions of CBT (CBT-D), integrated with MET/CBT-12, or with enhanced depression-treatment-as-usual in the community (D-ETAU). We estimate that 120 adolescents will be randomized; we will stratify randomization on gender, age, and presence/absence of a Major Depressive Episode. We will assess all 170 participants at baseline, weeks 4, 8, and 12 (after treatment), and at 3-, 6-, and 9-month follow-up. The first aim of this study is to describe the percentage of depressed AUD adolescents who demonstrate EDR during alcohol abuse treatment alone, examine EDR durability and EDR predictors. The second and third aims test the hypotheses that, for NEDR teens, an integrated treatment augmentation (CBT- D) will lead to better depression and alcohol outcomes, respectively, than augmentation with D-ETAU. We will compare outcomes of all three groups (EDRs; and NEDRs in each augmentation), on alcohol use, depressive symptoms, alcohol-related functional impairment, maintenance of alcohol treatment gains, and depression remission rates over time, and will analyze the temporal ordering of changes in alcohol use and depression during and after treatment. This is the first study to test an adaptive treatment model with depressed AUD youths, and thus has significant potential to guide clinical practice.

描述（由申请人提供）：酒精使用障碍（AUD）仍然是美国青少年中一个重要的公共卫生问题。 AUD 通常伴有同时发生的精神疾病，包括抑郁症。这种共病与 AUD 严重程度增加、治疗提前终止、预后较差以及自杀风险增加有关。目前，既没有达成共识，也没有标准的、基于证据的干预措施来满足对这两种疾病有效且可行的治疗的需求。然而，认知行为疗法（CBT）被发现对这些疾病分别有效。此外，在一些（但不是全部）患有这两种疾病的青少年中，抑郁症似乎对仅针对酒精或药物滥用的 CBT 反应迅速。这表明早期抑郁症反应者 (EDR) 可能不需要直接针对抑郁症的额外治疗，这与非早期反应 NEDR 者不同。然而，没有研究比较青少年 EDR 和 NEDR 的长期结果。此外，还没有随机对照研究验证了这样的假设：对 NEDR 青少年中同时发生的 AUD 和抑郁症进行综合 CBT 干预对这两种疾病都有效。 在这项针对 PA: PAS-10-251 提交的两地研究中，我们将招募 170 名符合条件的青少年（康涅狄格大学 102 名，杜克大学 68 名），年龄 13 至 18 岁，患有 AUD 和临床上显着的抑郁症。所有受试者都将接受为期 12 周的动机增强疗法/认知行为疗法 (MET/CBT-12)，这是针对酒精或药物滥用的标准循证干预措施。 4 周后，NEDR 青少年将被随机分配接受抑郁症强化治疗，要么进行七次 CBT (CBT-D)，与 MET/CBT-12 相结合，要么按照社区常规进行强化抑郁治疗 (D-ETAU)。我们估计 120 名青少年将被随机分组​​；我们将根据性别、年龄和是否存在重度抑郁发作进行随机分层。我们将在基线、第 4、8 和 12 周（治疗后）以及 3、6 和 9 个月的随访时对所有 170 名参与者进行评估。 本研究的首要目的是描述仅在酗酒治疗期间表现出 EDR 的抑郁 AUD 青少年的百分比，检查 EDR 持久性和 EDR 预测因素。第二个和第三个目标测试以下假设：对于 NEDR 青少年，综合治疗强化 (CBT-D) 将分别比 D-ETAU 强化治疗带来更好的抑郁和酒精结果。我们将比较所有三组（每次增强中的 EDR 和 NEDR）在饮酒、抑郁症状、酒精相关功能障碍、酒精治疗收益的维持和抑郁缓解率方面的结果，并将分析治疗期间和治疗后饮酒和抑郁变化的时间顺序。这是第一项针对抑郁症 AUD 青少年测试适应性治疗模型的研究，因此具有指导临床实践的巨大潜力。