Treatment for Teens with Alcohol Abuse and Depression

描述（由申请人提供）：酒精使用障碍（AUD）仍然是美国青少年的一个重大公共卫生问题。AUD通常伴随有同时发生的精神疾病，包括抑郁症。这种合并症与AUD严重程度增加、治疗提前终止、结局较差和自杀风险增加相关。目前，既没有共识，也没有标准的循证干预措施来解决这两种疾病的有效和可行的治疗需求。然而，认知行为疗法（CBT）已被发现对这些疾病中的每一种都有效。此外，在一些但不是所有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。这表明早期抑郁反应者（EDRs）可能不需要直接针对抑郁症的额外治疗，不像他们的非早期反应NEDR对应者。然而，没有研究比较了青少年EDR和NEDR的长期结果。此外，没有随机对照研究已经验证了这一假设，即在NEDR青少年中，对合并发生的AUD和抑郁症进行综合CBT干预对这两种疾病都有效。 在本研究中，我们将招募170名符合条件的青少年（102名来自康涅狄格大学，68名来自杜克大学），年龄为13 - 18岁，患有AUD和临床显著抑郁症。所有受试者将接受为期12周的动机增强疗法/认知行为疗法（MET/CBT-12），这是一种针对酒精或药物滥用的标准循证干预。四周后，NEDR青少年将被随机分配到抑郁症治疗增强组，无论是七次CBT（CBT-D），与MET/CBT-12相结合，还是在社区中增强抑郁症治疗（D-ETAU）。我们估计将有120名青少年接受随机分组;我们将根据性别、年龄和是否有重度抑郁发作进行随机分组。我们将在基线、第4、8和12周（治疗后）以及3、6和9个月随访时评估所有170名参与者。 本研究的第一个目的是描述在酒精滥用治疗期间表现出EDR的抑郁AUD青少年的百分比，检查EDR的持久性和EDR的预测因素。第二个和第三个目标测试的假设，对于NEDR青少年，综合治疗增强（CBT-D）将导致更好的抑郁症和酒精的结果，分别比增强与D-ETAU。我们将比较所有三组（EDR;和每次增强的NEDR）的结果，包括酒精使用，抑郁症状，酒精相关的功能障碍，酒精治疗收益的维持以及抑郁缓解率，并将分析治疗期间和治疗后酒精使用和抑郁变化的时间顺序。这是第一项测试抑郁AUD青少年适应性治疗模型的研究，因此具有指导临床实践的重大潜力。

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.