Treatment for Teens with Alcohol Abuse and Depression

描述(由申请人提供)：酒精使用障碍(AUD)在美国青少年中仍然是一个重要的公共卫生问题。AUDS通常伴随着包括抑郁症在内的共生精神疾病。这种共同的发病率与AUD的严重程度增加、更早终止治疗、较差的结果和更高的自杀风险有关。目前，既没有一个共识，也没有一个标准的循证干预措施来解决对这两种疾病有效和可行治疗的需要。然而，认知行为疗法(CBT)已被发现分别对这些障碍中的每一种都有效。此外，在一些但不是所有患有这两种障碍的青少年中，抑郁症似乎对只针对酒精或药物滥用的CBT反应迅速。这表明，与非早期抑郁症反应者不同，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。然而，还没有研究将青少年EDR与NEDR的长期结果进行比较。此外，还没有随机对照研究检验这一假设，即CBT对AUD和抑郁症并存的综合干预对NEDR青少年的这两种疾病都有效。在这项针对PA：PAS-10-251提交的两个站点的研究中，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)，年龄在13至18岁之间，患有AUD和临床上显著的抑郁症。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、循证干预措施。四周后，NEDR青少年将随机接受抑郁症强化治疗，要么接受7个疗程的CBT(CBT-D)，结合MET/CBT-12，要么接受社区常规强化抑郁症治疗(D-Etau)。我们估计120名青少年将被随机分组；我们将根据性别、年龄和是否有严重抑郁发作进行分层随机分组。我们将在基线、4周、8周和12周(治疗后)以及3个月、6个月和9个月的随访时评估所有170名参与者。这项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预测因素。第二和第三个目标测试了这样的假设，即对于NEDR青少年，综合治疗强化(CBT-D)将分别导致更好的抑郁和酒精结果，而不是D-Etau强化治疗。我们将比较所有三组(EDRs；以及每个增强中的NEDRs)在酒精使用、抑郁症状、与酒精相关的功能损害、酒精治疗成果的维持以及抑郁缓解率方面的结果，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。这是第一项对抑郁的AUD青少年进行适应性治疗模式的研究，因此具有显著的指导临床实践的潜力。

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.