Integrating Combined Therapies for Persons with Co-occurring Disorders

描述(由申请人提供)：与那些没有酒精使用诊断的人相比，有酒精使用障碍的人患上共同发生的精神障碍的可能性高出三倍。酒精和精神障碍并存在临床环境中非常普遍，相对于那些只有一种障碍的患者，这些患者的治疗和康复经历更具挑战性。综合治疗会产生更有利的结果，但这些服务并不广泛获得。这是一个修订的R21应用程序，“为患有共生疾病的人整合综合治疗。”我们建议评估来自NIAAA项目的联合行为干预(CBI)的综合适应。CBI以三种循证行为疗法为特色：动机增强疗法(MET)、认知行为疗法(CBT)和十二步促进疗法(TSF)。我们将CBI改进为一种新的手动指导的干预方法，用于治疗同时发生的精神和物质相关问题。综合治疗(ICT)是一种个人形式的治疗，旨在转移到常规护理环境中，并由现有劳动力提供。一项小型先导性研究支持了信息和通信技术的临床前景及其安全性和实用性。在现在提出的研究中，我们将随机将76名符合条件的社区门诊成瘾患者分配到适应ICT的标准护理与只接受标准护理的情况下。主要结果将在基线、3个月和6个月的随访期进行评估。我们假设，信息和通信技术适应的标准护理将显示出酒精、药物和精神结果的改善，并且信息和通信技术参与者将在治疗服务中有更好的保留。正如我们在初步研究中发现的那样，我们也希望典型的项目顾问能够以令人满意的忠诚度和能力教授ICT。酒精使用障碍的循证治疗的发现和常规提供之间的差距很大。当人们考虑到公众获得药物使用和精神障碍并存的人获得有效综合服务的差距时，这个问题就变得更加复杂。目前的研究致力于解决这个问题，通过严格评估一种有希望的、对社区友好的广谱心理社会治疗方案。如果在这项试验中被发现是有效的，下一个合乎逻辑的研究步骤将是在更大的随机对照试验中以及在拆解和部分析因设计中进一步研究ICT的有效性。这项研究的首要目标是为患有共生疾病的个人提供更好的治疗和康复结果。

DESCRIPTION (provided by applicant): Persons with alcohol use disorders are three times more likely to have a co-occurring psychiatric disorder than those without alcohol use diagnoses. Co-occurring alcohol and psychiatric disorders are highly prevalent in clinical settings and, relative to those with a single disorder alone, these patients have more challenging treatment and recovery experiences. Integrated treatments result in more favorable outcomes, yet these services are not widely available. This is a revised R21 application, "Integrating combined therapies for persons with co-occurring disorders." We propose to evaluate an integrated adaptation of the Combined Behavioral Intervention (CBI) from NIAAA Project COMBINE. CBI features three evidence-based behavioral therapies: Motivational Enhancement Therapy (MET), Cognitive Behavioral Therapy (CBT) and Twelve Step Facilitation Therapy (TSF). We adapted CBI into a novel manual-guided intervention for co-occurring psychiatric and substance-related problems. Integrating Combined Therapies (ICT) is an individual-format treatment designed to be transferable to routine care settings and for delivery by the existing workforce. A small pilot study supported the clinical promise of ICT as well as its safety and practicality. In the research now proposed, we will randomly assign 76 eligible patients in community outpatient addiction treatment to ICT adapted standard care versus standard care only. Primary outcomes will be assessed at baseline, 3-, and 6- month follow-up periods. We hypothesize that ICT adapted standard care will demonstrate improved alcohol, drug and psychiatric outcomes, and that ICT participants will have better retention in treatment services. As found in our preliminary research, we also expect typical program counselors to be able to deliver ICT with satisfactory adherence and competence. The gap between the discovery and routine delivery of evidence-based treatments for alcohol use disorders is substantial. This problem is compounded when one considers the disparity in public access to efficacious integrated services for persons with co-occurring substance use and psychiatric disorders. The present research stands to address this issue, by rigorously evaluating a promising and community- friendly option for a broad spectrum psychosocial therapy. If found to be effective in this trial, the next logical research steps would be further efficacy study of ICT in a larger randomized controlled trial, as well as in dismantling and fractional factorial designs. The overarching goal of this research is to contribute to better treatment and recovery outcomes for individuals with co-occurring disorders.