Integrating Combined Therapies for Persons with Co-occurring Disorders

描述（由申请人提供）：患有酒精使用障碍的人同时患有精神障碍的可能性是没有酒精使用诊断的人的三倍。同时发生的酒精和精神疾病在临床环境中非常普遍，相对于仅患有单一疾病的患者，这些患者的治疗和康复经历更具挑战性。综合治疗的效果更好，但这些服务并没有得到广泛应用。这是一份修订后的R21申请，“整合合并疾病患者的联合治疗”。我们建议评估来自NIAAA项目COMBINE的综合行为干预（CBI）的综合适应性。CBI有三种基于证据的行为疗法：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改编为一种新的手动引导干预，用于同时发生的精神和物质相关问题。综合综合疗法（ICT）是一种个人形式的治疗，旨在转移到常规护理环境中，并由现有工作人员提供。一项小型试点研究支持了信通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，我们将随机分配76名符合条件的社区门诊成瘾治疗患者接受ICT适应的标准治疗，而不是仅接受标准治疗。主要结果将在基线、3个月和6个月的随访期间进行评估。我们假设，适应ICT的标准治疗将显示出改善的酒精、药物和精神方面的结果，ICT参与者将更好地保留治疗服务。正如我们在初步研究中发现的那样，我们也期望典型的项目顾问能够以令人满意的依从性和能力提供ICT。酒精使用障碍循证治疗的发现与常规提供之间存在巨大差距。如果考虑到同时存在药物使用和精神疾病的人在公众获得有效综合服务方面存在差异，这一问题就更加复杂。目前的研究站在解决这个问题，通过严格评估一个有前途的和社区友好的选择，广泛的社会心理治疗。如果在本试验中发现有效，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进一步研究ICT的疗效，以及在拆解和分数因子设计中。这项研究的首要目标是为患有共存疾病的个体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.