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患有并发精神疾病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，相对于那些单独患有单一疾病的患者，这些患者的治疗和恢复经历更具挑战性。综合治疗会产生更有利的结果，但这些服务并不普遍。这是一个修订后的R21应用程序，“整合合并疾病的人的联合治疗。“我们建议评估NIAAA项目组合的综合行为干预（CBI）的综合适应。CBI有三种循证行为疗法：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指导干预，用于同时发生的精神病和物质相关问题。整合联合疗法（ICT）是一种个体形式的治疗，旨在转移到常规护理环境中，并由现有的劳动力提供。一项小型试点研究支持ICT的临床承诺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适应性标准治疗与仅接受标准治疗。将在基线、3个月和6个月随访期评估主要结局。我们假设，信息和通信技术适应的标准治疗将证明改善酒精，药物和精神疾病的结果，信息和通信技术的参与者将有更好的保留在治疗服务。正如我们在初步研究中发现的那样，我们还希望典型的项目辅导员能够以令人满意的坚持和能力提供信息和通信技术。酒精使用障碍循证治疗的发现和常规治疗之间存在着巨大的差距。如果考虑到同时患有药物使用和精神疾病的人在获得有效综合服务方面的差距，这一问题就更加复杂了。目前的研究旨在解决这个问题，通过严格评估一个有前途的和社区友好的选择，为广谱心理社会治疗。如果在本试验中发现有效，接下来的逻辑研究步骤将是在更大的随机对照试验中以及在拆卸和部分析因设计中进一步研究ICT的有效性。这项研究的总体目标是为患有并发症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.