Brief Substance Abuse Treatment for Homeless Adolescents

描述(由申请人提供)： 无家可归的青年是物质使用障碍和相关的心理社会后果的高危青少年群体，但为这一群体制定的干预措施很少。为了响应PA-99-107，NIDA行为疗法开发计划，本申请寻求对第一阶段开发项目的支持。这项为期四年的研究计划将开发和测试针对无家可归青年的特殊需求而量身定做的简短激励增强和服务联系干预。对青少年行为有很大影响的社会结构(如家庭和学校)通常不能进行干预。大多数年轻人没有寻求药物滥用治疗。青年还遭受高比例的创伤、精神疾病并存、贫困和受害。干预将遵循跨理论的行为改变模型(普罗查斯卡和迪克莱门特，1983)。我们建议发展一个简短、激励和服务挂钩的干预措施，旨在促进对现有服务的改变和使用的考虑。干预将在为期一个月的几次单独会议上进行。咨询师将提供关于物质使用行为和社交网络关系的个性化反馈，使用非对抗性临床访谈技术(动机访谈)，并提供凭证以鼓励参与。建议对没有寻求治疗的青年进行干预，并将其与当地机构内的其他服务相结合。干预的目标将是鼓励无家可归的青少年质疑药物使用的社会影响，质疑关于药物效果的假设，考虑药物问题的治疗，并利用现有的社会服务。初期资金将用于制定试点干预措施，借鉴在成人和青少年中测试的简短干预措施，并完成对无家可归青少年服务利用的过程分析。随后，将进行随机对照试验。按年龄和性别分层的100名青年样本将被随机分配到动机增强治疗(ME)或照常治疗(TAU)。TAU包括临时加入的计划(卫生、食品、物质援助和病例管理)。在治疗后1个月和3个月进行后续访谈，评估药物使用、改变的阶段和服务利用情况。

DESCRIPTION (provided by applicant): Homeless youth constitute a group of adolescents at high risk for substance use disorders and associated psychosocial consequences, yet few interventions have been developed for this population. In response to PA-99-107, NIDA Behavioral Therapies Development Program, this application seeks support for a Stage I developmental project. The four-year research program will develop and test a brief motivational enhancement and service-linking intervention tailored to the special needs of homeless youth. Social structures that have strong influence on adolescent behavior (such as families and schools) are not typically available for intervention. Most youth are not seeking substance abuse treatment. Youth also suffer from high rates of trauma, psychiatric co-morbidity, poverty, and victimization. The intervention will be guided by the Transtheoretical Model of behavior change (Prochaska and DiClemente, 1983). We propose to develop a brief, motivational and service linking intervention aimed at facilitating contemplation of change and use of available services. The intervention will be conducted over several individual meetings over a period of one month. Counselors will provide personalized feedback on substance use behavior and social network relations, use non-confrontational clinical interviewing techniques (Motivational Interviewing), and provide vouchers to encourage participation. The intervention is proposed to be conducted with youth who are not seeking treatment, and to be conducted and integrated with additional services within a local agency. The goals of the intervention will be to encourage homeless adolescents to question social influences about substance use, question assumptions about drug effects, consider treatment for drug problems, and make use of available social services. An initial period of funding will be used to develop a pilot intervention drawing from brief interventions tested with adults and adolescents, and to complete process analyses of service utilization among homeless adolescents. Subsequently, a randomized controlled trial will be conducted. A sample of 100 youth-stratified by age and gender, will be randomly assigned to Motivational Enhancement treatment (ME) or Treatment as Usual (TAU). TAU includes drop-in programs (hygiene, food, material assistance, and case management). Follow-up interviews at one- and three-months post-treatment, will assess substance use, stage of change, and service utilization.