Transitional Treatment for Adolescents in Family Therapy

描述(由申请人提供)： 近年来，对青少年物质使用障碍的门诊治疗已经建立了相当大的经验支持。特别是，已经发现了强有力的证据表明家庭治疗在减少药物滥用和相关问题方面的有效性。不幸的是，复发是一个严重的问题，治疗结果研究表明，接受治疗的青少年中，只有不到一半的人在治疗后一年内保持戒毒或戒酒。一些证据表明，参与善后照料可以降低吸毒青少年的复发风险。然而，目前还没有关于家庭治疗的有益效果是否可以通过增加后续护理成分而变得更持久的研究。拟议的第一阶段治疗发展研究的主要目的是调查旨在补充家庭治疗的过渡性善后干预措施，从而加强青少年药物滥用治疗的长期效果。以家庭为基础的治疗文献表明，传统的家庭治疗加上多系统的生态重点干预成分，在产生显着结果方面是成功的，至少可持续治疗12个月。然而，由于其复杂和密集的性质，以生态为重点的以家庭为基础的干预措施已被证明很难在自然主义的临床环境中实施。团体干预结合了认知行为策略的有效性，如应对、拒绝药物、情绪管理和沟通技能，以及同伴社会支持的好处，以激励继续减少药物使用，是一种有希望的替代方案。这项拟议的研究将考察一个群体和一个以生态为重点的干预，与第三个最低限度的过渡性干预有关，在该干预中，每隔一周与家人进行电话联系将有助于加强家庭治疗的成果。IA阶段将主要涉及完善和初步测试三项人工干预措施。第IB阶段将在90名滥用药物青少年及其家庭中正式试行这些干预措施的开发版本。参与者将接受最初12周的功能性家庭治疗，这是一种针对青少年问题行为的既定治疗方法。然后，家庭将被随机分配到三种为期8周的善后护理条件中的一种，即基于技能的小组、基于家庭的系统性干预或最低限度的过渡性干预。治疗保留和药物使用将被用作结果的衡量标准，以展示干预措施的潜在前景。还将审查与不同过渡干预措施有关的几个关键行动机制。

DESCRIPTION (provided by applicant): Considerable empirical support has been established in recent years for outpatient treatments for adolescent substance use disorders. In particular, strong evidence has been found for the efficacy of family therapy in reducing drug abuse and associated problems. Unfortunately, relapse is a critical problem, with treatment outcome studies showing that fewer than half of treated adolescents remain drug or alcohol free up to one year after treatment. Some evidence suggests that participation in aftercare can reduce the risk of relapse among drug abusing adolescents. No research exists, however, on whether the beneficial effects of family therapy can be made more durable by the addition of an aftercare component. The primary purpose of the proposed Stage I treatment development study is to investigate transitional aftercare interventions designed to supplement family therapy, thereby enhancing the long-term effects of treatment on adolescent substance abuse. The family-based treatment literature indicates that traditional family therapy augmented with multi-systemic ecologically focused intervention components is successful in producing significant outcomes that endure at least12 months posttreatment. Yet, ecologically focused family-based interventions, because of their complex and intensive nature, have proven difficult to implement in naturalistic clinical settings. Group interventions that combine the effectiveness of cognitive behavioral strategies such as coping, drug-refusal, mood management, and communication skills with the benefits of peer social support to motivate continued reductions in substance use represent a promising alternative. The proposed study will examine a group and an ecologically focused intervention, in relation to a third minimal transitional intervention in which phone contacts with families every other week will serve to reinforce family therapy gains. Stage IA will primarily involve refining and initially testing the three manualized interventions. Stage IB will formally pilot test the developed versions of the interventions with 90 substance abusing adolescents and their families. Participants will receive an initial 12-week course of Functional Family Therapy, an established treatment for adolescent problem behaviors. Families will then be randomly assigned (30 per condition) to one of the three 8-week aftercare conditions, the skills-based group, family-based systemic, or minimal transitional interventions. Treatment retention and drug use will be used as measures of outcome to demonstrate the potential promise of the interventions. A few key mechanisms of action associated with the different transitional interventions will also be examined.