Home Based Treatment for Drug Use in Early Adolescents

描述(由申请人提供)： 破坏性行为障碍(DBD)包括注意力缺陷/多动障碍、对立违抗障碍和行为障碍，是早发性药物滥用和依赖发展的最强烈的风险因素之一。然而，针对早期药物使用和滥用以及DBD的症状和损害的手动治疗仍有待开发。目前的开发/探索性(R21)研究提案寻求为早期青少年开发一种基于家庭的行为干预或基于家庭的治疗(HBT)，以阻止通常与DBD相关的早发性药物滥用的逐渐发展。该提案由两个研究阶段组成。初步治疗发展和标准化活动将在议定书的第一阶段进行，在12名青少年及其家庭中开展试点工作。在第二阶段，36名患有DBD和亚诊断使用或滥用一种或多种物质的患者将被随机分配到使用该年龄组DBD的标准治疗或新开发的干预措施的治疗中。然后，将24名被分配接受研究干预的患者的治疗结果与12名被分配接受标准治疗的患者的治疗结果进行比较。干预措施包括三个主要部分：(1)家长培训已被证明可以减少对立行为和品行问题的技能，包括亲子沟通技能、家长管教做法和加强对青少年行为的监测；(2)以家庭为基础的青少年干预措施，旨在改善有品行、ADHD和药物滥用问题的青少年通常缺乏的一系列技能(如组织技能、沟通技能、解决问题的技能、预防复发等)；以及(3)在以家庭为基础的课程中进行亲子谈判培训，以改善父母和青少年之间的沟通和解决问题的技能。这些组成部分将在12周内通过每周一次的会议进行管理，随后的12周内每月进行3次强化会议。这些干预措施预计不仅会改善药物滥用的结果，而且还会改善与DBD相关的一系列损害和症状，以及早发性物质使用障碍的高风险。

DESCRIPTION (provided by applicant): Disruptive behavior disorders (DBDs), which include Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder, are among the most robust risk factors for the development of the early onset type of substance abuse and dependence. However, manualized treatments that target early substance use and abuse, as well as the symptoms and impairments of the DBDs collectively, remain to be developed. The current Development/Exploratory (R21) research proposal seeks to develop a home-based behavioral intervention or Home Based Therapy (HBT) for early adolescents that halts the progressive development of the early onset substance abuse that is often associated with the DBDs. The proposal is composed of two study phases. Preliminary treatment development and standardization activities will occur in Phase I of the protocol in pilot work with 12 adolescents and their families. In Phase II, 36 patients with a DBD and sub-diagnostic use or abuse of one or more substances will be randomly assigned to treatment using either standard treatment for DBDs in this age group or the newly developed intervention. Treatment outcomes for the 24 patients assigned to receive the study intervention will then be compared to outcomes for the 12 patients assigned to receive standard treatment. The intervention includes three major components: (1) parent training in skills which have been shown to reduce oppositional behavior and conduct problems, including parent-adolescent communication skills, parent discipline practices and increased monitoring of adolescent behaviors; (2) home-based interventions with the adolescent designed to improve a range of skills typically deficient among teens with conduct, ADHD, and substance abuse problems (e.g., organizational skills, communication skills, problem-solving skills, relapse prevention, etc.); and (3) parent-teenager negotiation training in family-based sessions to improve communication and problem-solving skills between parents and adolescent. These components will be administered through weekly sessions over 12 weeks with 3 monthly booster sessions over 12 subsequent weeks. These interventions are expected to improve not only substance abuse outcomes, but a range of impairments and symptoms associated with the DBDs and high risk for the early onset type of substance use disorder.