MI for Teen Substance Abuse with Psychiatric Comorbidity

描述(由申请人提供)： 患有药物使用障碍的青少年经常患有伴随的精神障碍。不幸的是，在接受精神治疗的青少年中，物质使用问题往往没有得到充分的评估或解决，尽管这种并存的精神病理学造成了有害的后果。这项研究计划的总体目标是开发有效的短期干预方法来解决患有精神障碍的高危青少年的物质使用问题，并在治疗结果研究的背景下促进我们对精神障碍和物质使用障碍之间关系的了解。 这项拟议的研究将测试定制的、基于社会学习的简短动机干预和个性化反馈的比较效果，与通常治疗相比，减少青少年同时患有药物使用和精神障碍的药物使用。我们还将测试治疗对中间变量的影响，如药物使用问题、精神症状、改变的动机和住院后治疗的参与度，并将检查改变的机制。 这项研究是一项随机(通过队列)的两组设计，随着时间的推移重复测量，比较：(A)个性化反馈(MI)与常规治疗(TAU)的量身定制、简短的动机访谈干预的效果。年龄在13岁到17岁之间的250名青少年精神科住院患者将被招募到这项研究中。受试者将符合一种或多种DSM-IV(非尼古丁)物质使用障碍的标准，以及除物质使用障碍外的一种或多种额外的电流轴I障碍。受试者将被跟踪12个月，并将使用呼气分析和唾液药物测试来验证自我报告的戒毒情况。 我们预计，这项研究将为相当大比例的青少年合并使用药物和精神障碍开发一种专门、有效的干预方法，因此将具有重要的临床和公共卫生影响。

DESCRIPTION (provided by applicant): Adolescents with substance use disorders frequently suffer from concomitant psychiatric disorders. Unfortunately, substance use problems among adolescents presenting for psychiatric treatment are often not adequately assessed or addressed despite the deleterious consequences of this comorbid psychopathology. The overall objective of this research program is to develop effective brief intervention approaches to address substance use problems in high-risk adolescents with comorbid psychiatric disorders, and to advance our knowledge of the relationship between psychiatric and substance use disorders within the context of a treatment outcome study. The proposed study will test the comparative efficacy of a tailored, social learning-based brief motivational intervention with personalized feedback compared to treatment as usual for reducing substance use in adolescents hospitalized with comorbid substance use and psychiatric disorders. We will also test the effects of treatment on intermediate variables such as substance use problems, psychiatric symptoms, motivation to change and post-hospitalization treatment involvement, and will examine the mechanisms of change. The study is a randomized (by cohort), two group design with repeated measures over time, comparing the efficacy of: (a) a tailored, brief motivational interviewing intervention with personalized feedback (MI) vs. (b) treatment as usual (TAU). A sample of 250 adolescent psychiatric inpatients between the ages of 13 and 17 will be recruited into the study. Subjects will meet criteria for one of more DSM-IV (non-nicotine) substance use disorders and for one or more additional current Axis I disorders, other than a substance use disorder. Subjects will be followed for 12 months, and self-reported abstinence from substance use will be verified using breath analysis and saliva drug tests. We expect that this study will result in the development of a specialized, efficacious intervention approach for the significant percentage of adolescents with comorbid substance use and psychiatric disorders, and will therefore have important clinical and public health implications.