Medical Office Intervention for Adolescent Drug Use

本申请提交给NIDA，以响应PA-03-126，行为疗法开发计划，并提出了一项针对青少年药物滥用的医疗办公室简短干预的Ib期疗效试验。药物的使用与各种卫生保健问题有关，使青少年接受常规医疗护理的环境成为实施常规筛查和早期干预的理想场所。然而，目前在这方面医疗设施利用不足，需要新的循证战略， 改进实践模式，包括标准化的筛查、评估、干预和转诊治疗方法。该调查小组以前曾进行过旨在评估青少年医疗病人中药物滥用筛查测试的可靠性的研究。然后，我们开发了一个新的简短的屏幕，CRAFFT，这是既适合青少年的发展和实用的忙碌诊所设置使用。我们还完成了基于动机访谈的基于医疗办公室的简短干预的第1a阶段可行性研究。阶段1a研究的初步结果表明，我们的方法将有效减少12-18岁青少年医疗患者的药物使用。我们 已经制定了治疗手册草案、临床诊疗表、临床医生培训协议和测量电池。我们现在准备进行一项新干预措施的1b期研究，该研究将使用随机对照设计。拟议计划的具体目标是：（1）测试简短干预对药物使用的影响，（2）测试简短干预对参与治疗的影响，（3）测试简短干预对其他物质相关结局的影响，以及（4）确定调节和/或介导干预对关注结局影响的因素，并估计其效应量。对药物滥用进行有效的短暂干预可以在青少年接受常规医疗保健的环境中广泛实施，并将在美国各地具有巨大的公共卫生意义。

This application is submitted to NIDA in response to PA-03-126, Behavioral Therapies Development Program, and proposes a Stage lb efficacy trial of a medical office brief intervention for adolescent drug abuse. Use of drugs is associated with a variety of health care problems, making settings where adolescents receive routine medical care ideal for implementation of routine screening and early intervention. However, medical settings are currently underutilized in this regard and new evidence-based strategies are needed to improve practice patterns, including standardized methods of screening, assessment, intervention, and referral to treatment. This investigative team has previously conducted studies aimed at assessing the reliability of substance abuse screening tests among adolescent medical patients. We then developed a new brief screen, the CRAFFT, which is both developmentally appropriate for adolescents and practical for use in busy clinic settings. We also completed a Stage 1a feasibility study of a medical office-based brief intervention based on motivational interviewing. Preliminary results from the Stage 1a study suggest that our approach will be effective in reducing use of drugs among 12-18 year old adolescent medical patients. We have developed a draft therapy manual, clinical encounter forms, a clinician training protocol, and a measurement battery. We are now prepared to conduct a Stage 1b study of the new intervention, which will use a randomized controlled design. The specific aims of the proposed plan are to: (1) Test the effect of the brief intervention on drug use, (2) Test the effect of the brief intervention on engagement in treatment, (3) Test the effect of the brief intervention on other substance-related outcomes, and (4) Identify factors that moderate and/or mediate the effect of the intervention on outcomes of interest and estimate their effect sizes. An effective brief intervention for drug abuse could be widely implemented in settings where adolescents receive routine healthcare, and would be of enormous public health significance across the U.S.