Course of Problems in Adolescent Drug Treatment Intakes

描述(由申请人提供)： 该提案响应了NIDA于2001年5月21日发布的关于药物滥用健康服务研究的计划公告PA-01-097。它在四个托管护理药物滥用治疗地点的400名青少年样本中检查了3年和5年的问题疗程，并评估了药物滥用问题和治疗与医疗利用和费用的关系。收集了基线、6个月和12个月的随访数据。这项拟议的研究建立在关于青少年药物滥用的纵向和治疗结果文献的基础上，并确定了药物使用模式和问题的5年时间路径的决定因素。药物使用的时间路径或“轨迹”与青少年药物治疗领域具有理论和应用上的相关性，在青少年药物治疗领域，药物滥用问题越来越被视为慢性和复发性的，同时，许多人“成熟”地摆脱了问题。分析利用潜在曲线分析技术来比较物质使用轨迹的形状及其决定因素。我们考察了人口统计特征、问题严重性(即药物使用类型和严重程度、医疗和精神并存、社会问题和生活应激源)、治疗(即开始治疗、指数治疗的住院时间和再入院)和“额外治疗”(例如，同伴影响、家庭功能、十二步参与)因素对5年问题进程的影响。这项拟议的研究对青少年药物滥用的纵向文献的另一个重要贡献是检查了共病的医疗条件，以及它们与青少年药物滥用过程的关系。我们还在每一波研究中都采访了一位家长，并通过药物测试检查了附属报告和自我报告的有效性。卫生组织拥有持续的计算机化数据，其中包括治疗的日期和停留时间、接受的所有精神和医疗服务及其费用。我们从青少年和父母那里收集健康计划未涵盖的治疗和医疗服务利用情况的自我报告数据。我们对青少年进行了5年的跟踪调查，这段时间是青少年成长的关键时期，也就是许多人“成熟”出问题的时候，这让我们能够审视这一过程背后的个人、环境和服务因素，看看那些成功的人和那些失败的人。

DESCRIPTION (provided by applicant): This proposal responds to NIDA's Program Announcement, PA-01-097, of 5/21/01, on Drug Abuse Health Services Research. It examines the 3- and 5-year course of problems in an "intent to treat" sample of 400 adolescent intakes in four managed care substance abuse treatment sites, and assesses the relationship of substance abuse problems and treatment to medical utilization and cost. Baseline, 6- and 12-month follow-up data have been collected. The proposed study builds on the longitudinal and treatment outcome literature on adolescent substance abuse, and identifies the determinants of 5-year time paths of substance use patterns and problems. Time paths, or "trajectories" of substance use are of both theoretical and applied relevance to the adolescent drug treatment field, where substance abuse problems are increasingly viewed as chronic and relapsing, and at the same time, many individuals "mature out" of problems. Analyses draw on latent curve analysis techniques to compare the shape of trajectories of substance use and their determinants. We examine the influences that demographic characteristics, problem severity (i.e., substance use type and severity, medical and psychiatric comorbidities, social problems, and life stressors), treatment (i.e., starting treatment and length of stay of index treatment, and readmissions), and "extra-treatment" (e.g., peer influences, family functioning, twelve-step participation) factors have on the 5-year course of problems. Another important contribution of the proposed study to the longitudinal literature on adolescent substance abuse is the examination of co-morbid medical conditions, and their relationship to the course of adolescent substance abuse. We have also interviewed a parent at each wave of the study, and we examine collateral reports and validity of self-report through drug testing. The HMO has on-going computerized data on the dates and length of stay of treatment episodes and all psychiatric and medical services received, as well as their costs. We collect self-report data from teens and parents on treatment and medical service utilization not covered by the health plan. We follow adolescents for 5 years during the crucial "becoming young adult" period when many individuals "mature out" of problems, which allows us to examine the individual, environmental, and service factors that underlie this process, for those who succeed and those who do not.