Medical Office Intervention for Adolescent Drug Use

本申请是根据PA-03-126《行为疗法开发计划》向NIDA提交的，并建议对一家医疗机构对青少年药物滥用进行短暂干预的Lb阶段疗效试验。药物的使用与各种保健问题有关，这使得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选择。然而，医疗机构目前在这方面没有得到充分利用，需要新的循证战略来 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。该调查小组此前曾进行研究，旨在评估青少年内科患者药物滥用筛查测试的可靠性。然后，我们开发了一种新的简短屏幕，CRAFFT，它既适合青少年的发育，也适用于繁忙的诊所环境。我们还完成了基于激励性访谈的以医疗办公室为基础的短期干预的1a阶段可行性研究。1a阶段研究的初步结果表明，我们的方法将有效地减少12-18岁青少年内科患者的药物使用。我们 已经制定了治疗手册草案、临床见面表、临床医生培训方案和测量电池。我们现在准备进行新干预措施的1b阶段研究，该研究将使用随机对照设计。拟议计划的具体目标是：(1)测试短暂干预对药物使用的影响，(2)测试短暂干预对参与治疗的影响，(3)测试短暂干预对其他物质相关结果的影响，以及(4)确定影响和/或调节干预对感兴趣结果的影响的因素，并估计其影响大小。对药物滥用的有效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.