Mechanisms of Change in Alcohol Treatment for Dually Diagnosed Youth

描述（由申请人提供）：为响应RFA-AA-07-005《酒精使用障碍治疗中的行为改变机制》，本项目将改变物质使用的意愿作为酒精和其他药物使用变化的关键近端、高度可塑性认知因素进行研究。本研究的重点是改变物质使用的准备程度，因为它被假设为预示和预测物质使用的变化，并作为治疗效果的敏感标志。强化评估时间表将用于确定治疗（特异性和非特异性效果）如何影响接受强化门诊（IOP）治疗的双重诊断（共同发生的物质使用和精神疾病）青少年改变物质使用的意愿。青少年将在治疗初始评估后立即进行评估，在参加第一次IOP治疗之前，在每次IOP治疗之后，以及在治疗开始后通过6个月的随访每月进行评估。密集的评估将用于确定手动的、基于群体的IOP治疗和其他因素（例如，共同发生的精神病理、缓刑状态）如何影响青少年改变药物使用的意愿。我们将前瞻性研究从青少年双重诊断诊所招募的50名青少年（14-18岁）。每个青少年都将有一个家长作为辅助信息提供者。临床医生将在每次IOP会议后提供青少年参与评分。该项目有三个具体目标：(1)跟踪青少年改变药物使用的意愿（例如，戒断的动机）的变化，这是一种建议的药物使用行为改变的中介，从青少年双重诊断诊所治疗的初始评估开始，在每次参加强化门诊（IOP）会议后立即开始，并在IOP开始后每月进行6个月的随访；(2)检验改变物质使用行为的意愿作为治疗效果和物质涉入的中介，并确定患者特征和治疗外因素在治疗前、治疗中和治疗后6个月影响改变物质使用意愿；(3)确定治疗期间和治疗后某一功能领域的变化（例如，物质使用行为）与另一领域的功能（例如，共同发生的精神病理）之间的关系。结果对改善双重诊断青年的治疗内容和提供具有重要意义。成瘾治疗的一个重要目标是增加和保持患者改变药物使用的意愿。该项目将研究治疗如何影响青少年双重诊断（药物使用和同时发生的精神疾病）门诊患者的准备改变。研究结果对改善双重诊断青少年的治疗设计和提供具有重要意义。

DESCRIPTION (provided by applicant): In response to RFA-AA-07-005, Mechanisms of behavior change in treatment of alcohol use disorders, this project examines readiness to change substance use as a key proximal, highly malleable cognitive factor underlying change in alcohol and other drug use. This study focuses on readiness to change substance use because it is hypothesized to precede and predict changes in substance use, and serves as a sensitive marker of treatment effect. An intensive assessment schedule will be used to determine how treatment (specific and non-specific effects) impacts readiness to change substance use among dually diagnosed (co-occurring substance use and psychiatric illness) adolescents admitted to intensive outpatient (IOP) treatment. Adolescents will be assessed starting immediately after the initial evaluation for treatment, prior to attending the first IOP session, after each IOP session, and monthly after the start of treatment through 6-month follow-up. Intensive assessment will be used to determine how manualized, group-based IOP treatment and other factors (e.g., co-occurring psychopathology, probation status) impact youths' readiness to change substance use. We will prospectively study 50 adolescents (age 14-18) recruited from an Adolescent Dual Diagnosis Clinic. Each adolescent will have a parent collateral informant. Clinicians will provide ratings of youth participation after each IOP session. The project addresses three specific aims: (1) track changes in adolescents' readiness to change substance use (e.g., motivation to abstain), a proposed mediator of change in substance use behavior, starting at the initial evaluation for treatment at an adolescent dual diagnosis clinic, immediately after each intensive outpatient (IOP) session attended, and monthly after the start of IOP through 6-month follow-up; (2) examine readiness to change substance use behavior as a mediator of treatment effects and substance involvement, and to identify patient characteristics and extra-treatment factors that influence readiness to change substance use pre-, during, and through 6-months after treatment entry; and (3) determine how change during and post treatment in one area of functioning (e.g., substance use behavior) is associated with functioning in another domain (e.g. co-occurring psychopathology). Results have important implications for improving the content and delivery of treatment provided to dually diagnosed youth. An important goal of addictions treatment is to increase and maintain patients' readiness to change substance use. This project will examine how treatment impacts readiness to change in adolescent dual diagnosis (substance use and co-occurring psychiatric illness) outpatients. Results have important implications for improving the design and delivery of treatment provided to dually diagnosed adolescents.