Development of a Family-Based Treatment for Adolescent Methamphetamine Abuse

描述(申请人提供)：冰毒在美国的滥用已经达到流行的程度，特别是在西部各州，并与一系列身体和心理问题有关。更令人不安的是，在青春期使用冰毒可能会干扰正常的大脑发育。这些发现表明，冰毒的地方性使用需要开发和测试针对青少年滥用者的有效治疗方法，以防止潜在的有害后果。此外，将临床和神经科学的方法结合在一个跨学科的模式中，应该会导致更多的处方和有效的治疗。因此，在目前的研究中，我们结合了针对冰毒的干预措施的开发，并更详细地检查了冰毒的使用如何影响神经系统，以及特定大脑区域的变化如何影响治疗反应。这项拟议的研究代表了IA/IB阶段的治疗开发项目，利用跨学科的方法，与NIH路线图保持一致，旨在开发、完善和试点测试针对青少年滥用或依赖冰毒的理论上扎根的干预措施。冰毒特定干预(AMT)将把家庭治疗与有效的成人冰毒治疗计划的核心要素结合起来，以适应青少年的发育需要。这将与独立的家庭治疗干预(FFT)进行比较，FFT是一种治疗青少年物质使用障碍的有效方法。此外，为了给我们的治疗方法提供信息，将开发一项实验室任务来衡量决策(即冒险和冲动)，并与脑功能成像程序(FMRI)相结合，以评估冰毒和其他药物使用对这些认知功能潜在的神经回路的影响。我们的第1A阶段研究目标是开发和测试特定于冰毒的手动治疗方案。此外，我们还将在32名接受冰毒治疗的青少年和16名非药物使用对照组的青少年中，检查我们的fMRI程序在评估大脑中已知受冰毒影响的奖励相关通路功能方面的有效性，以确定两组人做出决策的大脑结构是否有显著差异。1B阶段的目标如下：试行人工AMT程序以确定其可行性，并验证其与FFT的区分性，通过检查参与率和保留率来验证治疗的可接受性，确定与FFT相关的重大临床结果，并检查预测的介体和调节物以确定治疗效果的核心机制。功能磁共振成像措施将被视为与告知治疗参与和保留以及短期和长期治疗结果有关。1B阶段研究将涉及60名青少年冰毒滥用者，随机分配到AMT或FFT，他们将在治疗前、治疗开始后3个月和6个月接受评估。这项研究的最终目的是根据功能磁共振成像技术评估AMT干预的潜在前景，以便在正式的第二阶段临床试验中进行进一步研究。

DESCRIPTION (provided by applicant): Methamphetamine (meth) abuse in the U.S. has reached epidemic proportions, especially in the Western States and has been linked to a host of physical and psychological problems. Even more troubling, meth use during the adolescent period may interfere with normal brain development. These findings suggest that the endemic use of meth will require the development and testing of effective treatments aimed at adolescent abusers to forestall potentially deleterious outcomes. Moreover, combining clinical and neuroscientific approaches in an interdisciplinary model should lead to more prescriptive and efficacious treatments. In the current study, therefore, we merge the development of meth-specific interventions with a more detailed examination of how meth use affects neural systems and how alterations in specific brain areas influence treatment response. The proposed study represents a Stage IA/IB treatment development project, utilizing an interdisciplinary approach, consistent with the NIH Roadmap and designed to develop, refine, and pilot test a theoretically grounded intervention for adolescent meth abuse or dependence. The meth-specific intervention (AMT) will integrate family therapy with core elements of effective adult meth treatment programs, adapted to be developmentally appropriate for adolescents. This will be compared to a stand-alone family therapy intervention (FFT), an efficacious and effective treatment for adolescent substance use disorders. Further, in an effort to inform our treatment approach, a laboratory task will be developed to measure decision-making (i.e., risk-taking and impulsivity) and combined with functional brain imaging procedures (fMRI) to assess the effect of meth and other drug use on the neural circuits underlying these cognitive functions. Our Stage 1A research aim is to develop and test the meth-specific manualized treatment protocol. As well, we will examine the validity of our fMRI procedures in assessing the function of reward-related pathways in the brain known to be affected by meth in a subset of 32 adolescents referred for meth treatment and 16 nondrug-using controls to determine if the brain structures underlying decision-making in the two groups differ significantly. Stage 1B aims following will pilot test the manualized AMT procedure to establish its feasibility and validate its discriminability from FFT, verify the acceptability of the treatment by examining rates of engagement and retention, determine significant clinical outcomes relative to FFT alone, and examine predicted mediators and moderators to determine the core mechanisms of treatment efficacy. fMRI measures will be viewed relative to informing treatment engagement and retention as well as both short-term and long-term treatment outcomes. Stage 1B research will involve 60 adolescent meth abusers randomly assigned to either AMT or FFT who will be assessed at pretreatment, and at 3- months and 6-months following treatment initiation. The ultimate purpose of the research is to evaluate the potential promise of the AMT intervention, as informed by fMRI technology, for further investigation in a formal Stage 2 clinical trial.