Prevention of Substance Abuse and Problem Behaviors in High-Risk Adolescents

描述(由申请人提供)：大量研究表明，轻微犯罪通常是吸毒的前兆，这两种行为的开始通常发生在儿童正在经历其他艰难的人生转变时。有证据表明，犯罪和吸毒之间存在相互作用的关系，这使得研究人员假设了一系列共同的潜在原因，其中可能包括认知和自我控制缺陷，在某些情况下还包括心理健康问题。这项研究提出了这样一种可能性，即针对犯罪或吸毒(或潜在的共同原因)的干预可能有助于防止这两种行为的持续或升级。不幸的是，我国社会中最脆弱的青年也极有可能与关键的社会制度脱节。这表明，选择性预防干预的一个特别重要的交付环境可能是少年司法系统。我们要求提供资金，以实施和试行综合认知行为疗法(CBT)计划，该计划在青少年管教环境中广泛使用，但尚未调整为在社区环境中用于青少年罪犯群体或进行测试。以社区为基础的CBT方案与拘留期间提供的方案相比，与更多的青少年罪犯人口相关，必须解决拘留环境中不那么紧迫的额外挑战，例如确保方案的持续参与，以及应对外部社区对青少年态度和结果的影响。我们提议的项目是芝加哥大学跨学科研究团队与库克县巡回法院青少年缓刑和法院服务部之间的独特合作使之成为可能。目标人群是受少年缓刑监督的13-17岁青年这一大群体。这项拟议的研究采用了两个阶段的设计：(1)预随机化开发阶段，涉及一项小组可行性研究，以使CBT干预模式适应社区试用环境；(2)疗效的试点随机临床试验(RCT)。RCT将随机分配接受缓刑监督的青少年：(A)现状缓刑服务(N=100)；(B)针对高危青少年的为期12周的团体CBT干预(CBT-ARY)(N=100)；或(C)以出勤增援人员补充CBT的综合干预，以鼓励计划参与(CBT-ARY+)(N=100)。主要结果评估将侧重于干预的近期目标，包括认知过程、态度和心理健康。还将衡量药物使用、攻击、其他形式的暴力或犯罪行为的远端后果，以及累犯率。这两个阶段的结果将指导未来进行全面有效性试验的申请。 公共卫生相关性：拟议的项目将对居住在社区环境中的少年犯实施并试点测试一种综合认知行为疗法，少年犯是公共卫生关注的关键人群。先前对青少年被拘留者进行的研究表明，这种干预措施在减少药物使用和犯罪方面具有潜在的前景，尽管这种前景尚未在其他青少年犯罪群体中得到严格评估。研究调查人员与青少年拘留和缓刑当局之间的密切合作提高了该项目的公共卫生意义，该项目有可能影响美国第三大城市的政策和实践，从而影响整个国家。

DESCRIPTION (provided by applicant): A large body of research suggests that minor delinquency is often a precursor to substance use, and that initiation of both behaviors often occurs as children are experiencing other difficult life transitions. Evidence of a reciprocal relationship between delinquency and substance use has led researchers to hypothesize a set of shared underlying causes, which may include cognitive and self-control deficits and in some cases mental health problems as well. This research raises the possibility that interventions that target either delinquency or substance use (or underlying shared causes) may help prevent the persistence or escalation of both behaviors. Unfortunately the most vulnerable youth in our society are also disproportionately likely to be disconnected from key social systems. This suggests that a particularly important delivery context for selective prevention interventions may be the juvenile justice system. We request funding to implement and pilot-test an integrated cognitive behavioral therapy (CBT) program that is widely used in juvenile correctional settings but has not yet been adapted for delivery or tested for use with juvenile offender populations in the community setting. A community-based CBT program, which would be relevant for a much larger juvenile offender population compared to a program delivered in detention, must address additional challenges that are less pressing within the detention setting, such as ensuring sustained program participation and contending with outside community influences on youth attitudes and outcomes. Our proposed project is made possible by a unique collaboration between our interdisciplinary University of Chicago-based research team and the Juvenile Probation and Court Services Department of the Circuit Court of Cook County. The targeted population is the large group of youth 13-17 years of age who are under the supervision of Juvenile Probation. The proposed study utilizes a two-phase design: (1) a pre-randomized development phase that involves a small group feasibility study to adapt the CBT intervention model for the community probation setting; and (2) the pilot randomized clinical trial (RCT) of efficacy. The RCT will randomly assign youths who are under probation supervision to: (a) status quo probation services (N=100); (b) a 12-week group CBT intervention for at-risk youth (CBT-ARY) (N=100); or (c) a combined intervention that supplements CBT with attendance reinforcers to (CBT-ARY+) encourage program participation (N=100). Primary outcome measures will focus on proximal goals of intervention, including cognitive processes, attitudes, and mental health. Distal outcomes of substance use, aggression, other forms of violent or criminal behavior, and recidivism rates will be also be measured. Results from the two phases will guide a future application for a full-scale effectiveness trial. PUBLIC HEALTH RELEVANCE: The proposed project would implement and pilot-test an integrated cognitive behavioral therapy for juvenile offenders who live in community settings-a key population of public health concern. Prior research conducted with juvenile detainees suggests the potential promise of such interventions in reducing substance use and delinquency, though this promise has yet to be rigorously evaluated in other juvenile offending populations. The close partnership between study investigators and juvenile detention and probation authorities heightens the public health significance of this project, which has the potential to influence policy and practice in the nation's third-largest city, and hence across the nation.