Motivational Therapy for Stimulant Users with Depression

描述(由申请者提供)：拟议的职业发展奖旨在通过支持一项培训计划，为缺乏服务的物质使用障碍(SUDS)人群开发和评估动机干预措施，以补充申请者在潜在成瘾行为动机过程方面的基础科学背景。该计划将促进申请者转变为卫生服务研究的独立调查员，专门为患有精神健康障碍的滑动症人群提供心理社会干预。这项拟议的5年试点研究考察了动机干预与认知行为疗法(CBT)相结合的善后心理社会治疗计划相对于标准护理、十二步促进疗法(TSF)对患有兴奋剂依赖和合并严重抑郁障碍的个人的增量疗效。尽管在过去的十年里，新的认知和动机干预措施改善了物质使用结果，但很少有研究系统地探索这些方法联合使用对患有物质使用障碍和共病精神健康障碍的患者的疗效。拟议的随机试验将包括80名被诊断为兴奋剂依赖和严重抑郁障碍非物质依赖性诊断的双重诊断患者。在接受抑郁症药物治疗的患者中，我们将比较12周的CBT联合激励疗法(CBT-MT)和12周的TSF对抑郁、物质使用、艾滋病毒危险行为和其他保健结果的6周、12周、24周和36周的结果。主要的假设是CBT-MT将产生比TSF更好的结果。我们还将检查早期磨损和治疗保留的预测因素，并检查治疗保留和结果的神经心理学预测因素。这项研究的结果可能会为治疗患有抑郁症的兴奋剂使用者提供一种双重诊断、认知激励的替代方案，以取代传统的善后计划。

DESCRIPTION (provided by applicant): The proposed career development award is designed to complement the applicant's basic science background in motivational processes underlying addictive behaviors by supporting a training program in the development and evaluation of motivational interventions for underserved populations with substance use disorders (SUDs). This program will facilitate transition of the applicant to an independent investigator in health services research with specialty in psychosocial interventions for SLID populations with comorbid mental health disorders. The proposed 5 year pilot study examines the incremental efficacy of an aftercare psychosocial treatment program of a motivational intervention combined with cognitive behavioral therapy (CBT), relative to standard care, twelve-step facilitation therapy (TSF) for individuals with stimulant dependence and comorbid major depressive disorder. Although the past decade has seen new cognitive and motivational interventions producing improvement in substance use outcomes, few studies have systematically explored the efficacy of these approaches in combination in patients with substance use disorders and comorbid mental health disorders. The proposed randomized trial will include 80 dually diagnosed individuals with stimulant dependence and a substance-independent diagnosis of Major Depressive Disorder. In patients receiving pharmacotherapy for depression, we will compare 12 weeks of CBT combined with motivational therapy (CBT-MT) to 12 weeks of TSF on 6, 12, 24, and 36 week outcomes for depression, substance use, HIV-risk behaviors, and other healthcare outcomes. The primary hypothesis is that CBT-MT will produce better outcomes than TSF. We will also examine predictors of early attrition and treatment retention and examine neuropsychological predictors of treatment retention and outcome. The results of this study might provide a dual-diagnosis specific, cognitive- motivational alternative to traditional aftercare programs for the treatment of stimulant users with depression.