Development and Testing of Adolescent Twelve-Step Facilitation

描述（由申请人提供）：青少年中酒精和其他药物使用失调是一个顽固的公共卫生问题。尽管对患有这些疾病的青少年的有效治疗方法取得了相当大的进展，但复发是非常常见的（Dennis, Godley et al ., 2004），只有大约三分之一的青少年表现出广泛的物质相关的介入和损害，参与任何持续的护理（Godley, Godley et al ., 2001）。免费提供的社区资源，如匿名戒酒会（AA）和匿名戒毒会（NA）已被证明是有助于预防复发和康复的资源，而且对许多不同类型的物质使用障碍（SUD）的成年患者来说也具有成本效益（Humphreys和Moos, 2001; 2007）。来自成人研究的证据也表明，使用各种形式的专业领导的十二步促进（TSF）可以大大提高SUD患者参加同伴领导的十二步奖学金的可能性（Kahler等人，2004；Kaskutas等人，2009；Nowinski等人，1992；Sisson和Malams, 1982; Timko， DeBenedetti等人，2006;Walitzer， Dermen等人，2008）。然而，尽管有证据表明青少年几乎都被转到AA/NA小组（Kelly， Yeterian等人，2008；Knudsen等人，2008），并且在相关研究中，青少年似乎从参与中受益（Chi， Kaskutas等人，2009；Kennedy和Minami, 1993; Kelly， Brown等人，2008），但尚未在青少年中进行随机对照的TSF调查。迫切需要实验研究设计来适当地消除困扰相关研究的自我选择偏差。鉴于美国青少年治疗提供者广泛使用12步转诊和相关治疗方法（Drug Strategies, 2003; Knudsen et al, 2008），这样的研究将批判性地告知我们关于青少年TSF方法的适当性和相对有效性的知识，如果被证明是有效的，将最终提供有用的临床工具，将产生广泛的社区影响。该项目的主要目标是开发一种人工的、适合发展的干预措施，将MET/CBT与TSF结合起来，形成一种针对青少年的“综合TSF”（“iTSF”）治疗，并与现有的循证治疗（MET/CBT）（包括标准转诊到AA/NA）进行比较，获得该干预措施的效应量估计。第一阶段研究的效应大小估计将为未来应用进行大规模第二阶段随机临床试验提供基础，该试验将用于测试作用的中介机制。最终，我们期望这一研究项目将产生一种明确的、有效的干预措施，可以很容易地传播开来。

DESCRIPTION (provided by applicant): Alcohol and other drug use disorders among youth present a tenacious public health problem. Despite considerable advances in the development of efficacious treatments for adolescents with these disorders, relapse is very common (Dennis, Godley et al, 2004) and only about one third of adolescents exhibiting a broad range of substance-related involvement and impairment engage in any continuing care (Godley, Godley et al, 2001). Freely available community resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have been shown to be helpful relapse prevention and recovery resources and also appear cost-effective (Humphreys and Moos, 2001; 2007) for many different types of adult patients with substance use disorder (SUD). Evidence from adult studies also suggests that the use of various forms of professionally-led Twelve-Step Facilitation (TSF) can enhance substantially the likelihood that patients with SUD will participate in peer-led 12-step fellowships (Kahler et al, 2004; Kaskutas et al, 2009; Nowinski et al, 1992; Sisson and Malams, 1982; Timko, DeBenedetti et al, 2006; Walitzer, Dermen, et al, 2008). However, no randomized controlled TSF investigations have been conducted among adolescents, despite evidence that youth almost uniformly receive referrals to AA/NA groups (Kelly, Yeterian et al, 2008; Knudsen et al, 2008) and appear, in correlational studies, to benefit from participation (Chi, Kaskutas et al, 2009; Kennedy and Minami, 1993; Kelly, Brown et al, 2008). Experimental study designs are sorely needed to properly eliminate the self-selection biases that plague correlational studies. Given the widespread use of 12-step referrals and related treatment approaches in the United States among adolescent treatment providers (Drug Strategies, 2003; Knudsen et al, 2008), such a study will critically inform our knowledge of the appropriateness and relative efficacy of TSF approaches for youth and, if shown to be efficacious, will eventually provide helpful clinical tools that will exert a widespread community impact. The primary objectives of this project are to develop a manualized, developmentally-appropriate, intervention that combines MET/CBT with TSF to form an "integrated TSF" ("iTSF") treatment for adolescents and to obtain an effect size estimate for this intervention compared to an existing evidence-based treatment (MET/CBT) that will include a standard referral to AA/NA. The effect size estimates from this Stage I research would provide the foundation for a future application to conduct a large-scale, Stage II, randomized clinical trial that would be powered to test mediational mechanisms of action. Ultimately, we expect this program of research will result in a well-specified, efficacious intervention that could be readily disseminated. PUBLIC HEALTH RELEVANCE: Alcohol and other drug use disorders among youth present a tenacious public health problem. Despite considerable advances in the development of efficacious treatments for adolescents with these disorders, relapse is common. Interventions that emphasize continuing care, such as Twelve-Step Facilitation (TSF) may be able to help sustain remission, but have not been developed or tested for appropriateness and efficacy among youth. This study will develop and test the efficacy of a developmentally-appropriate, integrated TSF treatment for adolescents.