Computer Based Training in CBT for Spanish-Speaking Substance Users

描述（由申请人提供）：药物滥用是西班牙裔美国人的一个严重问题，他们代表了美国最大的少数民族群体。与欧洲人和非洲裔美国人相比，拉丁裔/亚裔接受精神健康和药物滥用治疗服务的可能性往往更小，他们经历了不成比例的药物使用不良后果，但在临床和研究样本中的代表性却严重不足。为了解决改善获得经验验证疗法的问题，我们开发了一种计算机辅助版本的认知行为疗法（认知行为疗法的计算机培训，CBT4CBT），并已证明其作为标准门诊药物滥用治疗的辅助疗法的有效性和持久性。我们现在建议将CBT4CBT项目应用于以西班牙语为主要语言/首选语言的大量药物滥用者，并评估其在这一人群中的疗效。如果这个西班牙语版本的CBT4CBT被发现是一种有效的辅助治疗方法，它将相对便宜，并且可以直接在广泛的项目中传播和实施。因此，这也将是使循证疗法更广泛地适用于这一重要且服务不足的人群的重要一步，从而解决美国严重的健康差距和NIH的优先事项。我们建议，首先，调整我们的个性化，互动式，基于网络的培训计划（CBT4CBT）为西班牙语药物使用者。其次，我们建议进行一项初始随机试验，评估在社区治疗项目中像往常一样将cbt4cbt -西班牙语加入治疗的可行性和有效性，研究对象为100名符合当前药物滥用依赖标准的讲西班牙语的个体。参与者将被随机分为两组：(1)在康涅狄格精神健康中心的西班牙裔诊所接受标准治疗（ST），或(2)接受cbt4cbt -西班牙语项目作为辅助治疗的ST。治疗效果的长期持久性和/或延迟出现将通过6个月的随访来评估。主要结果措施将是减少药物使用，通过尿液毒理学筛查确认每周减少药物使用频率来实施。次要结果将包括艾滋病毒风险降低，心理社会功能，以及参与者展示CBT4CBT干预目标技能的能力，作为结果的中介。

DESCRIPTION (provided by applicant): Substance abuse is a significant problem among Hispanic Americans, who represent the largest ethnic minority group in the United States. Latino/as tend to be less likely to receive mental health and substance abuse treatment services than European and African Americans, experience disproportionate levels of adverse consequences of drug use, and yet are highly underrepresented in clinical and research samples. To address the issue of improving access to empirically validated therapies, we have developed a computer-assisted version of cognitive behavioral therapy (Computer Based Training for Cognitive Behavioral Therapy, CBT4CBT) and have demonstrated its efficacy and durability as an adjunct to standard outpatient substance abuse treatment. We now propose to adapt the CBT4CBT program for use with a broad range of substance abusers whose principal/preferred language is Spanish and to evaluate its efficacy in this population. If this Spanish version of CBT4CBT is found to be an effective adjunct to treatment, it would be comparatively inexpensive and straightforward to disseminate and implement in a wide range of programs. It would thus also represent a significant step in making evidence-based therapies more broadly available to this important and underserved population and hence to address a critical health disparity in the US and an NIH priority. We propose to, first, adapt our individualized, interactive, web-based training program (CBT4CBT) for Spanish- speaking substance users. Second, we propose to conduct an initial randomized trial evaluating the feasibility and efficacy of adding CBT4CBT-Spanish to treatment as usual in a community based treatment program in a population of 100 Spanish-speaking individuals who meet current criteria for substance abuse dependence. Participants will be randomized to one of two conditions: (1) standard treatment (ST) at the Hispanic Clinic of the Connecticut Mental Health Center, or (2) ST with access to the CBT4CBT-Spanish program as an adjunct to treatment. The long-term durability and/or delayed emergence of treatment effects will be evaluated through a six month follow-up. The primary outcome measures will be reduction in substance use, operationalized as reduction in the frequency of substance use by week confirmed by urine toxicology screens. Secondary outcomes will include HIV risk reduction, psychosocial functioning, and the participants' ability to demonstrate the skills targeted in the CBT4CBT intervention as a mediator of outcome. PUBLIC HEALTH RELEVANCE: This project proposes to develop a Spanish-language, web-based version of our 'Computer-Based Training in Cognitive-Behavioral Therapies', or CBT4CBT and to conduct a randomized clinical trial evaluating it among Spanish speaking substance users. The goal of this project is to address a major challenge in health disparities as defined by NIH and the Institute of Medicine, specifically, the need for accessible, effective, evidence-based treatments for Latino/as