Adaptive Treatment for Adolescent Cannabis Use Disorders

描述（由申请人提供）：本申请是为了响应项目公告# PA-08-263，特别是关于护理连续性临床质量改进的部分。青少年药物滥用治疗包括反复的、孤立的急性护理。传统的实验设计强调比较标准化、固定的干预措施作为评估治疗效果的主要方法。基于这种方法的治疗计划忽视了临床严重程度和治疗反应的异质性（Waldron & Turner, 2008）。在过去十年中，针对成人药物滥用者的适应性治疗研究一直在发展，以解决临床严重程度和治疗反应的异质性（Collins et al., 2004; Sobell & Sobell, 2000）。这已被证明是一个很有前途的基于绩效的程序，在这个程序中，对初始水平的循证有效治疗反应不佳的个体，然后提供相同治疗的不同或更强化的版本（McKay, 2009）。非/不良反应的定义和变化的时机是自适应治疗方案的关键决策规则，其中包括干预选择算法。这种方法应扩大到青少年药物滥用治疗结果研究，以克服传统干预措施的局限性，推动该领域的发展。230名13至18岁的大麻使用障碍（CUD）青少年将参加一项随机对照研究。所有参与者将接受有效的循证实践干预，即2次个人动机增强疗法，随后5次认知行为疗法（即MET/CBT-7），为期7周。然后，反应不良的患者将被随机分配到两种适应性治疗条件中的一种。第一种是每周10次的个性化认知行为治疗。第二种是一种不同的治疗方式，青少年社区强化方法（a - cra）。A-CRA每周10次会议包括：6次个人，2次家长，2次联合。包括MET/CBT-7完成者在内的所有研究参与者将在治疗开始后的第17、21、25、38和52周参与治疗结果的随访评估。提出的研究被认为是开发综合适应性治疗策略的第一步。

DESCRIPTION (provided by applicant): This application is in response to program announcement # PA-08-263, in particular the section addressing the clinical quality improvement of continuity of care. Adolescent substance abuse treatment consists of repeated, isolated episodes of acute care. The traditional experimental designs have emphasized the comparison of standardized, fixed interventions as the primary method for evaluating treatment efficacy. Treatment planning based on this approach has overlooked the heterogeneity of both clinical severity and treatment response (Waldron & Turner, 2008). Adaptive Treatment research for adult substance abusers has been developing during the last decade in order to address the heterogeneity in both clinical severity and treatment response (Collins et al., 2004; Sobell & Sobell, 2000). This has been shown to be a promising performance-based procedure in which individuals who respond poorly to an initial level of evidence-based efficacious treatment are then provided a different or a more enhanced version of the same treatment (McKay, 2009). The definitions of non/poor response and the timing of change are pivotal decision rules in an Adaptive Treatment protocol, which includes intervention options algorithm. This approach should be expanded to youth substance abuse treatment outcome research in order to overcome the limitations of traditional interventions and advance the field. Two hundred and thirty consenting and eligible adolescents ages 13 to 18 with cannabis use disorder (CUD) will participate in a randomized controlled study. All participants will receive an effective evidence-based practice intervention that is, 2 individual sessions of Motivational Enhancement Therapy followed by 5 group sessions of Cognitive Behavioral Therapy (i.e., MET/CBT-7) for 7 weeks. Then the poor-responders will be randomized into one of two Adaptive Treatment conditions. The first is an augmented individualized 10 weekly CBT sessions. The second is a different treatment modality, the Adolescent Community Reinforcement Approach (A-CRA). The A-CRA 10 weekly sessions include: 6 individual, 2 parents, and 2 joint. All participants in the study including completers of MET/CBT-7 will participate in follow-up assessments of treatment outcomes at weeks 17, 21, 25, 38 and 52 from treatment onset. The proposed study is viewed as an initial step in the development of comprehensive adaptive treatment strategies for youth with CUD.