Development and Testing of Adolescent Twelve-Step Facilitation

描述（由申请人提供）：青少年中的酒精和其他药物使用障碍是一个棘手的公共卫生问题。尽管在开发针对患有这些疾病的青少年的有效治疗方面取得了相当大的进展，但复发非常常见（Dennis，Godley et al，2004），并且只有约三分之一的青少年表现出广泛的物质相关受累和损害，并参与任何持续护理（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）已被证明是有用的复发预防和恢复资源，也似乎具有成本效益（Humphreys和Moos，2001; 2007），为许多不同类型的成年患者的物质使用障碍（SUD）。来自成人研究的证据也表明，使用各种形式的专业领导的跨步骤促进（TSF）可以大大提高SUD患者参加同行领导的12步研究的可能性（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，尚未在青少年中进行随机对照TSF研究，尽管有证据表明青少年几乎一致地接受AA/NA组的转诊（Kelly，Yeterian et al，2008; Knudsen et al，2008），并且在相关研究中似乎从参与中获益（Chi，Kaskutas et al，2009; Kennedy和Minami，1993; Kelly，Brown et al，2008）。迫切需要实验研究设计，以适当消除困扰相关研究的自我选择偏见。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，（《药物战略》，2003年; Knudsen等人，2008年），这样的研究将批判性地告知我们TSF方法对青年的适当性和相对有效性的知识，如果证明是有效的，最终将提供有用的临床工具，发挥广泛的社会影响。该项目的主要目标是开发一种手动的、适合发展的干预措施，将MET/CBT与TSF相结合，形成一种针对青少年的“综合TSF”（“iTSF”）治疗，并获得与现有循证治疗（MET/CBT）（包括AA/NA的标准转诊）相比，该干预措施的效应量估计。来自该I期研究的效应量估计将为未来应用提供基础，以进行大规模II期随机临床试验，该试验将有能力测试中介作用机制。最终，我们希望这项研究计划将导致一个明确的，有效的干预，可以很容易地传播。

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.