Adaptive Treatment for Adolescent Cannabis Use Disorders

描述（由申请人提供）：本申请是对项目公告# PA-08-263的回应，特别是涉及连续性护理的临床质量改进的章节。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将标准化的固定干预措施的比较作为评价治疗效果的主要方法。基于这种方法的治疗计划忽略了临床严重程度和治疗反应的异质性（沃尔德龙和特纳，2008）。在过去的十年中，针对成年物质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（柯林斯等人，2004; Sobell & Sobell，2000）。这已被证明是一种有前途的基于表现的程序，其中对初始水平的循证有效治疗反应不佳的个体随后被提供相同治疗的不同或更增强的版本（McKay，2009）。无/不良反应的定义和变化的时间是适应性治疗方案中的关键决策规则，其中包括干预选项算法。应将这一做法扩大到青年药物滥用治疗结果研究，以克服传统干预措施的局限性，推动这一领域的发展。230名年龄在13至18岁之间的大麻使用障碍（CUD）青少年将参加一项随机对照研究。所有参与者都将接受有效的循证实践干预，即2个单独的动机增强疗法，然后是5个小组的认知行为疗法（即，MET/CBT-7）7周。然后，不良反应者将被随机分配到两种适应性治疗条件之一中。第一个是增强的个性化10周CBT会议。第二种是一种不同的治疗方式，即青少年社区强化方法。A-CRA每周10次会议包括：6次个人会议，2次家长会议和2次联合会议。研究中的所有参与者，包括MET/CBT-7的完成者，将在治疗开始后第17、21、25、38和52周参与治疗结局的随访评估。这项研究被认为是为青少年CUD制定全面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.