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的发展取得了相当大的进展，但复发是非常普遍的(Dennis，Godley等人，2004年)，只有大约三分之一的青少年表现出广泛的与物质有关的参与和损害，从事任何持续的护理(Godley，Godley等人，2001年)。免费提供的社区资源，如戒酒互助会(AA)和戒毒互助会(NA)，已被证明是有益的复发预防和康复资源，而且对于许多不同类型的药物使用障碍(SUD)成人患者来说似乎也具有成本效益(Humphreys and Moos，2001；2007)。来自成人研究的证据还表明，各种形式的专业领导的十二步促进(TSF)的使用可以显著增加SUD患者参加同行领导的12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，德曼等人，2008)。然而，还没有在青少年中进行随机对照的TSF调查，尽管有证据表明，青少年几乎一致地被转介到AA/NA群体(Kelly，Yeterian等人，2008年；Knudsen等人，2008年)，并在相关研究中似乎从参与中受益(Chii，Kaskutas等人，2009；Kennedy and Minami，1993；Kelly，Brown等人，2008)。为了正确消除困扰相关研究的自我选择偏差，迫切需要实验研究设计。鉴于12步转诊和相关治疗方法在美国青少年治疗提供者中的广泛使用(药物战略，2003年；Knudsen等人，2008年)，这项研究将关键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，最终将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手工化的、适合发育的干预措施，将MET/CBT与TSF结合起来，形成针对青少年的“综合TSF”(“ITSF”)治疗，并获得与现有循证治疗(MET/CBT)相比的效果大小估计，现有循证治疗将包括转诊至AA/NA。这项第一阶段研究的效应大小估计将为未来的应用提供基础，以进行大规模的第二阶段随机临床试验，该试验将被用于测试中介作用机制。最终，我们预计这项研究计划将产生一种明确、有效的干预措施，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.