Computer Based Training in CBT for Spanish-Speaking Substance Users

描述(由申请人提供)：药物滥用是拉美裔美国人的一个严重问题，他们代表着美国最大的少数族裔群体。与欧洲和非洲裔美国人相比，拉丁裔/AS接受精神健康和药物滥用治疗服务的可能性较小，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严重不足。为了解决改善获得经验性治疗的机会的问题，我们开发了一种计算机辅助版本的认知行为治疗(基于计算机的认知行为治疗培训，CBT4CBT)，并证明了其作为标准门诊药物滥用治疗的辅助工具的有效性和持久性。我们现在建议调整CBT4CBT计划，使其适用于主要/首选语言为西班牙语的广泛药物滥用者，并评估其在这一人群中的效果。如果这种西班牙语版本的CBT4CBT被发现是一种有效的治疗辅助手段，那么在广泛的项目中传播和实施将是相对廉价和直接的。因此，这也将代表着在向这一重要和服务不足的人群更广泛地提供循证疗法方面迈出了重要的一步，从而解决了美国的严重健康差距和NIH的优先事项。我们建议，首先，为讲西班牙语的物质使用者调整我们的个性化、交互式、基于网络的培训计划(CBT4CBT)。其次，我们建议进行一项初步的随机试验，评估在社区治疗计划中将CBT4CBT-西班牙语添加到常规治疗中的可行性和有效性，该治疗计划针对100名符合当前物质滥用依赖标准的讲西班牙语的个人。参与者将被随机分为两种情况：(1)在康涅狄格州精神卫生中心的西班牙裔诊所接受标准治疗(ST)，或(2)接受CBT4CBT-西班牙语计划作为辅助治疗的ST。治疗效果的长期持久性和/或延迟出现将通过六个月的随访进行评估。主要的结果措施将是减少物质使用，操作上是通过尿毒学筛查确认的每周减少物质使用频率。次要结果将包括降低艾滋病毒风险、心理社会功能，以及参与者展示CBT4CBT干预措施中作为结果调解人的技能的能力。

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.