Adolescents with Major Depression and AUD: Community-Based Integrated Treatment

描述（由申请人提供）：研究一致表明青春期精神健康障碍与酒精使用障碍（AUD）之间存在关联。特别是，AUD与重度抑郁症（MDD）的合并症已得到充分证实，并与一系列负面结果相关，包括更长、更严重的疾病发作和更大的心理社会障碍（包括行为障碍）。与成人相比，这一人群的治疗可能更具挑战性，因为患有重度抑郁症/AUD的青少年除了AUD外，通常还有其他外化障碍。针对这一人群的治疗研究相当有限，《健康人2020目标》（MHMD HP 2020- 2014）直接针对这一领域：“增加同时存在药物滥用和精神障碍的患者接受这两种疾病治疗的比例”。本申请的目的是进行一项随机临床试验，比较认知行为疗法-综合（CBT- I）对患有重度抑郁症和AUD的青少年和标准治疗（SC），即治疗技术的折衷组合。两组随机设计将用于检验主要假设，即设计用于治疗12至18岁患有AUD/ MDD的青少年的综合CBT- I方案与标准治疗相比，在以下方面会产生更好的治疗结果：1)大量饮酒/酒精问题可能导致抑郁和外化行为，其中最严重的会导致昂贵的住宿安置和逮捕/监禁；2)抑郁和自杀事件，后者可能需要昂贵的急诊和精神病院住院治疗。综合CBT-I和SC条件将由社区心理健康诊所的执业心理健康咨询师提供，该诊所使用强化门诊项目模式治疗患有AUD和精神健康障碍的青少年，这些青少年之前的门诊治疗失败，需要更多的强化服务。处于CBT-I状态的临床医生将每周接受监督，重点关注CBT-I方案的使用。SC的临床医生将提供标准的临床监督，这在本质上更加折衷，与典型的社区护理一致。结果数据将在治疗后一年收集。项目目标的成功完成可能会改变向这一高风险群体提供服务的方式。它的临床意义在于解决了该领域的一个关键障碍：如何治疗重度抑郁症/AUD青少年。

DESCRIPTION (provided by applicant): Studies have consistently shown an association between mental health disorders and alcohol use disorders (AUD) during adolescence. In particular, the comorbidity of AUD with Major Depressive Disorder (MDD) is well established and associated with a range of negative outcomes including longer and more severe episodes of illness and greater psychosocial impairment including behavior disturbance. This population may be even more challenging to treat than their adult counterparts because adolescents with MDD/AUD so often have other externalizing disorders besides AUD. Treatment research for this population is quite limited and Healthy People 2020 Objective MHMD HP 2020-14 directly addresses this area: "increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment for both disorders". The purpose of this application is to conduct a randomized clinical trial comparing Cognitive Behavioral Therapy - Integrated (CBT- I) for adolescents with MDD and AUD to standard care (SC), i.e. an eclectic mix of therapy techniques. A two group randomized design will be used to test the primary hypothesis that the integrated CBT- I protocol designed to treat adolescents aged 12 to 18 years with AUD/ MDD will produce better treatment outcomes compared to standard care with respect to 1) heavy volume alcohol use/ alcohol problems which can contribute to both depression and externalizing behaviors, the most severe of which result in costly residential placements and arrests/incarceration; and 2) depression and suicidal events, the latter potentially requiring expensive Emergency Department visits and inpatient psychiatric hospitalizations. Both the integrated CBT-I and SC condition will be delivered by licensed mental health counselors at a community mental health clinic that uses an Intensive Outpatient Program model to treat adolescents with AUD and mental health disorders who have failed prior outpatient therapy and require more intensive services. Clinicians in the CBT-I condition will receive weekly supervision that focuses on use of the CBT-I protocol. Clinicians in SC will be provided standard clinic supervision that is more eclectic in nature, consistent with typical community care. Outcome data will be collected at one year post treatment. Successful completion of the project aims could change how services are delivered to this high risk group. Its clinical significance lies in ts addressing a critical barrier to the field: how to treat MDD/AUD adolescents.