Testing a Promising Treatment for Youth Substance Abuse in a Community Setting

描述(由申请人提供)：拟议的随机试验的首要目的是检查在社区治疗环境中提供的有前景的和有效的青少年药物滥用门诊治疗的有效性。尽管青少年药物滥用的几种循证治疗方法正在出现(例如，见Waldron&Turner，2008)，但没有一种在社区环境中得到广泛采用。因此，正如医学研究所(1998)十多年前指出并在最近(例如，McCarty等人，2007年)重申的那样，在青少年和成年人的药物滥用治疗方面，存在着相当大的科学服务差距。在拟议的研究中，204名符合药物滥用或依赖诊断标准的青少年将被随机分为应急管理-家庭参与(CM-FAM；Henggler等人，2012)或照常治疗(TAU)条件。在招募后3、6、9、12和18个月，将使用多方法、多应答方法来跟踪临床结果。临床水平的结果与青少年使用药物、犯罪行为、心理健康功能和青少年严重反社会行为的关键中介有关(例如，自我控制、父母监督、与越轨同龄人交往)。此外，将确定CM-FAM的增量成本，以用于成本效益分析。目的1：在招募后18个月的随访中，确定CM-FAM与TAU在减少青少年参与者的药物使用、犯罪活动(包括监禁)和精神健康症状方面的相对有效性；并评估CM-FAM在实现这些结果方面的成本效益。目标2：检查干预效果的可能调节因素和调节因素。主持人变量将包括青年人口统计和临床(例如，共病)特征。中介变量将包括自我控制、父母教养和与离经叛道的同龄人的联系--CM-FAM的目标结构。

DESCRIPTION (provided by applicant): The overriding purpose of the proposed randomized trial is to examine the effectiveness of a promising and efficient outpatient treatment of adolescent substance abuse delivered in a community-based treatment setting. Although several evidence-based treatments of adolescent substance abuse are emerging (see e.g., Waldron & Turner, 2008), none have experienced widespread adoption in community settings. Thus, as noted by the Institute of Medicine (1998) more than a decade ago and reiterated more recently (e.g., McCarty et al., 2007), a considerable science-service gap exists in regards to treatment of substance abuse in adolescents and adults. For the proposed study, 204 adolescents meeting diagnostic criteria for substance abuse or dependence will be randomized to either the Contingency Management-Family Engagement (CM-FAM; Henggeler et al., 2012) or Treatment as Usual (TAU) conditions. A multimethod, multirespondent approach will be used to track clinical outcomes at 3, 6, 9, 12, and 18 months post recruitment. Clinical level outcomes pertain to youth substance use, criminal behavior, mental health functioning, and key mediators of serious antisocial behavior in adolescents (e.g., self-control, parental supervision, associatio with deviant peers). In addition, the incremental cost of CM-FAM will be determined for use in cost effectiveness analyses. Aim 1: Over an 18-month post-recruitment follow-up, determine the relative effectiveness of CM-FAM vs. TAU in reducing adolescent participants' substance use, criminal activity (including incarceration), and mental health symptoms; and evaluate the cost effectiveness of CM-FAM in achieving these outcomes. Aim 2: Examine possible moderators and mediators of intervention effectiveness. Moderator variables will include youth demographic and clinical (e.g., co-occurring disorders) characteristics. Mediator variables will include measures of self-control, parenting, and association with deviant peers - constructs targeted by CM- FAM.