Integrative Risk Reduction and Treatment for Teen Substance Use Problems and PTSD

儿童性虐待(CSA)是青少年问题最强烈和最一致的预测因素之一。 经历过CSA的年轻人在早期开始、使用和滥用药物方面有很大的风险。 例如。研究表明，青少年CSA受害者报告的可能性是前者的3.5倍以上 大麻滥用/依赖与非CSA受害者的比较。其他负面后遗症，如 创伤后应激障碍(PTSD)和HIV性危险行为也明显与 CsA。值得注意的是，还没有为此开发和严格评估任何行为干预措施 人口：a)采取综合办法，通过利用现有的经验，针对这种后遗症 得到支持的干预措施；以及b)将减少症状较少的青年的风险纳入其中。降低风险和 为青少年CSA受害者量身定做的治疗，解决个人、家庭和社区风险和 青少年药物使用问题的复原力因素，并纳入基于暴露的治疗 创伤后应激障碍症状，以及艾滋病毒相关性行为的循证预防干预措施，以及 这是正当的。通过家庭治疗降低风险(RRFT)是由NIDA-K奖获得者Pi开发的 (K23DA018686)和早期调查员，为此目的。1a阶段可行性的初步结果 试验和阶段1b试点随机对照试验(RCT)是有希望的，表明RRFT可以很容易地 忠实地学习和实施，它可以导致药物使用和与药物使用有关的改善 风险和保护因素、创伤后应激障碍症状和HIV性危险行为(Danielson等人，2010年)。在……里面 遵循NIDA推荐的行为治疗发展阶段模式，这一总体目标是 应用是进行第二阶段随机对照试验，以更严格地评估RRFT的疗效(与AS治疗相比 通常)从治疗前到18个月。拟议研究的第一个具体目标是评估 RRFT在减少CSA患者药物使用问题和预后因素方面的效果 创伤相关症状。第二个具体目标是评估RRFT在减少创伤后应激障碍和 这一人群中的HIV性危险行为。为了更好地最大限度地利用来自此的数据 建议的疗效试验并告知这一治疗研究的潜在下一步步骤(根据NOT-DA-019)， 作为探索性目标，还将对RRFT的作用机制进行初步调查。 具体地说，RRFT的中间目标，如育儿实践和情绪反应，被认为是 改善药物使用、创伤后应激障碍和危险性行为的行动机制将是 探索过了。拟议研究的结果将对公众健康产生重大影响，因为它提供了 对青少年CSA受害者多方面临床需求的干预努力，他们是毒品的高危人群 使用，艾滋病毒感染，青春期和成年期的其他问题。证明了这一前景看好的 降低风险和治疗方法可以为社区治疗师提供一种有价值的临床工具。

Child Sexual Abuse (CSA) is one of the strongest and most consistent predictors of adolescent problems. Youth who have experienced CSA are at significant risk for early initiation, use, and abuse of substances. For example. research has indicated that adolescent CSA victims are over 3.5 times more likely to report marijuana abuse/dependence compared to non-CSA victims. Other negative sequelae, such as posttraumatic stress disorder (PTSD) and HIV sexual risk behaviors, also have been clearly linked with CSA. Remarkably, no behavioral interventions have been developed and rigorously evaluated for this population that: a) take an integrated approach to targeting such sequelae through use of existing empirically supported interventions; and b) incorporate risk reduction for less symptomatic youth. Risk reduction and treatment tailored to adolescent CSA victims, which addresses the individual, family, and community risk and resiliency factors for adolescent substance use problems and incorporates exposure-based treatment for PTSD symptoms, as well as evidence based prevention interventions for HIV-related sexual behaviors, and is warranted. Risk Reduction through Family Therapy (RRFT) has been developed by the PI, a NIDA-K awardee (K23DA018686) and Early Stage Investigator, for this purpose. Preliminary findings from a Stage 1a feasibility trial and a Stage 1b pilot randomized controlled trial (RCT) are promising, indicating that RRFT can be readily learned and implemented with fidelity, and that it can lead to improvements in drug use and drug use-related risk and protective factors, PTSD symptoms, and HIV sexual risk behaviors (Danielson et al., 2010). In following NIDA's recommended stage model of behavioral therapy development, the overall goal of this application is to conduct a Stage II RCT to more rigorously evaluate the efficacy of RRFT (vs. Treatment As Usual) from pre-treatment through 18 months. The first specific aim of the proposed study is to evaluate the efficacy of RRFT in reducing substance use problems and prognostic factors among CSA victims experiencing trauma-related symptoms. The second specific aim is to evaluate the efficacy of RRFT in reducing PTSD and HIV sexual risk behaviors among this population. In order to better make maximum use of the data from this proposed efficacy trial and to inform potential next steps in this line of treatment research (per NOT-DA-019), preliminary investigation on mechanisms of action in RRFT also will be pursued as an exploratory aim. Specifically, intermediate targets of RRFT, such as parenting practices and emotional reactivity, as putative mechanisms of action for improvements in substance use and PTSD and risky sexual behaviors will be explored. The results of the proposed study will have a significant impact on public health by informing intervention efforts for the multifaceted clinical needs of adolescent CSA victims, who are at high risk for drug use, HIV infection, other problems in adolescence and adulthood. Demonstrating the efficacy of this promising risk reduction and treatment approach could provide a valuable clinical tool for community-based therapists.