Intervention for Teens with ADHD and Substance Use

描述（由申请人提供）：患有ADHD的个体处于增加的物质使用和物质使用障碍的显著高风险中（SUD; Barkley等人，2004; Charach等人，2011; Derefinko & Pelham，出版中; Lee等人，2011; Molina & Pelham，2003; Sibley等人，2011年）。他们对各种物质的使用率很高，包括非法药物、酒精和香烟（阿里亚斯等人，2008; Molina & Pelham，2003; Szobot等人，2007），并且处于物质使用行为和障碍的早期发作的风险中（阿里亚斯等人，2008; Milberger等人，1997; Molina & Pelham，2003）。重要的是，这些物质使用问题不会随着时间的推移而减轻;在患有成人ADHD的个体中，物质使用障碍的比率接近40%（Kalbag & Levin，2005; Biederman等人，1995年），这表明需要早期干预。然而，ADHD和物质使用的治疗同时给临床医生带来了许多问题，包括治疗依从性差、缺乏治疗进展和治疗目标的实现受损（卡罗尔和Rounsaville，1993; Levin等人，2004; Wise等人，2001年）。鉴于这些障碍，很明显，未来的预防和干预发展应该遵循目前关于ADHD和物质使用治疗的文献提供的指导方针。针对青少年SUD的几种心理社会干预措施已经确立（沃尔德龙和特纳，2008年;温特斯和莱滕，2007年）。然而，典型的研究已经检查了药物使用干预的有效性，只进行了二次分析，看看是否共病精神病诊断中度的结果。目前还没有关于共病ADHD如何影响早期药物使用早期干预效果的对照评估。考虑到ADHD和物质使用开始并存的个体的负面轨迹的强有力证据，我们的目标是通过使用来自两种治疗文献的证据，对针对ADHD青少年修改的物质使用的简短早期干预（BEI; Teen Intervene，Winters & Leitten，2007）进行对照检查。重要的是，这种干预措施将针对那些已经开始使用药物，但尚未达到SUD标准的个人。虽然简短的干预措施已被发现在其他人群中是有效的，他们的疗效在ADHD人群与新兴的物质使用仍然没有调查。我们预计BEI对一些但不是所有ADHD青少年有效，其应答率低于非ADHD人群。为了更好地理解为什么一些患有ADHD和物质使用的青少年对BEI有反应，而其他人没有，我们调查了几个认知，近端和情境因素对治疗反应的贡献。最后，我们将BEI无应答者随机分为三种次要治疗条件（仅监测，父母培训/青少年认知行为治疗，药物加父母培训/青少年认知行为治疗），以确定这些更强化干预措施对短期治疗应答不足者的相对疗效。

DESCRIPTION (provided by applicant): Individuals with ADHD are at markedly high risk for increased substance use and Substance Use Disorder (SUD; Barkley et al., 2004; Charach et al, 2011; Derefinko & Pelham, in press; Lee et al., 2011; Molina & Pelham, 2003; Sibley et al., 2011). They have high rates of substance use across a wide range of substances, including illicit drugs, alcohol, and cigarettes (Arias et al., 2008; Molina & Pelham, 2003; Szobot et al., 2007), and are at risk for early onset of substance use behaviors and disorders (Arias et al., 2008; Milberger et al.,1997; Molina & Pelham, 2003). Importantly, these substance use problems do not abate over time; among individuals with adult ADHD, rates of substance use disorders approach 40% (Kalbag & Levin, 2005; Biederman et al., 1995), suggesting the need for early intervention. However, treatment of ADHD and substance use concurrently presents a number of problems for clinicians, including poor treatment adherence, lack of treatment progress, and impaired achievement of treatment goals, (Carroll & Rounsaville, 1993; Levin et al., 2004; Wise et al., 2001). Given these barriers, it is clear that future prevention and intervention development should follow the guidelines provided by the current literature on both ADHD and substance use treatment. Several psychosocial interventions for teens with SUD are well-established (Waldron & Turner, 2008; Winters & Leitten, 2007). However, typical studies that have examined efficacy of substance use interventions have conducted only secondary analyses to see if comorbid psychiatric diagnoses moderate outcome. There have been no controlled evaluations of how comorbid ADHD affects the efficacy of early intervention for early substance use. Given the strong evidence for the negative trajectory for individuals with co-occurring ADHD and substance use initiation, our goal is to conduct a controlled examination of a brief, early intervention for substance use (BEI; Teen Intervene, Winters & Leitten, 2007) modified for adolescents with ADHD by using the evidence from both treatment literatures. Importantly, this intervention will address individuals who have initiated substance use, but do not yet meet criteria for an SUD. Although brief interventions have been found to be effective in other populations, their efficacy in an ADHD population with emerging substance use remains uninvestigated. We expect BEI to be effective for some but not all ADHD teens, with lower rates of response than have been obtained with nonADHD populations. To better understand why some adolescents with ADHD and substance use initiation respond to BEI and others do not, we investigate the contributions of several cognitive, proximal and situational factors to treatment response. Finally, we will randomize non-responders to the BEI to three secondary treatment conditions (monitor only, parent training/adolescent cognitive behavioral therapy, and medication plus parent training/adolescent cognitive behavioral therapy) to determine the relative efficacy of these more intensive interventions for insufficient responders to brief treatment.