Group Community Reinforcement Training for Parents of Treatment-Elusive Youth

描述(由申请人提供)：青少年吸毒者对他们自己和他们的家人来说，特别容易出现一系列问题，如与艾滋病毒有关的行为。不幸的是，在美国，很少有滥用药物或依赖药物的青少年得到治疗。这一未接受治疗的青年人口代表着青少年保健方面的巨大“治疗缺口”，使阳萎成为预防慢性药物滥用和相关困难的潜在重要途径。虽然少年司法系统是将吸毒青少年与治疗服务联系起来的一条重要途径，但法律系统只逮捕了每年需要治疗的青少年的五分之一。结果，大量需要治疗的青年通过最典型的进入系统的方式没有被发现。此外，大多数青少年吸毒者缺乏治疗动机，这大大降低了这些青少年接受治疗的可能性，除非法律系统或其他社会机构的授权。这些青少年代表着一个相当大的、迄今为止被忽视的、难以接受治疗的青年群体。疗效研究表明，社区增援培训(CRT)是一种教父母如何让他们的青年参与治疗的方法，可以招募60%-80%的这些难以接受治疗的青年。拟议的研究将改进我们以前的工作，使用小组形式提供一种成本较低的让青年参与治疗的程序，使其更便于治疗机构、学校、少年司法和寻求向父母提供支持或让青年参与治疗的其他社区组织使用，从而大大增加该方法的采纳率和可持续性。拟议的试点研究将检验团体模式(G-CRT)与传统的个人模式(I-CRT)相比，在帮助父母让缺乏动力、有抵抗力的年轻人参与治疗方面的有效性。父母(n=60)将被随机分配到G-CRT或I-CRT。我们将评估G-CRT与I-CRT在青少年参与率方面的不同疗效。我们预计，与I-CRT相比，G-CRT还将与父母对青少年戒酒、感受到的社会支持和家庭功能的更大鼓励有关。我们还预测，这些过程变量的变化将预测青少年参与的成功率增加。我们还将研究父母参与G-CRT或I-CRT对接受CBT的青少年的治疗结果。我们预测，父母在G-CRT中获得的更多支持将导致更多的药物使用和更低水平的艾滋病毒危险行为，结果被认为是由改变的动机和会议出勤率调节的。最后，我们将进行非正式的成本-效果分析，以得出每个结果单位每种治疗方式的相对成本的初步估计，并假设由于具有更高的临床有效性和更低的成本，G-CRT将比I-CRT更具成本效益。这里的成功结果将为更大样本的全面临床试验提供基础。

DESCRIPTION (provided by applicant): Adolescent drug abusers are particularly at high risk for a host of problems, such as HIV-related behaviors, for themselves and their families. Unfortunately, very few youth with drug abuse or dependence in the United States receive treatment. This population of untreated youth represents a massive "treatment gap" in adolescent health care that renders impotent a potentially important avenue for preventing chronic drug abuse and related difficulties. While the juvenile justice system represents a prominent path linking drug-abusing adolescents with treatment services, only one fifth of the adolescents who need treatment each year are apprehended by the legal system. As a result, large numbers of youth in need of treatment go undetected by the most typical entry way into the system. Moreover, the lack of motivation for treatment characterizing most adolescent drug abusers significantly decreases the likelihood these youth will enter treatment, barring mandates from the legal system or other social institutions. These adolescents represent a sizeable and, heretofore, overlooked population of treatment-elusive youth. Efficacy studies have demonstrated that Community Reinforcement Training (CRT), an approach that involves teaching parents how to engage their youth into treatment can work to recruit 60-80% of these treatment-elusive youth. The proposed study will improve upon our prior work by using a group format to provide a less costly procedure for engaging youth into treatment to make it more portable to treatment agencies, schools, juvenile justice, and other community organizations seeking to offer support to parents or engage youth in treatment, thus significantly increasing the adoption and sustainability of the approach. The proposed pilot research will examine the efficacy of the group format (G-CRT) for helping parents engage their unmotivated, resistant youth in treatment compared to the traditional individual format (I-CRT). Parents (n = 60) will be randomly assigned to G-CRT or to I-CRT. We will evaluate the differential efficacy of G-CRT, relative to I-CRT, on rates of adolescent engagement in treatment. We expect that G-CRT compared to I-CRT will also be associated with greater parent encouragement of adolescent sobriety, perceived social support, and family functioning. We also predict that changes on these process variables will predict increased success in engaging adolescents. We will also examine treatment outcomes for youth engaged in CBT as a function of parental involvement in G-CRT or I-CRT. We predict enhanced support received by parents in G-CRT will result in greater reductions in drug use and lower levels of HIV-risk behaviors, outcomes hypothesized to be mediated by motivation to change and session attendance. Finally, we will conduct an informal cost-effectiveness analysis to derive preliminary estimates of the relative costs of each treatment modality per outcome unit and hypothesize that G-CRT will be more cost effective than I-CRT by virtue of having higher clinical effectiveness and lower costs. Successful outcomes here will provide the basis for a full clinical trial with larger samples.