Computer adaptation of screening, brief MET intervention to reduce teen drinking

描述（由申请人提供）：本项目的目标是评估一种新的计算机化动机增强疗法（cMET）干预初级保健中涉及酒精的青少年的可行性、可接受性和效应量。我们以前开发了一个计算机化的筛查和提供者简要建议系统的初级保健，并比较了它的治疗照常（TAU）2096年12至18岁的患者。我们发现，与对照组相比，活动组3个月时的总体饮酒率大幅降低， 12个月时可检测到。尽管如此，大多数基线饮酒者继续饮酒，这表明需要一个更强大的干预，而不仅仅是提供简短的建议。在一个平行的研究中，我们调整动机增强疗法（MET），使其适合青少年的发展，并在忙碌繁忙的门诊医疗环境中由训练有素的顾问进行2至3次治疗，并在我们的门诊药物滥用评估和治疗计划中，在12至21岁（N=140）的青少年中进行了一项随机试验，比较标准治疗（SC）与SC+MET。我们发现，SC+MET患者在9个月的随访期间具有显著更高的治疗依从性，并降低了驾驶和骑行风险。为了促进其可转移到初级保健环境中，以覆盖更多的青少年，我们创建了一个交互式的计算机化版本的MET（cMET），为青少年和临床医生提供可定制的头像，所有MET的交互式电子版本，以及安全的患者-临床医生电子邮件通信和通知。该计划还产生每月提供者对青少年的健康促进信息，以延长干预效果随着时间的推移。cMET计划分两个<1小时的阶段完成;第一个完成的青少年将在医疗访问后尽快完成，第二个2周后在家中或其他地方的私人计算机上完成。患者在完成第2次治疗后4周返回其提供者处进行登记访视。我们现在准备在14至20岁的筛查+初级保健患者中进行cMET系统的第1阶段随机对照试点研究，与常规治疗相比，其标准化和效率得到了提高。我们的研究目的是：1）评估cMET的可行性和可接受性，并估计其对未成年人饮酒的影响大小。可行性：青少年完成cMET练习、cMET第1和第2阶段以及随访访视;可接受性：青少年和提供者满意度;效应量估计：比较3个月、6个月和9个月随访时cMET与TAU的饮酒率。假设：在14至20岁的初级保健患者中，接受cMET的患者的任何酒精使用率、酒精使用天数、每次饮酒日的饮酒量和重度间歇性饮酒天数均低于接受常规治疗的患者。2)估计烟草、大麻和其他药物使用的效应量，以及其他物质相关的风险和结果。3)确定cMET效应的潜在调节剂和介质。

DESCRIPTION (provided by applicant): The goal of this project is to evaluate the feasibility, acceptability, and effect size of a new computerized Motivational Enhancement Therapy (cMET) intervention for alcohol-involved adolescents in primary care. We previously developed a computerized screening and provider brief advice system for primary care, and compared it to treatment as usual (TAU) among 2096 12- to 18-yr-old patients. We found a large reduction in overall drinking rates at 3-months for the active condition versus control and the effect was still detectable at 12-months. Nonetheless, the majority of baseline drinkers continued to drink, demonstrating the need for a more robust intervention than provider brief advice alone. In a parallel line of research, we adapted Motivational Enhancement Therapy (MET) to be developmentally-appropriate for adolescents and practical for delivery in 2- to 3-sessions by a trained counselor in busy outpatient medical settings, and conducted a randomized trial comparing standard care (SC) vs. SC+MET among 12- to 21-yr-olds (N=140) in our outpatient substance abuse evaluation and treatment program. We found that SC+MET patients had significantly greater treatment adherence and reduced rates of driving and riding risks during the 9-month follow-up. To promote its transferability to primary care settings that reach many more adolescents, we created an interactive, computerized version of MET (cMET) with customizable avatars for the teen and clinicians, interactive electronic versions of all MET worksheets, and secure patient-clinician email communication and notifications. The program also generates monthly provider-to-teen health-promotion messages to extend the intervention effect over time. The cMET program is completed in two <1-hr sessions; the first completed adolescents will complete as soon as possible after the medical visit, and the second 2 weeks later on a private computer at home or elsewhere. Patients return for a check-in visit with their provider 4 weeks after completing session 2. We are now prepared to conduct a Stage-1 randomized controlled pilot study of the cMET system, with its enhanced standardization and efficiency, compared to treatment as usual, among 14- to 20-yr-old screen+ primary care patients. Our study aims are to: 1) Assess cMET feasibility and acceptability and estimate its effect size on underage drinking. Feasibility: teen completion of cMET exercises, cMET sessions 1 and 2, and follow-up visits; Acceptability: adolescent and provider satisfaction; Effect Size Estimate: compare cMET vs. TAU rates of alcohol use at 3-, 6-, and 9-month follow-ups. Hypothesis: Among 14- to 20-yr-old primary care patients, those receiving cMET will have lower rates of any alcohol use, days of alcohol use, drinks per drinking day, and days of heavy episodic drinking, than those receiving treatment as usual. 2) Estimate effect sizes for tobacco, cannabis, and other drug use, and other substance-related risks and outcomes. 3) Identify potential moderators and mediators of cMET's effect.