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

描述（由申请人提供）：提议的随机试验的主要目的是检查在社区治疗环境中提供的有希望和有效的青少年药物滥用门诊治疗的有效性。虽然一些基于证据的青少年药物滥用治疗正在出现（例如，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）在十多年前指出的，以及最近重申的（例如，McCarty等人，2007），在青少年和成人药物滥用的治疗方面存在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配到应急管理-家庭参与（CM-FAM; Henggeler et al., 2012）或常规治疗（TAU）组。采用多方法、多应答者的方法跟踪招募后3、6、9、12和18个月的临床结果。临床水平结果与青少年药物使用、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因素（如自我控制、父母监督、与越轨同伴的联系）有关。此外，CM-FAM的增量成本将被确定用于成本效益分析。目的1：招募后随访18个月，确定CM-FAM与TAU在减少青少年参与者物质使用、犯罪活动（包括监禁）和心理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。目的2：检查干预有效性可能的调节因子和中介因子。调节变量将包括青年人口统计学和临床（例如，共同发生的疾病）特征。中介变量将包括自我控制措施、父母教养和与异常同伴的关联——CM- FAM所针对的构念。

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.