Cost-Effectiveness & Efficacy of Computerized Therapy for Depression and Drug Use

描述（申请人提供）：本研究的目的是通过一种创新的、综合的计算机辅助策略，结合认知行为疗法和动机增强疗法（CBT/MET）的技术，增强抑郁药物治疗，改善对患有共病抑郁症的大麻依赖成人的治疗，以促进复发预防技能，减少大麻使用和抑郁症状，提高精神病治疗的依从性。2007年，申请人获得了职业发展奖，以研究综合CBT/MET干预措施，用于在初级精神卫生保健环境中治疗患有抑郁症的药物使用者。结果表明：（a）大麻依赖是在这种情况下抑郁成年人中最常见的成瘾性疾病之一;（B）将CBT/MET与抑郁症的精神治疗相结合，可显著减少抑郁症状，并有助于减少大麻使用，这与针对大麻依赖的心理社会干预研究中观察到的情况相当。为了将这种基于证据的心理治疗实施模式扩展到在初级精神病护理环境中接受常规护理（TAU）的抑郁症大麻使用者，以计算机为基础的平台，本研究的具体目标是：1）在195名接受TAU治疗的抑郁、大麻依赖成年人中进行RCT，比较计算机辅助的综合CBT/MET（cICBT/MET）解决大麻使用和抑郁症，相对于治疗师提供的综合CBT/MET（tICBT/MET）和TAU单独在改善大麻使用，抑郁症，精神病治疗依从性和医疗保健结果; 2）确定cICBT/MET的成本效益;和3）检查cICBT/MET的神经行为预测因子和作用机制，包括冲动性、延迟折扣和自我效能。我们假设cICBT/MET在减少物质使用、改善抑郁症状和精神病治疗依从性以及减少治疗期间和治疗后的卫生服务利用方面将产生相对于TAU的上级临床结局。此外，我们预计cICBT/MET的成本将更低，至少与cICBT/MET一样有效。此外，我们预计cICBT/MET将对心理变量产生直接影响，这些心理变量是CBT和MET变化的公认机制，这些变化将与大麻使用和抑郁症结果相关。通过提供支持，以最大限度地提高精神病治疗的依从性，再加上应对技能，以防止复发，cICBT/MET可以提供一个有前途的，具有成本效益的，易于部署的策略，治疗抑郁症大麻用户。

DESCRIPTION (provided by applicant): The objective of this research is to improve treatment for cannabis dependent adults with comorbid major depression by augmenting depression pharmacotherapy with an innovative, integrated computer-assisted strategy combining the techniques of cognitive behavioral therapy and motivational enhancement therapy (CBT/MET) to promote relapse prevention skills, reduce cannabis use and depressive symptoms, and improve psychiatric treatment adherence. In 2007 the applicant received a Career Development Award to study an integrated CBT/MET intervention for the treatment of substance users with comorbid major depression in a primary mental health care setting. Results show that (a) cannabis dependence is among the most frequently observed addictive disorders among depressed adults in this setting; (b) integrating CBT/MET with psychiatric treatment for depression produces significant reductions in depressive symptoms and facilitates reductions in cannabis use that are comparable to those observed in psychosocial intervention studies targeting cannabis dependence. To extend this model of evidence-based psychotherapy implementation for depressed cannabis users receiving usual care (TAU) in a primary psychiatric care setting to a computer-based platform, the specific aims of this research are: 1) To conduct an RCT among 195 depressed, cannabis dependent adults receiving TAU, comparing computer-assisted, integrated CBT/MET (cICBT/MET) addressing cannabis use and depression, relative to therapist-delivered integrated CBT/MET (tICBT/MET) and TAU alone in improving cannabis use, depression, psychiatric treatment adherence, and healthcare outcomes; 2) To determine the cost-effectiveness of cICBT/MET; and 3) To examine neurobehavioral predictors and mechanisms of action of cICBT/MET, including impulsivity, operationalized by delay discounting, and self-efficacy. We hypothesize that cICBT/MET will yield superior clinical outcomes relative to TAU in reducing substance use, improving depressive symptoms and psychiatric treatment adherence, and reducing health service utilization during and after treatment. Moreover, we expect that cICBT/MET will be less costly and at least as effective as cICBT/MET. Further, we expect that cICBT/MET will have a direct effect on psychological variables that are recognized mechanisms of change in CBT and MET, and these changes will be associated with cannabis use and depression outcomes. By providing support to maximize psychiatric treatment adherence, coupled with coping skills to prevent relapse, cICBT/MET may provide a promising, cost-effective, and easily deployable strategy for the treatment of depressed cannabis users.