Substance Use Treatment Outcomes: Effect of Psychiatric Comorbidity

项目摘要 许多患有物质使用障碍(SODS)的人也经历了严重的心理痛苦或 符合常见情绪和焦虑症的标准，可能对SUD有重大影响 结果和SUD治疗效果。研究这些影响对于确定最优 对患有合并症的患者的治疗。过去关于这种并存影响的研究已经 结果喜忧参半，主要是因为样本量较小或依赖观察性研究。在这 一项关于1)情绪和焦虑症以及2)心理困扰的影响的大规模研究 使用来自5000多名患者的数据，提出了关于SUD结果和SUD治疗效果的共病 来自20个药物和心理社会治疗肥皂症的随机对照试验(RCT) 由国家药物滥用研究所赞助。我们的目标包括使用现代的个人参与者 结合个体水平数据的元分析方法，并检查SUD是否和程度 在有和没有共病的患者中，结果和SUD治疗效果各不相同。结果将包括 保留治疗至试验结束，继续使用尿毒学确定的药物和自身 报告和社会结果(包括职业结果和刑事司法参与)。在目标1中，数据 将结合随机对照试验来检查精神疾病共病(即情绪和焦虑症)的影响 以及心理痛苦)对SUD结果的影响，而与治疗臂无关， 采用混合效应回归模型。随机对照研究样本将根据社会人口统计情况进行平衡。 以及临床因素，这些因素在使用倾向评分法的研究中可能会有所不同。Aim 2将使用类似的 检测共病对SUD治疗效果的调节作用的方法学 混合回归模型中共病对SUD治疗的交互作用项。在目标3中，我们将研究 情绪和焦虑症的同期药物治疗是否会改变这些影响 障碍对SUD转归及SUD治疗效果的影响。在目标4中，我们将RCT样本的权重重新设置为 类似于在普通人群中接受治疗的肥皂症患者的目标样本 排除(和可能代表不足)有严重精神疾病的患者参加SUD随机对照试验。 重新加权样本的结果将与原始未加权样本的结果进行比较。这个 该项目极大地推进了这些并存疾病对SUD结局和SUD影响的研究 使用来自史无前例的大规模严格执行的小组的个体参与者数据的治疗效果 试验使用了一套核心的标准化评估和一致的结果衡量标准。

Project Summary Many individuals with substance use disorders (SUDs) also experience significant psychological distress or meet the criteria for common mood and anxiety disorders with potentially significant implications for SUD outcomes and SUD treatment effects. Examining these implications is important for identifying optimal treatments for patients with comorbid conditions. Past research on the impact of such comorbidities has produced mixed results, mainly due to small sample sizes or reliance on observational studies. In this proposal, a large-scale study of the impact of 1) mood and anxiety disorder as well as 2) psychological distress comorbidity on SUD outcomes and SUD treatment effects is proposed using data from over 5,000 patients from 20 randomized controlled trials (RCTs) of pharmacological and psychosocial treatments of SUDs sponsored by the National Institute on Drug Abuse. Our aims include the use of modern individual participant meta-analytic methods to combine the individual level data and to examine whether and to what extent SUD outcomes and SUD treatment effects vary among patients with and without comorbidity. Outcomes will include retention in treatment to the end of the trial, continued use of drugs ascertained by urine toxicology and self- report, and social outcomes (including occupational outcomes and criminal justice involvement). In Aim 1, data from RCTs will be combined to examine the impact of psychiatric comorbidity (i.e., mood and anxiety disorders as well as psychological distress, jointly and separately) on the SUD outcomes, irrespective of treatment arm, using mixed effect regression models. The RCT samples will be balanced with regards to socio-demographic and clinical factors that may vary across studies using propensity score methods. Aim 2 will use a similar methodology to examine the moderating effect of comorbidity on SUD treatment effects by examining interaction terms of SUD treatment by comorbidity in mixed regression models. In Aim 3, we will examine whether concomitant medication treatment of mood and anxiety disorders will change the impact of these disorders on the SUD outcomes and SUD treatment effects. In Aim 4, we will reweight the RCT samples to resemble target samples of individuals with SUDs receiving treatment in the general population to address exclusion (and possible under-representation) of patients with severe psychiatric conditions from SUD RCTs. The results from reweighted samples will be compared with the results of the original unweighted samples. The project significantly advances research on the impact of these comorbidities on SUD outcomes and SUD treatment effects using individual participant data from an unprecedentedly large group of rigorously conducted trials that have used a core set of standardized assessments and consistent outcome measures.