Improving Treatment Engagement in Individuals with Co-occurring Substance Use and Psychosis: A Telemedicine Family-Based Approach

摘要治疗参与是首次发作精神病（FEP）患者的一个重要问题。 同时存在物质使用障碍是低治疗依从性和风险的主要预测因素。 治疗退出，超过50%的FEP患者有物质使用障碍的终身史。虽然 综合治疗可用于物质使用和FEP的个人，如果客户不愿意， 他们没有参与治疗。同时使用药物和FEP的客户， 药物使用，因为<20%的人成功地进行了推荐的药物使用治疗。这些结果要求 新的策略，增加对这一弱势群体的物质使用障碍治疗参与。 社区强化方法和家庭培训（CRAFT）是一种循证治疗， 显著增加了对跨诊断物质使用障碍的治疗参与。工艺 承认患有物质使用障碍的人可能还没有准备好改变他们的物质使用， 它利用家庭成员作为变革推动者的积极性。使CRAFT适应共同发生的 物质使用障碍和FEP人群有可能通过增加客户的 物质使用治疗参与和减少其使用。由于家庭压力的增加与 物质使用和精神病，减少家庭痛苦可能是一个潜在的机制， 提高了这一人群的治疗参与度。许多患有FEP的人经常与家人接触， 但时间、交通、资金和儿童保育是家庭成员获得额外服务的障碍。 利用远程医疗（视频会议）缓解了这些障碍，这样的工具可以实现类似的治疗 心理治疗的结果。扩大我在跨部门药物使用方面的背景知识， 从精神障碍研究到社会心理治疗研究，我建议1）开发和完善一个CRAFT 通过远程医疗（CRAFT-FT）和面对面（CRAFT-F）提供FEP的协议，以及2）进行试点 随机对照试验，以测试CRAFT-FT与患有 物质使用障碍和FEP与常规治疗（TAU）和CRAFT-F相比。确定变化 在治疗参与中，物质使用和家庭痛苦将为较大的R 01提供效应量估计 学习和高级培训。我的导师团队（Dost Öngür博士、Roger韦斯博士、Kim Mueser博士、Robert Meyers，Janet Wozniak和Jim哈德逊）将提供全面的指导，以解决我的培训差距：1） 治疗开发，2）远程医疗，3）临床干预研究，4）先进的统计方法，以及 5)专业发展（科学沟通/领导力），因为我成为一名独立的调查员。通过 实现我的K23研究和培训目标，我将获得必要的专业知识，为我的长期职业目标， 制定和实施新的和可获得的干预措施，同时确定治疗的预测因素 同时发生的物质使用和精神疾病的人及其家庭的结果。

ABSTRACT Treatment engagement is a significant concern for individuals with first episode psychosis (FEP). Having a co-occurring substance use disorder is a primary predictor of low treatment adherence and risk for treatment dropout, and over 50% of people with FEP have a lifetime history of substance use disorder. Though integrated treatments are available for individuals with substance use and FEP, they cannot be effective if clients are not engaged in treatment. Clients with co-occurring substance use and FEP have limited reductions in their substance use, as <20% successfully engage in recommended substance use treatment. These results call for novel strategies that increase substance use disorder treatment engagement for this vulnerable population. Community Reinforcement Approach and Family Training (CRAFT) is an evidence-based treatment that significantly increases treatment engagement for transdiagnostic substance use disorders. CRAFT acknowledges that people with substance use disorders may not be ready to change their substance use, and it capitalizes on the motivation of family members as agents of change. Adapting CRAFT to a co-occurring substance use disorder and FEP population has the potential to make a significant impact by increasing clients’ substance use treatment engagement and reducing their use. Since elevated family distress is associated with both substance use and psychosis, reducing family distress may be a potential mechanism by which CRAFT improves treatment engagement for this population. Many individuals with FEP have frequent contact with family, but time, transportation, finances, and childcare are barriers to family members accessing additional services. Utilizing telemedicine (video conferencing) mitigates these barriers, and such tools can achieve similar treatment outcomes to in-person psychotherapy. To expand my background in cross-sectional substance use and psychotic disorders research to psychosocial treatment research, I propose to 1) develop and refine a CRAFT protocol for FEP delivered via telemedicine (CRAFT-FT) and in-person (CRAFT-F), and 2) conduct a pilot randomized controlled trial to test preliminary efficacy of CRAFT-FT with family members of people with substance use disorders and FEP compared to treatment as usual (TAU) and CRAFT-F. Determining changes in treatment engagement, substance use, and family distress will provide effect size estimation for larger R01 studies and advanced training. My mentorship team (Drs. Dost Öngür, Roger Weiss, Kim Mueser, Robert Meyers, Janet Wozniak, and Jim Hudson) will provide comprehensive guidance to address my training gaps: 1) treatment development, 2) telemedicine, 3) clinical intervention research, 4) advanced statistical methods, and 5) professional development (scientific communication/leadership) as I become an independent investigator. By achieving my K23 research and training aims, I will gain the necessary expertise for my long-term career goal of developing and implementing novel and accessible interventions while identifying predictors of treatment outcomes for people with co-occurring substance use and psychiatric disorders and their families.