Integrated Treatment for Enhancing Growth in Recovery during Adolescence (InTEGRA)

项目摘要/摘要：约10%的青少年被诊断为酗酒或其他药物(AOD)使用 在美国，这种疾病每年都会增加过早死亡和发病率的风险，并带来负面影响 关于社会和神经认知功能、生物行为成熟和发展里程碑的成就。 尽管对青少年AOD的干预研究取得了进展，但总的来说，科学基础严重落后于此 5-7此外，很少有研究测试能够随着时间的推移维持青年病情缓解的有效治疗模式 青少年处于成年初期的高危时期。虽然针对青少年AOD的许多不同干预措施 障碍已经被开发和测试，并产生了类似的结果，1缺席是一种将年轻人与无处不在的、自由的联系起来的障碍 可利用的社区康复资源，例如戒酒互助会(AA)或戒毒互助会(NA)。系统化 与这些12步社区资源的临床联系有可能扩大和加强正式干预的效果 因为它们已经被证明能够动员由正式治疗动员的相同类型的治疗机制(例如， 通过提高动机/自我效能，改变社交网络)，8，9，但这样做是免费的，而且是长期的 社区。10、11支持成年人参与这些组织的证据随着调查结果的增加而大幅增加 支持以诊所为基础的12步促进(TSF)12-17步干预和社区12步小组参与12、18、19 在提高缓解率的同时降低医疗费用。20-22最近几年，几项自然主义研究检查了 系统地将年轻人与这些流行资源联系起来的临床和公共卫生效用23-31显示 长期受益于AA/NA8、28、30和在降低医疗保健成本方面，31与成人相似。虽然数十项研究表明 测试成人TSF有效性，17，32，33直到最近，还没有测试过青少年TSF有效性，尽管80%的青少年项目使用 12步实践和联系。28，34在NIH资助的第一项研究中，开发和测试可复制的、手动的青少年 然而，TSF，我们发现随机分配到接受新的联合治疗(综合治疗)的年轻人 促进青春期康复中的生长[Integra])，除了以下因素外，还包括TSF的关键元素 动机强化疗法/认知-行为疗法(MET/CBT)，临床表现为中-大 与仅接受MET/CBT的青年相比，在后续行动中发展起来的有意义的优势。他们还参加了 在治疗期间，12步会议的次数是12步会议的两到三倍，12步会议的参与者表现出明显更多的 戒酒。35鉴于初步疗效和广泛采用和实施的潜力，34、36、37现在需要 将在更大的样本中进行测试，并额外强调如何(即机制)和为谁(即主持人)测试 行得通。使用第一类混合实施-有效性设计，38本研究建议：1.进行充分的 动力(N=294)第二阶段RCT在两个临床地点测试相对于MET/CBT单独的INCELA疗效。2. 调查行为改变的机制(例如，12步参与；社会网络，自我效能) INCELA带来了好处。3.探索INCELA的影响的调节因素(例如，年龄、精神疾病/AOD严重程度)- 一年的随访。4.探讨广泛实施干预措施的障碍和促进者。

Project Summary/Abstract: Approximately 10% of adolescents are diagnosed with an alcohol or other drug (AOD) use disorder each year in the U.S. Such disorders increase risk of premature mortality and morbidity and confer negative effects on social and neurocognitive functioning, biobehavioral maturation, and the achievement of developmental milestones. Despite advances in intervention research for adolescent AOD,1-4 the science base, in general, has lagged sorely behind that of adults.5-7 Furthermore, few studies have tested effective treatment models that can sustain youth remission over time as adolescents navigate the high-risk period of emerging adulthood. While many different interventions for youth AOD disorders have been developed and tested producing similar results,1 absent is one that links youth to ubiquitous, freely available, community recovery resources, such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). Systematic clinical linkages to these 12-step community resources have the potential to extend and enhance formal interventions’ effects because they have been shown to mobilize the same kinds of therapeutic mechanisms mobilized by formal treatments (e.g., by enhancing motivation/self-efficacy, changing social networks),8, 9 but do so for free and over the long-term in the community.10, 11 The evidence in support of adult participation in these organizations has grown substantially with findings supporting clinic-based Twelve-Step Facilitation (TSF)12-17 interventions and community 12-step group participation12, 18, 19 in enhancing remission rates while reducing health costs.20-22 In more recent years, several naturalistic studies have examined the clinical and public health utility of systematically linking young people with these prevalent resources 23-31 showing long-term benefits from AA/NA8, 28, 30 and in reducing health care costs,31 similar to adults. While dozens of studies have tested adult TSF efficacy,17, 32, 33 until recently, none had tested youth TSF efficacy, despite 80% of youth programs using 12-step practices and linkage.28, 34 In the first NIH-funded study to develop and test a replicable, manualized, adolescent TSF, however, we found that youth randomly assigned to receive a novel combination treatment (Integrated Treatment for Enhancing Growth in Recovery during Adolescence [InTEGRA]) that incorporated key elements of TSF in addition to Motivational Enhancement Therapy/Cognitive-Behavioral Therapy (MET/CBT), showed moderate-large clinically meaningful advantages that grew across follow-ups when compared to youth receiving MET/CBT alone. They also attended two to three times as many 12-step meetings during treatment, with 12-step attendees showing significantly greater abstinence.35 Given initial efficacy and potential for widespread adoption and implementation,34, 36, 37 InTEGRA now needs to be tested in a larger sample, with additional emphases on how (i.e., mechanisms) and for whom (i.e., moderators) it works. Using a type I hybrid implementation-effectiveness design,38 this study proposes to: 1. Conduct an adequately powered (N=294) Phase II RCT to test InTEGRA efficacy relative to MET/CBT alone across two clinical sites. 2. Investigate mechanisms of behavior change (e.g., 12-step involvement; social networks, self-efficacy) through which InTEGRA confers benefit. 3. Explore moderators (e.g., age, psychiatric/AOD severity) of InTEGRA’s effects across a one- year follow-up. 4. Explore barriers and facilitators to the intervention’s widespread implementation.