Stage II Research on Outpatient Treatment for Adolescents with Comorbidity

项目摘要/摘要 青少年滥用药物会给青少年带来严重的负面后果和额外的代价， 他们的家庭、社区和社会。此外，精神疾病在物质之间的共患率 虐待青少年的比例从25%到82%不等，患有双重诊断的青少年的成本是前者的两倍多 与那些没有共病的人相比，需要治疗。对这些年轻人的社区治疗最常见的是 脱节，年轻人和家庭不得不通过单独的治疗系统来治疗这些疾病，或者只是 接受一种疾病的治疗。值得注意的是，多项研究表明，青少年与 问题的结果会更差，并越来越频繁地恢复到治疗前的药物使用水平 比那些没有精神疾病诊断的人要快。申请人首席调查员，一名新调查员， 最近完成了NIDA资助的第一阶段项目，重点是开发和试点一种心理社会 专门为青少年提供的治疗，以门诊治疗的共生物质使用和 内化(即情绪和/或焦虑)问题。试验组的结果是有希望的 表现出更少的药物使用和更快地减少焦虑和抑郁症状 与对照组比较。此外，还编写了广泛的治疗和治疗师培训手册 已生成。这项拟议的研究是一项II期随机临床试验(RCT)，以比较 试验性治疗(青少年门诊治疗；OPT-A)到KEY上的“活性安慰剂” 从治疗前到治疗18个月的临床指标。建议的随机对照试验(n=160)采用这种疗法。 开发了手册、质量保证方案和治疗师培训方案，并成功地在 第I阶段研究，评价OPT-A对青年参照门诊治疗的疗效。 发生物质使用和内化问题。将对以下结果进行评估：药物使用； 心理健康；行为、学校、同伴和家庭功能；以及消费者满意度。除了……之外 为了提供强有力的治疗效果测试，拟议的项目将利用 RCT提供对假定的作用机制的初步评价。总而言之，这项研究将 推进通过第一阶段行为疗法开发计划开发的有前景的治疗 进入第二阶段对照试验。它建立在治疗手册、治疗师培训材料和质量的基础上 已经开发出了保障体系。这一干预措施针对的是最普遍和最 在青少年门诊患者中出现具有挑战性、费用高昂且研究不足的问题。如果成功， 这项研究可以在青少年共生疾病治疗领域做出相当大的贡献 物质使用和内在化障碍。

PROJECT SUMMARY/ABSTRACT Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths, their families, communities, and society. Moreover, rates of psychiatric comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual diagnosis are more than twice as costly to treat compared to those with no comorbidity. Community-based treatment for these youth most often is disjointed, with youth and families having to navigate separate treatment systems for the disorders or only receiving treatment for a single disorder. Notably, multiple studies have shown that youth with co-occurring problems have worse outcomes and return to pre-treatment levels of substance use more often and more rapidly than those without a psychiatric diagnosis. The applicant principal investigator, a new investigator, recently completed a NIDA-funded Stage I project focused on developing and piloting a psychosocial treatment specifically for youth presenting for outpatient treatment with co-occurring substance use and internalizing (i.e., mood and/or anxiety) problems. Results were promising with the experimental group exhibiting significantly less substance use and more rapid reductions in anxiety and depressive symptoms compared to the control group. In addition, extensive treatment and therapist training manuals were generated. The proposed research is a Stage II randomized clinical trial (RCT) to compare the experimental treatment (OutPatient Treatment for Adolescents; OPT-A) to an "active placebo" on key clinical indices from pre-treatment through 18 months. The proposed RCT (n = 160) employs the treatment manual, quality assurance protocol, and therapist training protocol developed and successfully piloted in the Stage I study, to evaluate the efficacy of OPT-A for youth referred to outpatient treatment of co- occurring substance use and internalizing problems. The following outcomes will be evaluated: drug use; mental health; behavioral, school, peer, and family functioning; and consumer satisfaction. In addition to providing a strong test of treatment efficacy, the proposed project will leverage the data collection of the RCT to provide a preliminary evaluation of putative mechanisms of action. In summary, this study will advance a promising treatment developed through the Stage I behavioral therapies development program to a Stage II controlled trial. It builds on the treatment manual, therapist training materials, and quality assurance system already developed. The intervention addresses one of the more prevalent and most challenging, costly, and understudied presenting problems among adolescent outpatients. If successful, this research could provide a considerable contribution in the treatment field for youth with co-occurring substance use and internalizing disorders.