Adolescent Involvement in Parental Substance Abuse Treatment: Evaluation of EBFT

描述(由申请者提供)：许多研究人员研究了父母饮酒和吸毒对孩子结局的影响。这些研究得出的结论是，父母使用药物有可能对儿童的心理社会发展产生负面影响，因为它剥夺了他们得到适当照顾和监督的机会，阻碍了他们的社会情感和认知发展，和/或影响他们成为药物使用者。考虑到一个双向的、系统的模型来理解药物使用问题的发展、维持和恢复，得出的结论是孩子也会影响父母的行为。家庭治疗一贯表明，家庭成员参与药物使用者的治疗与更高的参与度和治疗中的保留率有关。许多研究报告称，在接受夫妇和家庭治疗的患者中，治疗前和治疗后药物使用和相关问题的减少。虽然家庭治疗的随机临床试验涉及夫妇治疗中的成人识别患者(IP)和家庭治疗中的青少年IP，但本研究将评估在成人治疗寻求者的治疗计划中涉及青春期儿童的家庭系统干预。在目前的研究中，将对居住在家中的青春期儿童(11-15岁)的成年母亲进行酒精和药物治疗。所有受试者将被随机分为(1)家庭生态化治疗(EBFT)+常规治疗(TAU)，(2)办公室EBFT+TAU，或(3)TAU+注意控制。这种方法的相对有效性将在基线后3、6、12和18个月进行评估。将对提出的家庭治疗改革机制(中介者)进行评估。将调查性别、酒精或药物使用家族史以及初级酒精与药物滥用(主持人)的不同治疗反应，以更好地了解干预措施。这项研究还将审查治疗参与度和留存如何影响父母和青少年对治疗的反应。通过该项目获得的信息将有助于评估将青少年家庭成员纳入其成年父母的治疗计划的效用。最后，这项研究将包括一个经济评估部分，以估计每次干预的经济成本，并确定哪种情况最具成本效益。包括关注亲子互动的干预措施有可能增加物质使用的减少，减少父母的复发，并改善成年人的家庭和情感健康。青少年的参与提供了增加对积极亲子关系的潜在保护的机会，这种关系被证明与积极的发展成果有关。叙述鉴于亲子互动的互惠性质，青少年参与其母亲的药物滥用治疗计划可能与减少成人复发和改善儿童功能有关。这些发现将支持这样的断言，即在药物滥用治疗方案中关注家庭动态是资源的有效利用和干预努力的重要目标。公共卫生相关性：鉴于亲子互动的互惠性质，青少年参与其母亲的药物滥用治疗计划可能与减少成人复发和改善儿童功能有关。这些发现将支持这样的断言，即在药物滥用治疗方案中关注家庭动态是资源的有效利用和干预努力的重要目标。

DESCRIPTION (provided by applicant): Many researchers have studied the effects of parental alcohol and drug use on child outcomes. These studies conclude that parental substance use has the potential to negatively impact children's psychosocial development by depriving them of adequate care and supervision, impeding their socioemotional and cognitive development and/or influencing them to become substance users as well. Considering a bidirectional, systemic model for understanding the development, maintenance and recovery of substance use problems, it follows that the child impacts parents' behaviors as well. Family therapy has consistently shown that involvement of family members in the treatment of substance users is associated with higher levels of engagement and retention in treatment. Many studies report pre to post treatment reductions in substance use and related problems among those receiving couples and family therapy. While randomized clinical trials of family therapy have involved adult identified patients (IPs) in couples therapy and adolescent IPs in family therapy, this study will evaluate a family systems intervention involving an adolescent child in the treatment plan of the adult treatment seeker. In the current study, alcohol and drug treatment seeking adult mothers of an adolescent child (11-15) living in the home will be engaged. All clients will be randomized to (1) ecologically-based family therapy (EBFT) in the home + treatment as usual (TAU), (2) EBFT at the office + TAU, or (3) TAU + attention control. The relative efficacy of this approach will be evaluated at 3, 6, 12, and 18 months post-baseline. Proposed change mechanisms (mediators) for family therapy will be evaluated. Differential treatment response as a function of gender, family history of alcohol or drug use, and primary alcohol v. drug abuse (moderators) will be investigated to better understand the intervention. The study will also examine how, if at all, treatment engagement and retention impact parent and adolescent response to treatment. Information gained through this project will help evaluate the utility of including adolescent family members in the treatment plan of their adult parents. Finally, the study will include an economic evaluation component to estimate the economic cost of each intervention and determine which condition is most cost effective. Intervention that includes a focus on parent-child interaction has the potential to enhance substance use reductions, reduce parent relapse, and improve family and emotional health among adults. Involvement of the adolescent offers the opportunity to increase the potential protection of a positive parent-child relationship which is shown to be associated with positive developmental outcomes. Narrative Given the reciprocal nature of parent-child interaction, involvement of the adolescent in their mother's substance abuse treatment plan might be associated with reductions in adult relapse and improvements in child functioning. These findings would support the assertion that focus on family dynamics in substance abuse treatment programs is an effective use of resources and an important target of intervention efforts. PUBLIC HEALTH RELEVANCE: Given the reciprocal nature of parent-child interaction, involvement of the adolescent in their mother's substance abuse treatment plan might be associated with reductions in adult relapse and improvements in child functioning. These findings would support the assertion that focus on family dynamics in substance abuse treatment programs is an effective use of resources and an important target of intervention efforts.