Treatment of Justice-Involved Emerging Adults with Substance Use Disorders

 描述(由申请人提供)：酒精和其他药物(AOD)滥用和犯罪活动的流行率在成年初期是最高的，比任何其他发育时期都要高，并给社会造成非凡的代价。他们也经常一起发生；有AOD滥用的新兴成年人(EA；17-21岁)的监禁率比没有AOD滥用的EA更高，AOD滥用的犯罪者比其他犯罪者的累犯率、严重犯罪率和监禁要高得多。这种严重的行为妨碍了他们顺利过渡到成年人--完成学业、就业、住房。因此，公共卫生迫切需要有效的治疗，以减少AOD滥用和司法介入EAS。令人惊讶的是，在有或没有AOD滥用的情况下，没有任何具有既定效力的干预措施来减少环境援助机构的犯罪活动。在较年轻的青少年中，通过有效的干预措施(例如，多系统治疗[MST]；多维治疗寄养护理[MTFC])解决了反社会行为的综合原因，目前的调查小组已经开发和评估了针对有犯罪行为的EAS的明确的、针对年龄的干预措施。制定的干预措施是对MST的改编，并整合了MTFC的技能培训部分，这两项措施都是行之有效的青少年司法干预措施。最初的MST-EA研究集中在有心理健康问题的年轻人身上，他们是犯罪者的高危亚群，但AOD滥用很快成为MST-EA团队处理的主要问题。作为一种单一来源的干预，MST-EA针对的是EA与犯罪活动和AOD滥用之间的关联，包括有利可图的EA活动(积极的关系、学校、工作和住房)和减少AOD滥用-部分是通过针对自我监管不力的近端机制。在一项成功完成的基于社区的开放试验中，确定了干预的安全性、可行性和初步疗效。 拟议的研究将评估MST-EA在减少司法介入和AOD滥用方面的有效性。有AOD滥用和司法参与(最近从司法机构逮捕或释放)的急救人员(n=240)将随机接受MST-EA或照常治疗(TAU)。在0个月、2个月、4个月、6个月、8个月、12个月和16个月将完成评估，并使用系统记录和抵押品报告对所有结果数据进行三角测量。目的将是评估MST-EA随着时间的推移对减少AOD滥用和犯罪活动的效果，以及评估MST-EA对治疗的关键近端目标(自我调节)和治疗的中间结果(有偿活动)的影响。这项研究的最终目的将是调查治疗对犯罪活动的直接影响是否通过其对自我调节、AOD滥用和有利可图的活动的影响而起中介作用。在这个特定的年龄段，完全没有滥用AOD和减少再犯罪率的有效治疗方法。拟议研究的最终结果将是减少AOD滥用和司法介入高危人群，以及改善具有重大社会影响的结果(例如，减少无家可归和失业)。

 DESCRIPTION (provided by applicant): Prevalence of alcohol and other drug (AOD) abuse and criminal activity is highest during emerging adulthood compared to any other developmental period, and causes extraordinary costs to society. They also frequently occur together; Emerging Adults (EAs; ages 17-21) with AOD abuse have greater incarceration rates than EAs without AOD abuse, and AOD-abusing offenders have significantly more recidivism, severe offending, and incarceration than other offenders. Such serious behavior interferes with successful transition into adulthood - school completion, employment, housing. Thus, there is a strong public health need for effective treatment to reduce AOD abuse and justice involvement in EAs. Surprisingly, there are no interventions with established efficacy to reduce criminal activity among EAs, with or without AOD abuse. Among younger adolescents, the comprehensive causes of antisocial behavior are addressed by effective interventions (e.g., Multisystemic Therapy [MST]; Multidimensional Treatment Foster Care [MTFC]), and the present investigative team has developed and evaluated a well-defined age-tailored intervention for EAs with criminal behavior. The developed intervention is an adaptation of MST and integrates a skills coaching component from MTFC, both well-established effective juvenile justice interventions. Initial MST-EA research focused on justice-involved young adults who had mental health problems, a high-risk subpopulation of offenders, but AOD abuse quickly became a primary problem the MST-EA team treated. As a single-source intervention, MST-EA targets the EA correlates of criminal activity and AOD abuse, including gainful EA activities (positive relationships, school, work, and housing) and reduced AOD abuse-in part by targeting the proximal mechanism of poor self- regulation. In a successfully completed community-based open trial, the safety, feasibility, and preliminary efficacy of the intervention were established. The proposed study will evaluate the effectiveness of MST-EA for reducing justice involvement and AOD abuse. EAs (n = 240) with AOD abuse and justice involvement (recent arrests or release from justice facilities) will be randomized to receive MST-EA or Treatment as Usual (TAU). At months 0, 2, 4, 6, 8, 12, and 16, assessments will be completed, with triangulation of all outcome data using system records and collateral reports. Aims will be to evaluate the effect over time of MST-EA for reducing AOD abuse and criminal activity, as well as to evaluate the effect of MST-EA on the key proximal target of treatment (self-regulation) and intermediate outcomes of treatment (gainful activities). A final aim of the study will be to investigate if the direct effect of treatment on criminal activity is mediated by its effect on self- regulation, AOD abuse, and gainful activities. In this specific age group, there is a complete absence of AOD abuse and recidivism reduction treatments with demonstrated effectiveness. The ultimate effect of the proposed research would be decreased AOD abuse and justice involvement in a high-risk population, as well as improved outcomes that have significant societal impact (e.g., reduced homelessness and unemployment).