Computerized Psychosocial Treatment for Offenders with Substance Use Disorders

描述(由申请人提供)：美国各地刑事司法环境中的大多数人都迫切需要以科学为基础的、针对药物使用和艾滋病毒危险行为的心理社会治疗。调查小组已经开发并展示了一种交互式的、基于计算机的心理社会治疗计划--治疗教育系统(TES)的有效性，它可以满足这一需求。理论上，TES以循证心理社会治疗(社区强化方法和认知行为治疗)为基础，并使用最先进、经过验证的信息技术和多媒体学习工具来促进技能获得、体验式学习和行为改变。这一以计算机为基础的治疗工具使复杂的干预措施得以忠实于循证模式，并且由于其自我指导性质(例如，所需的工作人员时间/培训最少)而以低成本提供，从而为今后的可持续性和在刑事司法系统内传播提供了相当大的潜力。这项研究采用了随机分配的方法，在8个监狱药物滥用项目中进行的多地点试验中，将患有药物使用障碍的监禁男性和女性罪犯(N=526)随机分配到(1)TES(N=263)或(2)标准护理(N=263)。与NDRI(申请组织)一起，合作研究网站(加州大学洛杉矶分校、坦普尔大学和肯塔基大学)运营着属于刑事司法药物滥用治疗研究(CJDATS)网络的研究中心，CJDATS是NIDA资助的合作协议，与美国各地惩教部门的刑事司法合作伙伴建立了关系。目标1是测试TES和标准护理在衡量药物使用(例如戒毒数周)和艾滋病毒危险行为(与性有关和与药物有关的艾滋病毒危险行为)方面的比较有效性，在出狱后3个月和6个月。以及使用惩教部官方记录的重新监禁率。目标2是评估TES相对于标准护理的成本和成本效益。研究人员预测，TES将比标准医疗明显更有效和更具成本效益。该项目具有重大意义，因为它使用了一种创新的计算机技术，并有可能大大增加向监狱中滥用药物的罪犯提供以科学为基础的社会心理治疗的效率和成本效益，从而对公共卫生作出重大贡献。因此，为拟议的为期两年的项目提供资金可以显著加快研究和传播努力的步伐和成果，以满足美国惩教界的需求，为其庞大的药物滥用人口提供有效和实用的治疗干预。 与公共卫生的相关性：拟议项目的重大意义在于，它使用了一种创新的计算机技术(在相关的药物使用者群体中证明了有效性)，从而大幅增加了为滥用药物的男性和女性罪犯提供有效和具有成本效益的社会心理治疗，从而对公共健康产生重大影响。为拟议的为期两年的研究项目提供资金，有可能加快研究和传播工作，使以科学为基础的心理社会治疗能够在美国各地的刑事司法环境中广泛适用于个人。

DESCRIPTION (provided by applicant): The majority of individuals in criminal justice settings across the U.S. have a critical need for science- based, psychosocial treatment that targets substance use and HIV risk behavior. The investigative team has developed and demonstrated the efficacy of an interactive, computer-based, psychosocial treatment program, the Therapeutic Education System (TES), which can answer this need. TES is theoretically grounded in evidence-based psychosocial treatments (Community Reinforcement Approach and Cognitive Behavioral Therapy), and employs state-of-the-art, proven informational technologies and multimedia learning tools to promote skills acquisition, experiential learning and behavioral change. This computer-based therapeutic tool allows complex interventions to be delivered with fidelity to the evidence-based model and at low cost due to its self-directed nature (e.g., minimal staff time/training needed), thus offering considerable potential for future sustainability and dissemination within criminal justice systems. The study employs random assignment of incarcerated male and female offenders with substance use disorders (N=526) to either (1) TES (N=263), or (2) Standard Care (N=263), in a multi-site trial conducted in 8 prison substance abuse programs. Along with NDRI (the applicant organization), the collaborating study sites (University of California Los Angeles, Temple University, and the University of Kentucky) operate Research Centers that belong to the Criminal Justice Drug Abuse Treatment Studies (CJDATS) network, a NIDA-funded cooperative agreement, which has established relationships with criminal justice partners from Departments of Corrections across the U.S. Aim 1 is to test the comparative effectiveness of TES vs. Standard Care on measures of drug use (e.g., weeks of abstinence) and HIV risk behavior (both sex-related and drug-related HIV risk behavior) at 3- and 6-months post prison discharge, as well as on reincarceration rates using official Department of Corrections records. Aim 2 is to evaluate the cost and cost-effectiveness of TES relative to standard care. The investigators predict that TES will be significantly more effective and cost effective than Standard Care. The project is significant in its use of an innovative, computer-based technology and in its potential to produce a major increase in the effective and cost-effective delivery of science-based psychosocial treatment to substance-abusing offenders in prison, and thereby make a considerable public health contribution. Thus, funding the proposed 2-year project can markedly accelerate the pace and achievement of research and dissemination efforts to meet the needs of the U.S. correctional community by providing effective and practical treatment interventions for its large substance-abusing population. PUBLIC HEALTH RELEVANCE: The proposed project is significant in its use of an innovative computer-based technology (of demonstrated efficacy with a related population of substance users) to produce a dramatic increase in the effective and cost- effective delivery of psychosocial treatment for male and female substance-abusing offenders, and thereby have a substantial impact on public health. Funding the proposed 2-year research project has the potential to accelerate research and dissemination efforts to enable widespread reach of science-based psychosocial treatment to individuals in criminal justice settings across the U.S.