Adapted Cognitive/Affective Remediation for Cannabis Misuse in Schizophrenia

描述(由申请人提供)：药物使用共病是精神分裂症患者最常见和最致残的问题之一，也是NIDA的关键治疗重点。多达65%的精神分裂症患者在药物使用方面经历了严重的问题，最常见的是大麻，这些人的病程、结果和生活质量最差。虽然针对严重精神疾病患者的综合精神和药物使用治疗以及特定行为干预的进展带来了更好的护理标准，但专门针对精神分裂症患者和共病药物使用问题的个人独特需求的有效治疗方法非常少。认知和情感调节障碍，目前对药物治疗无效，是精神分裂症患者大麻和其他物质滥用比率过高的主要原因，并突显了为这一人群制定有针对性的认知和情感补救计划的必要性。然而，到目前为止，还没有认知补救方法被适应于患有严重药物使用共病的精神分裂症患者的独特需求。针对RFA-DA-10-007，“改善药物滥用治疗结果的认知补救方法”，我们建议采取第一步，整合、适应和初步测试对精神分裂症患者滥用大麻的认知补救(认知增强疗法[CET])和情感调节(个人疗法[PT])干预。这两种心理社会干预措施都在没有药物使用问题的精神分裂症患者的大样本中进行了严格的测试，并被证明在补救可能导致这一人群使用药物的未经治疗的认知和情感障碍方面非常有效。该项目现在将整合和调整这些干预措施，并在32名有严重大麻使用问题的精神分裂症患者样本中对其可行性、可接受性和有效性进行初步检查。大麻是该人群中最常见的滥用药物。患者将随机接受CET/PT加常规治疗(TAU)或单独接受TAU治疗，治疗时间为18个月。在整个试验过程中，将收集治疗依从性、出勤率和满意度数据，以评估CET/PT治疗大麻滥用精神分裂症患者的可行性和可接受性。此外，在治疗前以及治疗9个月和18个月时，将对物质使用、功能、认知和情感结果进行全面评估，以评估CET/PT对关键结果的疗效。预计该项目的结果将为CET/PT治疗滥用大麻的精神分裂症患者的可接受性、可行性和有效性提供强有力的支持，这将证明进行更明确的试验是合理的，并最终为许多患有共病药物使用问题的精神分裂症患者带来显著的治疗进步。 与公共卫生相关：使用药物，最常见的是大麻，是精神分裂症的一个频繁和高度致残的问题，给社会带来了重大负担，而且几乎没有有效的治疗方法。这些问题的背后是认知和情感调节方面未经治疗的障碍，这促使许多患者使用药物。该项目具有重大的公共卫生意义，因为它建议对这一重大公共卫生问题进行基于证据的认知补救(认知增强疗法)和情感调节(个人疗法)干预，以努力推进精神分裂症重大物质使用共病的治疗，并减轻这些疾病对患者个人、其家庭和社会的负担。

DESCRIPTION (provided by applicant): Substance use comorbidity is among the most frequent and disabling problems experienced by persons with schizophrenia, and a key treatment priority for NIDA. As many as 65% of people with schizophrenia experience significant problems with substance use, most frequently cannabis, and these individuals have the worst course, outcomes, and quality of life. While advances in integrated psychiatric and substance use treatment and specific behavioral interventions for people with severe mental illness have led to better standards of care, remarkably few effective treatments exist that specifically target the unique needs of individuals with schizophrenia and comorbid substance use problems. Impairments in cognition and affect regulation, currently unresponsive to pharmacotherapy, are major contributors to the exceedingly high rates of cannabis and other substance misuse in schizophrenia and highlight the need for targeted cognitive and affective remediation programs for this population. To date, however, no cognitive remediation approach has been adapted to the unique needs of schizophrenia patients with significant substance use comorbidity. In response to RFA-DA-10-007, "Cognitive Remediation Approaches to Improve Drug Abuse Treatment Outcomes," we propose to take the first step in integrating, adapting, and preliminarily testing a cognitive remediation (Cognitive Enhancement Therapy [CET]) and affect regulation (Personal Therapy [PT]) intervention for cannabis misusing patients with schizophrenia. Both of these psychosocial interventions have been rigorously tested in large samples of individuals with schizophrenia who do not experience substance use problems, and have been shown to be highly effective at remediating the untreated cognitive and affective impairments that can lead this population to use drugs. This project will now integrate and adapt these interventions, and conduct an initial examination of their feasibility, acceptability, and efficacy in a sample of 32 schizophrenia patients with significant cannabis use problems, the most frequent drug of abuse in this population. Patients will be randomized to CET/PT plus treatment as usual (TAU) or TAU alone and treated for 18 months. Treatment adherence, attendance, and satisfaction data will be collected throughout the trial to assess the feasibility and acceptability of CET/PT for cannabis misusing schizophrenia patients. In addition, comprehensive assessments of substance use, functioning, cognitive, and affective outcomes will be administered prior to treatment, and at 9 and 18 months, to estimate the efficacy of CET/PT on critical outcomes. It is expected that the findings from this project will provide strong support for the acceptability, feasibility, and efficacy of CET/PT for cannabis misusing schizophrenia patients that will justify the conduct of a more definitive trial and ultimately result in a significant treatment advance for the many individuals with schizophrenia who experience comorbid substance use problems. PUBLIC HEALTH RELEVANCE: The use of drugs, most commonly cannabis, is a frequent and highly disabling problem in schizophrenia that places a significant burden on society, and for which few effective treatments exist. Underlying these problems are untreated impairments in cognition and affect regulation, which drive many patients to use drugs. This project is of significant public health relevance in that it proposes to bring an evidence-based cognitive remediation (Cognitive Enhancement Therapy) and affect regulation (Personal Therapy) intervention to bear on this major public health problem, in an effort to advance the treatment of significant substance use comorbidity in schizophrenia and reduce the burden of these disorders on the individuals who suffer from them, their families, and society.