Community Reinforcement and Family Training versus counselling for parents of treatment-refusing young adults with hazardous substance use: A randomized controlled trial

IF 5.2 1区医学 Q1 PSYCHIATRY Addiction Pub Date : 2024-01-16 DOI:10.1111/add.16429

Ola Siljeholm, Kerstin Edvardsson, Malin Bergström, Anders Hammarberg

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Abstract

Background and aims

Despite the high prevalence and negative effects of hazardous substance use, few young adults enter treatment. Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, has proved efficacious in promoting treatment entry. The aim of the current trial was to compare the efficacy of CRAFT with an active control for parents of young adults (aged 18–24 years) with hazardous substance use.

Design

This was a randomized controlled superiority trial comparing CRAFT (n = 58) with an active control group receiving manualized counselling (n = 55), with outcome assessments at 6, 12 and 24 weeks (primary end-point). A sequential design with a stopping rule was added post recruitment commencement.

Setting

The study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video-conference due to COVID-19.

Participants

Between October 2018 and May 2021, 113 participants (92% female) who were parents of young adults (87% male) were recruited. Recruitment was discontinued when 70% of the planned sample had been recruited, following an interim analysis of the primary outcome showing no difference between conditions.

Intervention and comparator

Participants were randomized (ratio 1 : 1) to eight manual-based individual CRAFT sessions or five individual manual-based counselling sessions + one voluntary psychoeducative group session, delivered over maximum 14 weeks.

Measurements

The primary outcome measure was the rate of young adult entry in substance use treatment during the trial period (24 weeks).

Findings

At the 24 weeks follow-up, 19 (33%) of CRAFT participants and 17 (31%) of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Both conditions reported clinically relevant reductions in young adult substance use, but no change in participants’ levels of depression, anxiety or stress.

Conclusions

This trial showed no statistically significant evidence that Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, is more efficacious than manual-based counselling regarding treatment entry for young adults.

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社区强化和家庭培训与针对拒绝接受治疗并使用有害物质的青少年父母的辅导：随机对照试验。

背景和目的：尽管使用有害物质的发病率很高，而且会产生负面影响，但接受治疗的年轻人却很少。社区强化和家庭培训（CRAFT）是一项针对药物使用障碍患者重要亲属的支持计划，在促进患者接受治疗方面具有显著效果。本次试验的目的是比较 "社区强化和家庭培训 "与积极对照组对有药物使用危险的年轻人（18-24 岁）的父母的疗效：这是一项随机对照优越性试验，将 CRAFT（58 人）与接受人工辅导的积极对照组（55 人）进行比较，分别在 6、12 和 24 周（主要终点）进行结果评估。招募开始后增加了一个带有停止规则的顺序设计：研究在瑞典斯德哥尔摩的两家年轻成人门诊诊所进行，随后因COVID-19而通过视频会议进行：2018年10月至2021年5月期间，共招募了113名参与者（92%为女性），他们都是年轻人的父母（87%为男性）。在对主要结果进行中期分析后发现，不同条件下的结果无差异，因此在招募到计划样本的 70% 后停止招募：受试者被随机分配（比例为 1:1）接受 8 次以人工方式进行的个人 CRAFT 课程或 5 次以人工方式进行的个人咨询课程 + 1 次自愿心理教育小组课程，最长时间为 14 周：主要结果是在试验期间（24 周）青少年接受药物使用治疗的比率：在 24 周的随访中，19 名（33%）CRAFT 参与者和 17 名（31%）心理咨询参与者报告了青少年接受治疗的情况，两种情况之间没有差异（CRAFT 与心理咨询的几率比为 0.84，95% 置信区间 = 0.35；1.99，P = 0.700）。两种情况都报告了临床相关的青少年药物使用减少情况，但参与者的抑郁、焦虑或压力水平没有变化：这项试验表明，在青壮年戒毒治疗方面，社区强化和家庭培训（CRAFT）这一针对药物滥用障碍患者重要亲属的支持项目，比人工咨询更有效，但没有统计学意义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.