Low Pretreatment Impulsivity and High Medication Adherence Increase the Odds of Abstinence in a Trial of N-Acetylcysteine in Adolescents with Cannabis Use Disorder.
Low Pretreatment Impulsivity and High Medication Adherence Increase the Odds of Abstinence in a Trial of N-Acetylcysteine in Adolescents with Cannabis Use Disorder.
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DOI：
10.1016/j.jsat.2015.12.003
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发表时间：
2016-04
影响因子：
3.9
通讯作者：
Gray KM
中科院分区：
文献类型：
--
作者：
Bentzley JP;Tomko RL;Gray KM
鉴于最近在药物干预治疗青少年大麻使用障碍方面取得的进展，重要的是要考虑哪些青少年特征可能与治疗的有利反应有关。本研究对大麻使用障碍青少年n -乙酰半胱氨酸（NAC）的父母随机对照试验进行了二次分析。我们假设高预处理冲动性和药物依从性与戒断率降低有关。参与者是寻求治疗的青少年（N = 115），他们符合大麻使用障碍的标准，并评估了预处理冲动。他们接受1200毫克NAC或安慰剂口服，每天两次，持续8周。使用重复测量逻辑回归模型进行意向治疗分析，将预处理冲动性（Barratt冲动性量表）和治疗组与戒断率（通过尿大麻素测试测量）联系起来。为了探索NAC可能减少大麻使用的机制，在第二个统计模型中评估了冲动性、依从性和戒断之间的关系，该模型使用了记录依从性和尿大麻素测试结果的参与者的数据（n = 54）。在意向治疗分析中，低预处理冲动性、NAC治疗和基线尿大麻素检测阴性分别增加了治疗期间尿大麻素检测阴性的几率（OR分别为2.1、2.3、5.3）。在有依从性数据的参与者样本中（n = 54），依从性使戒断的几率增加了三倍。值得注意的是，依从性对戒断的影响仅在NAC治疗组中观察到。最后，虽然高度冲动的参与者的戒断率降低了，但高度冲动的人坚持NAC治疗的戒断率比不坚持的人高。低冲动性、NAC治疗、药物依从性和基线大麻素阴性检测与寻求大麻使用障碍治疗的青少年戒断率增加有关。努力优化药物治疗依从性可能对高度冲动的个体尤其重要。理解和处理可能影响结果的因素，如冲动和依从性，可能有助于成功评估和开发潜在的有前途的药物治疗方法。
In light of recent progress toward pharmacologic interventions to treat adolescent cannabis use disorder, it is important to consider which adolescent characteristics may be associated with a favorable response to treatment. This study presents secondary analyses from a parent randomized controlled trial of N-acetylcysteine (NAC) in adolescents with cannabis use disorder. We hypothesized high pretreatment impulsivity and medication non-adherence would be associated with reduced abstinence rates. Participants were treatment-seeking adolescents (N = 115) who met criteria for cannabis use disorder and were assessed for pretreatment impulsivity. They received 1200 mg NAC or placebo orally twice daily for 8 weeks. An intent-to-treat analysis using a repeated-measures logistic regression model was used to relate pretreatment impulsivity (Barratt Impulsiveness Scale) and treatment group to abstinence rates, measured by urine cannabinoid tests. To explore mechanisms by which NAC may reduce cannabis use, relationships between impulsivity, adherence, and abstinence were assessed in a second statistical model using data from participants with recorded adherence and urine cannabinoid test results (n = 54). In the intent-to-treat analysis, low pretreatment impulsivity, NAC treatment, and negative baseline urine cannabinoid test results independently increased the odds of having negative urine cannabinoid tests during treatment (OR = 2.1, 2.3, 5.3 respectively). In the sample of participants with adherence data (n = 54), adherence tripled the odds of abstinence. Notably, the effect of adherence on abstinence was only observed in the NAC treatment group. Lastly, although the highly impulsive participants had reduced rates of abstinence, highly impulsive individuals adherent to NAC treatment had increased abstinence rates compared to non-adherent individuals. Low impulsivity, NAC treatment, medication adherence, and baseline negative cannabinoid testing were associated with increased rates of abstinence in adolescents seeking treatment for cannabis use disorder. Efforts to optimize pharmacotherapy adherence may be particularly crucial for highly impulsive individuals. Understanding and addressing factors, such as impulsivity and adherence, which may affect outcomes, may aid in the successful evaluation and development of potentially promising pharmacotherapies.