Adapting and evaluating an integrated intervention for adolescent substance use and pain during oral surgery

项目摘要 物质使用（SU）最常见于青春期。发病年龄较早与 更严重和持续的不良后果，如社会心理和教育功能受损， 无数的健康后果，以及与SU和成瘾的长期斗争-强调了迫切需要 尽早发现并干预SU。因此，公共卫生需要增加可用性， 对正在使用药物的青少年（ADOL）进行循证干预的质量不能被 言过其实，特别是在罗得岛，ADOL没有接受物质使用障碍治疗， 他们需要高于全国平均水平。该提案不仅旨在增加获得干预措施的机会， 使用物质的ADOL，但也通过以创新的方式共同解决疼痛来改善ADOL的简短干预措施。 术前背景剧烈疼痛的程序，如智齿拔除，是一个很好的时机， 由于SU和疼痛之间存在共同的风险因素，因此识别SU行为并在简短的干预中进行ADOL 以及可能接触处方阿片类药物目标1是调整和整合先前存在的证据- 将基于青少年SU（MET-CBT）和急性疼痛应对（CBT）的简短干预纳入术前简报 干预（PS-BI）的ADOL和他们的父母。PS-BI将由PI及其跨学科人员开发 指导团队结合关键信息提供者（例如，ADOL，父母和牙科提供者）的反馈。 目标2将在一项初步随机对照试验（RCT）中与当前最佳对照条件下评价PS-BI 在使用大麻（和其他物质）进行智齿治疗的ADOL（15-18岁）中的实践 萃取试点RCT（目标2）的关键结果是可行性和可接受性。生态瞬时 评估（EMA）方法将用于阐明疼痛，渴望和SU之间的关联（目标3）， 探索这些关联是否被PS-BI减弱（探索性目的）。这将是第一次测试内部- 假设的前兆的人关联（例如，疼痛强度），物质渴望，以及在 使用药物的ADOL患者的围手术期背景。高度结构化的培训计划将确保执行 提出的研究目标。具体而言，PI将接受以下方面的高级培训：（1）干预 开发和临床试验方法，（2）ADOL的综合SU干预，（3）EMA，（4）晚期 统计方法，包括纵向数据分析，以及（5）指导和领导技能，以联合收割机 凭借她在儿科心理学、医疗环境中的跨学科合作和儿科疼痛方面的专业知识。 培训将由具有高度相关专业知识和长期跟踪的一流导师团队指导 成功的指导记录。提出的研究和培训计划进一步得到了富人的支持 布朗大学酒精和成瘾研究中心的培训环境。通过K23， PI将获得专门的培训，以启动她的独立研究，重点是开发，评估， 在综合护理环境中对青少年SU和疼痛实施创新干预。

PROJECT SUMMARY Substance use (SU) is most commonly initiated during adolescence. Earlier age of onset is associated with more significant and persistent adverse outcomes, such as impaired psychosocial and educational functioning, myriad health consequences, and long-term struggles with SU and addiction — underscoring the critical need to identify and intervene on SU as early as possible. Thus, the public health need to increase availability and quality of evidence-based interventions for adolescents (ADOL) who are using substances cannot be overstated, especially in Rhode Island where ADOL are not receiving substance use disorder treatment that they need at higher than national averages. This proposal not only aims to increase access to interventions for ADOL using substances but also improve brief interventions for ADOL by co-addressing pain in an innovative pre-surgical context. Acutely painful procedures, such as wisdom tooth extraction, are an opportune time to identify SU behaviors and engage ADOL in brief intervention due to shared risk factors between SU and pain and the potential for exposure to prescription opioids. Aim 1 is to adapt and integrate pre-existing evidence- based brief interventions for adolescent SU (MET-CBT) and acute pain coping (CBT) into a pre-surgical brief intervention (PS-BI) for ADOL and their parents. PS-BI will be developed by the PI and her interdisciplinary mentorship team in conjunction with feedback from key informants (e.g. ADOL, parents, and dental providers). Aim 2 will evaluate PS-BI in a pilot randomized controlled trial (RCT) versus a control condition of current best practice among ADOL (age 15-18 years) who use cannabis (and other substances) undergoing wisdom tooth extraction. Key outcomes for the pilot RCT (Aim 2) are feasibility and acceptability. Ecological momentary assessment (EMA) methods will be used to elucidate associations between pain, craving, and SU (Aim 3) and explore if those associations are attenuated by PS-BI (Exploratory aim). This will be the first test of within- person associations of hypothesized precursors (e.g., pain intensity), substance craving, and use in the perioperative context among ADOL who use substances. A highly structured training plan will ensure execution of the proposed research aims. Specifically, the PI will receive advanced training in (1) intervention development and clinical trial methods, (2) integrated SU interventions for ADOL, (3) EMA, (4) advanced statistical approaches, including longitudinal data analysis, and (5) mentoring and leadership skills to combine with her expertise in pediatric psychology, interdisciplinary collaboration in medical settings, and pediatric pain. Training will be guided by a stellar mentorship team with highly relevant expertise and long-standing track records of successful mentorship. The proposed research and training plan is further supported by the rich training environment at the Center for Alcohol and Addiction Studies at Brown University. Through this K23, the PI will obtain specialized training to launch her independent research focused on developing, evaluating, and implementing innovative interventions for adolescent SU and pain in integrated care settings.