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

项目总结 物质使用(SU)最常在青春期开始。发病年龄较早与 更严重和持续的不良后果，如心理社会和教育功能受损， 无数的健康后果，以及长期与苏和毒瘾的斗争--强调了迫切的需要 以便及早识别和干预SU。因此，公共卫生需要增加可获得性和 对正在使用药物的青少年的循证干预质量(ADOL)不能 夸大其词，特别是在罗德岛，在那里ADUL没有接受药物使用障碍的治疗 他们需要比全国平均水平更高的工资。这项提议不仅旨在增加获得干预措施的机会， ADOL使用物质，但还通过共同解决创新的 手术前的情况。非常痛苦的手术，如拔智齿，是一个合适的时机 由于SU和疼痛的共同危险因素，确定SU行为并让ADOL进行简短的干预 以及接触处方阿片类药物的可能性。目标1是调整和整合先前存在的证据- 将青春期SU(MET-CBT)和急性疼痛应对(CBT)的简短干预纳入手术前简要 对ADOL及其父母的干预(PS-BI)。PS-BI将由PI和她的跨学科开发 指导团队与关键信息提供者(如ADOL、家长和牙科提供者)的反馈相结合。 AIM 2将在一项试点随机对照试验(RCT)中评估PS-BI与当前最佳对照条件的对比 15-18岁吸食大麻(及其他物质)进行智齿手术的实践 拔牙。试点区域合作研究(目标2)的主要成果是可行性和可接受性。生态瞬间 评估(EMA)方法将用来阐明疼痛、渴望和SU之间的联系(目标3)和 探索PS-BI(探索性目标)是否削弱了这些联系。这将是第一次内部测试- 假设的前驱物质(例如，疼痛强度)、物质渴望和使用的人在 使用药物的ADOL患者的围手术期环境。高度结构化的培训计划将确保执行 提出的研究目标。具体地说，PI将接受(1)干预的高级培训 开发和临床试验方法，(2)综合SU对ADOL的干预，(3)EMA，(4)高级 统计方法，包括纵向数据分析，以及(5)指导和领导技能相结合 凭借她在儿科心理学、医疗环境中的跨学科协作和儿科疼痛方面的专业知识。 培训将由一支具有高度相关专业知识和长期跟踪的优秀指导团队指导 成功辅导的记录。拟议的研究和培训计划进一步得到了RICH的支持 布朗大学酒精与成瘾研究中心的训练环境。通过这辆K23， PI将接受专门的培训，以启动她的独立研究，专注于开发、评估和 在综合护理环境中为青少年SU和疼痛实施创新干预措施。

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.