Leveraging Ecological Momentary Assessment to Examine Peer Affiliations as a Mechanism of Behavior Change in Youth Alcohol Use Treatment

项目摘要/摘要 背景资料。酒精使用(AU)和滥用，包括出现酒精使用障碍(AUD)，高峰期为 青春期和成年初现阶段。尽管非盟在年轻人中产生了不利影响，如增加风险 对于药物使用障碍的发展和与酒精有关的死亡风险的增加，现有的最好的 针对澳门氏症的心理社会干预在年轻人中只产生了不大的短期好处。一种改进的方法 AUD的治疗和减少与青年AU相关的公共卫生负担是为了促进我们的 了解干预措施如何发挥作用。几乎所有基于证据的心理社会干预都强调 从使用酒精的同伴转变为不使用同伴，因为青少年AU主要发生在 使用同龄人加入AU始终与复发和复发的风险增加相关 更糟糕的治疗结果。到目前为止，AUD治疗研究在很大程度上忽略了同龄人 青少年和初出茅庐的成年人，这特别令人担忧，因为没有考虑到 青少年非盟干预中的同伴关系导致减弱，在某些情况下，还会导致医源性影响。 明确的目标。这款F32支持了我们所知的第一项研究，即使用生态学瞬间 评估(EMA)，以检查每天的水平是否从饮酒的同伴转变为不饮酒的同伴 AUD治疗的结果是减少饮酒，并确定这些变化发生的时间。方法：研究方法。使用 检查药物(托吡酯)和激动剂效果的临床试验的现有数据集 使用EMA(N)的增强和认知行为疗法(MET-CBT)相对于安慰剂加MET-CBT =82；14-24岁)，该项目将调查1)年轻人饮酒的时间和 在托吡酯和安慰剂的情况下，从干预前到干预后的非使用同龄人，2)托吡酯是否 通过减弱酗酒与使用同伴之间的关系导致AU减少 和随后的AU，以及3)酒精使用水平是否较低，是否由减弱的关系造成 在使用酒精的同龄人在场和随后的托吡酯状态下的AU之间， 导致更多的时间花在与不喝酒的人一起使用同伴。长期目标。这项研究计划提供了 在确定青少年AUD治疗和行为改变机制方面的指导培训机会 在收集和分析复杂的EMA数据方面的高级培训。确定的指导团队包括 青少年成瘾治疗、行为改变机制研究、临床试验等领域的专家 研究、EMA数据收集和分析，并驻留在国际公认的临床和 成瘾研究中心。目前的F32项目将促进向研究的成功过渡 并将支持未来的拨款申请，这些申请将调查社会和生物 利用EMA设计的工艺影响和UD治疗。因此，这一F32有助于NIAAA的研究重点 确定药物治疗和减少青年AU的作用机制。

PROJECT SUMMARY/ABSTRACT BACKGROUND. Alcohol use (AU) and misuse, including the onset of alcohol use disorder (AUD), peak during adolescence and emerging adulthood. Despite the adverse effects of AU among youth, such as increased risk for the development of substance use disorders and increased risk of alcohol-related deaths, the best available psychosocial interventions for AUD yield only modest short term benefits among youth. One way to improve treatments for AUD and reduce the public health burden associated with youth AU is to advance our understanding of how interventions work. Virtually all evidence-based psychosocial interventions emphasize shifting from alcohol using peers to non-using peers because youth AU predominantly occurs in the presence of peers, and affiliating with AU using peers is consistently associated with increased risk for relapse and worse treatment outcomes. To date, AUD treatment research has largely neglected the peer context of adolescents and emerging adults and this is particularly concerning because failure to consider the centrality of peer relationships in adolescent AU interventions leads to diminished and, in some cases, iatrogenic effects. SPECIFIC AIMS. This F32 supports the first study, to our knowledge, to use ecological momentary assessment (EMA) to examine whether daily level shifts from alcohol using to non-using peers over the course of AUD treatment leads to reductions in drinking and identify when these shifts occur. METHODS. Using an existing data set of a clinical trial examining the effects of medication (topiramate) and motivational enhancement and cognitive behavioral therapies (MET-CBT) relative to placebo plus MET-CBT using EMA (N =82; ages 14-24 years), the project will examine 1) the amount of time youth spend with alcohol-using and non-using peers from pre to post intervention in topiramate and placebo conditions, 2) whether topiramate leads to reductions in AU by attenuating the relationship between being in the presence of alcohol using peers and subsequent AU, and 3) whether lower levels of alcohol use, resulting from the attenuated relationship between being in the presence of alcohol-using peers and subsequent AU in the topiramate condition, in turn, leads to greater time spent with non-alcohol using peers. LONG-TERM GOAL. This research plan provides the opportunity for mentored training in identifying mechanisms of behavior change for youth AUD treatments and advanced training in collecting and analyzing complex EMA data. The identified mentorship team includes experts in the fields of adolescent addiction treatment, mechanisms of behavior change research, clinical trials research, and EMA data collection and analysis., and is housed in internationally recognized clinical and addiction research centers. The current F32 project will facilitate a successful transition to research independence and will support future grant applications that will investigate how social and biological processes impact AUD treatment leveraging EMA designs. Thus, this F32 aids the NIAAA's research priorities of identifying mechanisms of action for pharmacotherapy and reducing youth AU.