Identifying Treatment Effects, Mechanisms, and Moderators in Youth Cannabis Use Treatment Using Ecological Momentary Assessment

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PROJECT SUMMARY/ABSTRACT BACKGROUND. Adolescent cannabis use disorder (CUD) interventions have demonstrated mixed efficacy, underscoring the need for improved treatment. Identifying treatment moderators (i.e., individual differences), as well as the mechanisms leading to behavior change, can increase treatment success. Virtually all evidence- based psychosocial interventions leverage aspects of social learning theory (SLT), including social, behavioral, and cognitive factors. One understudied aspect of SLT in the context of treatment is outcome expectancies, which are known to influence cannabis use and subjective effects. Research has suggested that outcome expectancies can serve as moderators and mediators of treatment outcomes; however, fine-grained approaches have yet to elucidate their role in adolescent CUD interventions. SPECIFIC AIMS. This F32 supports integrated research and training aims for applying ecological momentary assessment (EMA) to examine how SLT factors, e.g., outcome expectancies, may moderate adolescent CUD treatment outcomes and relate to mechanisms of behavior change. METHODS. The proposed project will use an existing dataset from a clinical trial examining the effects of pharmacotherapy (topiramate) and psychosocial intervention (motivational enhancement and cognitive behavioral therapy), relative to placebo and psychosocial intervention (N = 66, ages 15-24). The proposed study aims to understand 1) how outcome expectancies and corresponding subjective effects shift over the course of treatment, 2) if topiramate influences greater changes in subjective effects and expectancies throughout treatment, relative to placebo, and 3) how baseline expectancies may moderate topiramate’s effects on subjective effects and quantity of cannabis used. LONG- TERM GOAL. This research plan provides an opportunity for mentored training in identifying moderated mechanisms of behavior change for youth CUD treatments and advanced training in cleaning and analyzing complex EMA data. The selected mentorship team includes experts in the fields of adolescent CUD treatment, mechanisms of behavior change research, clinical trials research, and EMA data collection and analysis. Moreover, the training environment includes an internationally recognized substance dependence research center and a nationally leading child psychiatric hospital. Training gained through this F32 will provide necessary experiences to facilitate the transition to becoming an independent clinical scientist. Additionally, it will leverage EMA data to research the influence of social, cognitive, and behavioral individual differences on adolescent CUD treatment, thus supporting future grant applications. Thus, this F32 aids in NIDA’s research priorities of identifying psychosocial factors implicated in substance use disorders.