Improving Decision Making to Prevent Substance Misuse among Adolescents from Traditionally Underserved Communities

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Early childhood adversity is associated with significant risk for engaging in problematic substance use across the lifespan. Adolescents living in low-income neighborhoods are both more likely to experience adverse childhood events and less likely to have access to evidence-based preventative substance use interventions. Thus, there is a critical need to identify interventions that can effectively prevent the escalation of substance use in vulnerable youth and be feasibly disseminated in low-resource, traditionally underserved communities. Delay discounting has emerged in the literature as a critical etiological marker of substance use risk and a potential pathway from early life disadvantage to problematic alcohol and drug use. Elevated delay discounting is characterized by an exaggerated tendency to select rewards that are immediately available. Higher (more problematic) rates of delay discounting during adolescence are associated with more severe and frequent substance use and are predictive of steeper escalations in alcohol, marijuana and tobacco use. Working memory, the capacity to store and manipulate information utilized in decision making, is closely linked to delay discounting and a plausible neurocognitive mechanism linking early adverse environments to problematic discounting tendencies and subsequent substance use. Guided by an experimental therapeutics framework, recent findings from our own research team and others suggests the efficacy of utilizing a computer-based working memory training program to improve discounting among mid-life adults. Computer-based training programs may be particularly suitable to implement in low-resource communities for at-risk adolescents. Specifically, adolescence is a critical period for the development of both working memory and delay discounting, and interventions targeting working memory during this life stage have evidenced favorable clinical results. Further, computerized interventions require limited staff and space resources, making them both feasible and scalable in traditionally underserved communities. Building on promising findings from the investigator team’s formative research, this application proposes to pilot a computer-based working memory intervention among adolescents exposed to early life adversity in the low-resource community of Detroit, Michigan. Primary aims include establishing the preliminary feasibility, acceptability and appropriateness of delivering a computerized working memory intervention in a community setting serving low-income adolescents as well as conducting a small-scale Stage I randomized control trial to examine the effectiveness of this intervention in reducing rates of delay discounting. The subsequent impact of this intervention on changes in adolescent substance use over a three-month follow-up period will also be examined as an exploratory aim. The proposed research will provide valuable insight into the utility of targeting a specific pathway from early adversity to later substance use during adolescence and will establish a model for disseminating interventions in low-resource communities. Results of this study will also set the stage for future large-scale (R01) prevention research.