Mobile adaptive intervention to reduce negative consequences associated with simultaneous alcohol and marijuana use in young adults in primary care

项目摘要 多达三分之一的年轻人报告在过去的一个月里使用过大麻或酒精，8%的人每天都报告说 32%的人吸食大麻，32%的人酗酒。新兴市场期间大麻和酒精使用高峰期 成年后，仍然会对发育中的大脑产生影响。两种物质都与较低的 学业成就、对健康的负面影响、上瘾以及驾驶损伤和伤害。同时进行 酒精和大麻(SAM)的使用，定义为同时或近距离使用这两种物质 彼此之间存在重叠效应，在年轻人中很常见。过去的研究表明，SAM 近四分之一的年轻人服用这种药物，其负面后果可能比服用 任何一种物质都是单独存在的。虽然已经针对酒精和大麻的使用制定了简短的干预措施 单独来说，许多都是针对大学生群体的。社区中有患癌症风险的年轻人 发展中的物质使用障碍(SUD)通常有更有限的选择。靶向保护行为 战略(PBS)，如限制SAM的使用频率，可能有助于减少负面后果 并防止SUD的发展。目前没有针对SAM使用的干预措施，也很少有新的利用 吸引年轻人参与的技术方法(如智能手机)或战略(如PBS)。生态 瞬时干预(EMIS)和即时适应干预(JITAI)为 通过在人的自然状态下实时提供干预组件，对SAM的使用进行干预 环境，使用移动设备。技术进步提供了更强的适应性来支持 当他/她的环境发生变化时，当他/她乐于接受并需要帮助时，他/她的情况就会改变。的目标是 该治疗开发项目旨在开发基于自我调节的自适应电磁干扰(a-EMI)。 和社会认知理论。为了确定最有效的干预策略，我们将利用 多阶段优化策略(MOST)框架。从历史上看，大多数干预措施最初都是作为 一揽子战略，很难从这些战略中确定最有效的组成部分。作为替代方案， MOST框架允许对干预组件进行连续测试，以确定最佳组合。 在试点测试之后，我们将评估干预部分在两个结果上的可行性和有效性 (负面结果和PBS)使用部分析因实验设计，后评估和 一个月和三个月的随访。从初级保健诊所招募的136名不同的年轻人报告 目前使用的SAM将被随机分配到八组中的一组，代表 包括或不包括以减少渴求和公共广播为重点的干预策略。结果就是这样 导致改善结果的流程、单个和/或组合组件将保留在 随后进行随机对照试验，同时剔除无效成分。

Project Summary Up to one-third of young adults report use of marijuana or alcohol in the past month, with 8% reporting daily marijuana use and 32% engaging in heavy episodic drinking. Marijuana and alcohol use peak during emerging adulthood and can still have an impact on the developing brain. Both substances are associated with lower academic achievement, negative health effects, addiction, and driving impairment and injury. Simultaneous alcohol and marijuana (SAM) use, defined as use of both substances at the same time or in close proximation of each other with overlapping effects, is common among young adults. Past research has shown that SAM use occurs in almost one-fourth of young adults and can lead to more negative consequences than use of either substance alone. Though brief interventions have been developed for alcohol and marijuana use independently, many are targeted to college populations. Young adults in the community who are at risk for developing substance use disorders (SUDs) often have more limited options. Targeting protective behavioral strategies (PBS), such as setting limits on the frequency of SAM use, may help reduce negative consequences and prevent development of SUD. No current intervention addresses SAM use and few leverage new technological methods (e.g., smartphones) or strategies (e.g., PBS) to engage young adults. Ecological momentary interventions (EMIs) and just-in-time adaptive interventions (JITAIs) offer opportunity for interventions on SAM use by delivering intervention components in real-time, in a person's natural environment, using mobile devices. Technological advances afford increased adaptability to support an individual as his/her context changes, when the individual is receptive and in need of assistance. The goal of this treatment development project is to develop an adaptive EMI (a-EMI) that is grounded in self-regulation and social cognitive theories. To determine the most efficacious intervention strategies, we will utilize the Multiphase Optimization Strategy (MOST) framework. Historically, most interventions are built initially as a package of strategies, from which it is difficult to determine the most effective components. As an alternative, the MOST framework allows for successive testing of intervention components to identify the best combination. Following pilot testing, we will assess the feasibility and efficacy of intervention components on two outcomes (negative consequences and PBS) using a fractional factorial experimental design, with post-assessment and one- and three-month follow-ups. 136 diverse young adults recruited from primary care clinics who report current SAM use will be randomly assigned to one of eight groups, representing experimental conditions that include or do not include intervention strategies focused on craving reduction and PBS. As a result of this process, individual and/or combined components that lead to improved outcomes will be retained in a subsequent randomized controlled trial, while ineffective components will be eliminated.