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一个月内使用大麻或酒精，8%的人每天报告 大麻使用和32%的人从事大量的间歇性饮酒。饮酒和饮酒在新兴时期达到高峰 成年后仍然会对发育中的大脑产生影响。这两种物质都与较低的 学业成绩、负面健康影响、成瘾、驾驶障碍和伤害。同时 酒精和大麻（SAM）的使用，定义为同时使用这两种物质或在接近 相互重叠的影响，在年轻人中很常见。过去的研究表明，SAM 几乎四分之一的年轻人使用这种药物， 单独的物质。虽然针对酒精和大麻的使用已经开发了简短的干预措施， 独立地，许多是针对大学生的。社区中有风险的年轻人 发展中的物质使用障碍（SUD）通常有更有限的选择。针对性保护行为 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。目前没有干预措施解决SAM的使用问题， 技术方法（例如，智能手机）或策略（例如，PBS）吸引年轻人。生态 瞬时干预（EMI）和即时适应性干预（JITAI）为 通过实时提供干预成分，在一个人的自然环境中， 环境，使用移动的设备。技术进步提供了更大的适应性，以支持 当个人乐于接受和需要援助时，他/她的环境发生变化。的目标 该治疗开发项目是开发一种基于自我调节的自适应EMI（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 这是一套战略，很难从中确定最有效的组成部分。作为替代方案， 社会变革管理计划框架允许对干预措施的组成部分进行连续测试，以确定最佳组合。 在试点测试之后，我们将评估干预成分在两个结果方面的可行性和功效 （负面后果和PBS）使用部分析因实验设计，进行后评估， 一个月和三个月的随访。从初级保健诊所招募了136名不同的年轻人， 目前SAM的使用将被随机分配到八个组中的一个，代表实验条件， 包括或不包括以减少渴望和PBS为重点干预策略。由于这种 过程中，个别和/或合并的组成部分，导致改善的结果将保留在一个 后续随机对照试验，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.