Reaching and Motivating Change in Teen Marijuana Smokers

描述(申请人提供)：项目摘要。这是根据NIDA的行为和综合治疗发展计划(PA-07-111)重新提交的竞争延续申请(5 RO1 DA14296；达到并激励青少年吸食大麻者的变化)，最初于2008年11月提交。这项试验的目的是评估增强型青少年大麻检查方案的有效性，以接触和干预大量使用大麻的非寻求治疗的青少年。250名大量吸食大麻的青少年将接受为期两次的个人激励增强疗法。所有参与者还将有机会在12个月内反复重新开始大麻咨询。参与者将被随机分配到两种定期后续联系中的一种：基于动机访谈的大麻签到(MCI)或教育反馈控制(EFC)会议。所有参与者将在注册3、6、9、12和15个月的周年纪念日进行重新评估。在最初的动机增强治疗之后，125名实验条件参与者将在注册4个月、7个月和10个月的周年纪念日额外与他们的顾问进行动机增强治疗“登记”会议，旨在加强维持治疗成果并激励继续成功，增加未达到大麻使用目标的参与者改变的动机，和/或根据需要迅速利用认知行为治疗(CBT)会议。这125名对照参与者将在相同的时间间隔接受大麻教育，以作为注意力控制。实验条件的基本原理基于：A)我们当前试验的结果表明，MET反馈会议在3个月的随访中显示出在促进减少大麻使用和相关后果方面的明显效果，B)在12个月的跟踪调查中，干预的效果不再明显，C)使用额外的认知行为疗法很少，但可能有帮助，以及D)最近的研究表明，持续护理检查会议在促使未能从咨询中受益的参与者重新参与治疗方面具有有效性。具体目标是：(1)通过在最初干预后的9个月内制定和实施定期大麻登记(MCI)，加强TMCU MET干预的效果；(2)评估MET/MCI方法是否比MET/教育条件下更大程度地减少大麻使用和增加治疗参与度；(3)评估MCI条件下参与者更多地使用CBT疗法是否部分地调节了大麻使用频率和其他结果的影响；以及(4)检查干预对大麻使用结果的影响的其他潜在中介因素，包括自我效能、感知描述性规范和成本/收益分析。一种强化的青少年干预模式，促进了大麻行为的改变，保持了这种改变，并在需要时促使个人参与咨询，很可能会延长原本不接受治疗的青少年的行为改变结果。

DESCRIPTION (provided by applicant): Project Summary. This is a resubmission of a competing continuation application (5 RO1 DA14296;Reaching and Motivating Change in Teen Marijuana Smokers) originally submitted November 2008 in response to NIDA's Behavioral and Integrative Treatment Development Program (PA-07-111). The goal of this trial is to evaluate the efficacy of an enhanced Teen Marijuana Check-Up protocol to reach and intervene with non- treatment seeking adolescents who use marijuana heavily. Two hundred fifty adolescents who use marijuana heavily will receive a 2-session individual motivational enhancement therapy. All participants will also be offered the opportunity, over a 12-month period, to repeatedly reinitiate marijuana counseling. Participants will be randomly assigned to receive one of two types of periodic follow-up contacts: Motivational interviewing- based Marijuana Check-Ins (MCI) or Educational Feedback Control (EFC) sessions. All participants will be reassessed at the 3, 6, 9, 12, and 15-month anniversaries of enrollment. Following their initial motivational enhancement therapy, the 125 experimental condition participants will additionally have a motivational enhancement treatment "check-in" session with their counselor at the 4, 7, and 10-month anniversaries of enrollment intended to reinforce the maintenance of treatment gains and motivate continued success, increase motivation to change for participants who did not meet their marijuana use goals, and/or prompt utilization of cognitive-behavioral treatment (CBT) sessions as needed. The 125 comparison participants will receive marijuana education at the same time intervals to serve as an attentional control. The experimental condition's rationale is based on: A) findings from our current trial that demonstrated MET feedback sessions showed clear efficacy in fostering reductions in marijuana use and associated consequences at a 3-month follow-up, B) the effects of the intervention were no longer evident at a 12-month follow-up, C) utilization of additional cognitive behavior therapy was minimal but potentially helpful and D) recent research demonstrating the efficacy of continuing care check-up sessions in prompting treatment reengagement by participants who failed to benefit from counseling. The specific aims are: (1) to enhance the effects of the TMCU MET intervention by developing and implementing periodic marijuana check-ins (MCI) over a 9-month period following the initial intervention; (2) to assess whether the MET/MCI approach results in greater reductions in marijuana use and increased treatment engagement than an MET/Educational condition, (3) to assess whether greater utilization of the CBT therapy sessions by MCI condition participants partially mediates the effect on frequency of marijuana use and other outcomes, and (4) to examine other potential mediators, including self-efficacy, perceived descriptive norms, and cost/benefit analyses, of the effect of the intervention on marijuana use outcomes. An enhanced model of intervening with adolescents that promotes marijuana behavior change, the maintenance of such change and prompts the individual to engage in counseling when needed, will likely extend behavior change outcomes in adolescents who would otherwise go untreated.