Experimental Mediation Research Aimed at Enhancing Adolescent Substance Abuse Treatment

项目摘要/摘要 患有物质使用障碍(SUD)的青少年有很高的风险产生严重的有害后果。 尽管存在几种针对青少年sud的循证治疗方法，但它们只能产生中小规模的效果。 效果迅速减弱(30-70%的6个月复发率)。一种很有希望的方法来确定如何 加强治疗是实验性的调解研究。与传统相关关系不同 作为调解方法，实验性调解允许因果推理，并由关键步骤组成： (A)确定治疗的假定中介变量。(B)加强治疗，以针对 调解人的态度更加强烈。(C)将青年随机安排到不同条件下，采用标准版本和增强版本 针对同一介体的不同“水平”的治疗。(D)衡量调解人和结果 纵向的。(E)进行现代调解分析，并结合评估因果关系的分析 推论，以确定介体的变化是否对结果的变化负责。这 注重因果关系的调解实验测试通过以下方式促进了治疗的快速改进 明确目标的变化机制，以改善结果。这些步骤将被遵循到 阐明青少年SUD治疗中的中介过程，最终目的是加强 SUD处理的强度和耐用性。中最常见的三个假设中介变量 青少年SUD的治疗方法包括父母管理、行为规范和同伴关系。为了这个 研究表明，家长管理被选为目标是因为它证明了 在青年结果中产生了可概括的变化，也被证明间接地改善了青年的 行为规范和同伴关系。以家庭为基础的青春期SUD现有治疗方案 应急管理(CM)被选为需要加强的治疗方法，因为它具有高度的适应性 与其他SUD治疗相比，没有那么复杂，并积累了 在有效性和传播潜力方面提供了相当大的支持。因此，以下是实验性的 调解步骤，患有SUD的青年将被随机接受标准CM或增强型CM(即， Cm+)，这是更强烈地针对育儿的。12个月的重复评估和纵向评估 分析将允许对调解过程进行测试。我们将考察家长的管理技能是否 调解治疗对青少年药物使用和行为问题的影响(目标1)。此外，我们 将决定父母的管理技能是否会在治疗对青少年行为的影响中起中介作用 监管和不正常的同伴关系(目标2)。最后，我们将测试行为规范和 偏差同伴关系在父母管理对青少年物质使用和行为影响中的中介作用 问题(目标3)。这一发现可能会对多种青少年SUD治疗产生广泛影响。

PROJECT SUMMARY/ABSTRACT Adolescents with substance use disorders (SUD) are at high risk for significant deleterious outcomes. Although several evidence-based practices for adolescent SUD exist, they yield only small to medium effects that rapidly diminish (30-70% 6-month relapse rates). A promising approach for determining how to enhance treatment is experimental mediation research. In contrast to traditional correlational mediation approaches, experimental mediation permits causal inference and is comprised of key steps: (A) Identify the putative mediating variable for a treatment. (B) Enhance the treatment to target that mediator more intensely. (C) Randomize youth to conditions, with the standard and enhanced versions of the treatment targeting different “levels” of the same mediator. (D) Measure the mediator and outcomes longitudinally. (E) Perform modern mediation analyses, coupled with analyses evaluating causal inference, to determine if changes in the mediator are responsible for changes in outcomes. This experimental test of mediation, focused on causality, facilitates rapid improvement of treatments by specifying change mechanisms to target in order to improve outcomes. These steps will be followed to elucidate the mediating processes in treatment for adolescent SUD, with the ultimate goal of enhancing the strength and durability of SUD treatments. The three most common putative mediating variables in adolescent SUD treatments are parent management, behavioral regulation, and peer relations. For this study, parent management was chosen as the target because it has evidenced the most potential for yielding generalizable change in youth outcomes and also has been shown to indirectly improve youths’ behavioral regulation and peer relations. Of existing treatments for adolescent SUD, family-based Contingency Management (CM) was chosen as the treatment to enhance because it is highly amenable to an augmented focus on parenting, is less complex relative to other SUD treatments, and has amassed considerable support in terms of efficacy and dissemination potential. Thus, following experimental mediation steps, youth with SUD will be randomized to receive either standard CM or enhanced CM (i.e., CM+) that targets parenting more intensely. Repeated assessments for 12 months and longitudinal analyses will allow testing of mediating processes. We will examine whether parent management skills mediate the effect of treatment on youth substance use and behavior problems (Aim 1). In addition, we will determine whether parent management skills mediate the effect of treatment on youth behavioral regulation and deviant peer relations (Aim 2). Finally, we will test whether behavioral regulation and deviant peer relations mediate the effect of parent management on youth substance use and behavior problems (Aim 3). Findings could have broad impact across multiple adolescent SUD treatments.