Experimental Mediation Research Aimed at Enhancing Adolescent Substance Abuse Treatment

项目总结/摘要 青少年物质使用障碍（SUD）是在重大有害后果的高风险。 虽然存在几种针对青少年SUD的循证实践，但它们仅产生小到中等的效果。 效果迅速减弱（6个月复发率为30-70%）。一种很有前途的方法， 加强治疗是实验性的调解研究。与传统的相关 调解方法，实验调解允许因果推理，并包括关键步骤： (A)确定治疗的假定中介变量。(B)加强治疗， 调解员更强。(C)随机青年的条件，与标准和增强版本的 治疗针对同一介质的不同“水平”。(D)衡量调解人和结果 纵向。(E)执行现代中介分析，以及评估因果关系的分析 推断，以确定是否在调解人的变化是负责结果的变化。这 调解的实验测试，侧重于因果关系，通过以下方式促进治疗的快速改善： 具体说明目标变革机制，以改善成果。将遵循这些步骤， 阐明青少年SUD治疗的中介过程，最终目标是提高 SUD处理的强度和耐久性。三个最常见的假定中介变量， 青少年SUD的治疗方法是父母管理，行为调节和同伴关系。为此 研究，父母管理被选为目标，因为它已被证明是最有潜力的， 在青年成果方面产生了可推广的变化，并已被证明间接改善了青年的 行为调节和同伴关系。在青少年SUD的现有治疗中， 应急管理（CM）被选为治疗，以加强，因为它是高度顺应 与其他SUD治疗相比， 在有效性和传播潜力方面获得了相当大的支持。因此，根据实验 调解步骤，患有SUD的青少年将被随机接受标准CM或增强CM（即， CM+），更强烈地针对育儿。12个月重复评估和纵向评估 分析将有助于对调解进程进行测试。我们将研究父母的管理技能 调解治疗对青少年物质使用和行为问题的影响（目的1）。另外我们 将确定父母管理技能是否介导治疗对青少年行为的影响， 规管和越轨的同伴关系（目标2）。最后，我们将测试行为监管和 父母管理对青少年物质使用和行为的影响以偏差同伴关系为中介 问题（目标3）。研究结果可能对多种青少年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.