Adapting and evaluating an integrated intervention for adolescent substance use and pain during oral surgery

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PROJECT SUMMARY Substance use (SU) is most commonly initiated during adolescence. Earlier age of onset is associated with more significant and persistent adverse outcomes, such as impaired psychosocial and educational functioning, myriad health consequences, and long-term struggles with SU and addiction — underscoring the critical need to identify and intervene on SU as early as possible. Thus, the public health need to increase availability and quality of evidence-based interventions for adolescents (ADOL) who are using substances cannot be overstated, especially in Rhode Island where ADOL are not receiving substance use disorder treatment that they need at higher than national averages. This proposal not only aims to increase access to interventions for ADOL using substances but also improve brief interventions for ADOL by co-addressing pain in an innovative pre-surgical context. Acutely painful procedures, such as wisdom tooth extraction, are an opportune time to identify SU behaviors and engage ADOL in brief intervention due to shared risk factors between SU and pain and the potential for exposure to prescription opioids. Aim 1 is to adapt and integrate pre-existing evidence- based brief interventions for adolescent SU (MET-CBT) and acute pain coping (CBT) into a pre-surgical brief intervention (PS-BI) for ADOL and their parents. PS-BI will be developed by the PI and her interdisciplinary mentorship team in conjunction with feedback from key informants (e.g. ADOL, parents, and dental providers). Aim 2 will evaluate PS-BI in a pilot randomized controlled trial (RCT) versus a control condition of current best practice among ADOL (age 15-18 years) who use cannabis (and other substances) undergoing wisdom tooth extraction. Key outcomes for the pilot RCT (Aim 2) are feasibility and acceptability. Ecological momentary assessment (EMA) methods will be used to elucidate associations between pain, craving, and SU (Aim 3) and explore if those associations are attenuated by PS-BI (Exploratory aim). This will be the first test of within- person associations of hypothesized precursors (e.g., pain intensity), substance craving, and use in the perioperative context among ADOL who use substances. A highly structured training plan will ensure execution of the proposed research aims. Specifically, the PI will receive advanced training in (1) intervention development and clinical trial methods, (2) integrated SU interventions for ADOL, (3) EMA, (4) advanced statistical approaches, including longitudinal data analysis, and (5) mentoring and leadership skills to combine with her expertise in pediatric psychology, interdisciplinary collaboration in medical settings, and pediatric pain. Training will be guided by a stellar mentorship team with highly relevant expertise and long-standing track records of successful mentorship. The proposed research and training plan is further supported by the rich training environment at the Center for Alcohol and Addiction Studies at Brown University. Through this K23, the PI will obtain specialized training to launch her independent research focused on developing, evaluating, and implementing innovative interventions for adolescent SU and pain in integrated care settings.