Identifying Treatment Effects, Mechanisms, and Moderators in Youth Cannabis Use Treatment Using Ecological Momentary Assessment

项目总结/摘要 背景青少年大麻使用障碍（CUD）干预措施的效果好坏参半， 强调需要改善治疗。识别治疗调节器（即，个体差异），如 以及导致行为改变的机制，可以增加治疗的成功率。几乎所有的证据- 基于心理社会干预的杠杆社会学习理论（ESTA）的方面，包括社会，行为， 和认知因素。在治疗的背景下，一个未充分研究的方面是结果预期， 这是众所周知的影响大麻的使用和主观效果。研究表明， 期望值可以作为治疗结果的调节剂和调解剂;然而， 方法尚未阐明其在青少年CUD干预中的作用。具体目标。F32 支持综合研究和培训目标，应用生态瞬时评估（EMA）， 检查干扰因素，例如，结果预期，可能会缓和青少年CUD治疗结果 与行为改变的机制有关。方法.拟议项目将使用现有数据集 来自一项检查药物治疗（托吡酯）和心理社会干预效果的临床试验 （动机增强和认知行为疗法），相对于安慰剂和心理社会干预 （N = 66，年龄15-24）。拟议的研究旨在了解1）结果预期和 相应的主观效应在治疗过程中发生变化，2）如果托吡酯影响更大的变化， 在整个治疗过程中，相对于安慰剂的主观效应和预期，以及3）基线 预期可能缓和托吡酯对主观效应和大麻使用量的影响。长- 长期目标。本研究计划提供了一个机会，指导培训，以确定温和的 青少年CUD治疗的行为改变机制以及清洁和分析方面的高级培训 复杂EMA数据。选定的指导团队包括青少年CUD治疗领域的专家， 行为改变机制研究、临床试验研究和EMA数据收集与分析。 此外，培训环境包括国际公认的药物依赖研究 中心和全国领先的儿童精神病医院。通过F32获得的培训将提供 必要的经验，以促进过渡到成为一个独立的临床科学家。而且 将利用EMA数据研究社会，认知和行为个体差异对 青少年CUD治疗，从而支持未来的赠款申请。因此，F32有助于NIDA的研究 确定与物质使用障碍有关的社会心理因素的优先事项。

PROJECT SUMMARY/ABSTRACT BACKGROUND. Adolescent cannabis use disorder (CUD) interventions have demonstrated mixed efficacy, underscoring the need for improved treatment. Identifying treatment moderators (i.e., individual differences), as well as the mechanisms leading to behavior change, can increase treatment success. Virtually all evidence- based psychosocial interventions leverage aspects of social learning theory (SLT), including social, behavioral, and cognitive factors. One understudied aspect of SLT in the context of treatment is outcome expectancies, which are known to influence cannabis use and subjective effects. Research has suggested that outcome expectancies can serve as moderators and mediators of treatment outcomes; however, fine-grained approaches have yet to elucidate their role in adolescent CUD interventions. SPECIFIC AIMS. This F32 supports integrated research and training aims for applying ecological momentary assessment (EMA) to examine how SLT factors, e.g., outcome expectancies, may moderate adolescent CUD treatment outcomes and relate to mechanisms of behavior change. METHODS. The proposed project will use an existing dataset from a clinical trial examining the effects of pharmacotherapy (topiramate) and psychosocial intervention (motivational enhancement and cognitive behavioral therapy), relative to placebo and psychosocial intervention (N = 66, ages 15-24). The proposed study aims to understand 1) how outcome expectancies and corresponding subjective effects shift over the course of treatment, 2) if topiramate influences greater changes in subjective effects and expectancies throughout treatment, relative to placebo, and 3) how baseline expectancies may moderate topiramate’s effects on subjective effects and quantity of cannabis used. LONG- TERM GOAL. This research plan provides an opportunity for mentored training in identifying moderated mechanisms of behavior change for youth CUD treatments and advanced training in cleaning and analyzing complex EMA data. The selected mentorship team includes experts in the fields of adolescent CUD treatment, mechanisms of behavior change research, clinical trials research, and EMA data collection and analysis. Moreover, the training environment includes an internationally recognized substance dependence research center and a nationally leading child psychiatric hospital. Training gained through this F32 will provide necessary experiences to facilitate the transition to becoming an independent clinical scientist. Additionally, it will leverage EMA data to research the influence of social, cognitive, and behavioral individual differences on adolescent CUD treatment, thus supporting future grant applications. Thus, this F32 aids in NIDA’s research priorities of identifying psychosocial factors implicated in substance use disorders.