Developing a mobile-health intervention to reduce problematic alcohol use in young adults with ADHD

项目摘要/摘要 拟议中的K23的PI特雷西·肯尼迪博士是一名临床科学家，他的长期目标是领导一个项目 开发和测试干预措施以减少弱势青少年中有问题的酒精使用的研究 人们，特别是患有注意力缺陷/多动障碍(ADHD)的年轻人。有问题的酒精使用 在年轻人(18-25岁)中，艾滋病具有严重的个人和社会后果，但大多数人得不到治疗。 ADHD显著增加了风险，并限制了现有治疗的有效性。抑制性控制是关键 ADHD和有问题的酒精使用背后的跨诊断和可改变的风险因素。这个K23项目 旨在开发和测试一种新的、可访问的移动健康(MHealth)的可行性和初步效果 以即时抑制控制为目标的干预措施，以减少青少年中有问题的饮酒 多动症。短信将提示使用行为策略，以在整个过程中增强抑制控制 白天和高危时刻。为了激励行为策略的使用，生态瞬时评估(EMA) ADHD症状和个性化的自适应反馈将提高对抑制性控制缺陷的自我意识。 目标1是开发可行的、可接受的行为策略提示。首先，将制定战略内容 在一项正在进行的试点研究(研究1a)中，对患有ADHD的年轻成年饮酒者进行了亚样本(n=10)。下一首, 将在新的试点样本中(n=16)改进战略提示内容以及交付时间和频率 患有ADHD的成年人，每周饮用4/5饮料/场合(女性/男性)(即大量饮酒者) 来自关键利益攸关方小组的意见(研究1b)。目标2是审查该方案的可行性和可接受性 对患有ADHD的重度饮酒者(N=70)进行的结果干预，一半随机分配到 干预和酒精监测控制条件的一半为3周(研究2)。被动的用法 将探索智能手机的抑制控制指数(例如，屏幕解锁率)，以告知未来 个性化。目标3是测试初步干预效果，包括酒精之间的动态交易 使用、抑制性控制和生命损伤。这一创新、可扩展的干预措施满足了以下关键需求 帮助患有ADHD的年轻人遏制有问题的饮酒行为。结果将导致未来的全能疗效 审判。拟议的研究和培训(教学、会议、导师指导的培训)将使PI具备 开启酒精干预领域独立研究事业的必备技能：瞬间能力 饮酒捕获；专注于mHealth的干预科学专业知识；以及对抑制的深入了解 控制力。Sarah Pedersen博士(导师)，瞬时饮酒过程、EMA和抑制控制方面的专家，以及 布鲁克·莫利纳博士(共同导师)，干预科学专家，重点关注ADHD和成瘾，将指导 私家侦探的培训和研究。一个顾问团队将补充培训(统计分析、酒精 移动健康干预措施的制定和评估，以及被动感知)。这个K23有直接的公共卫生 影响和解决了NIAAA在开发针对共病条件的酒精治疗方面的优先事项。

PROJECT SUMMARY/ABSTRACT Dr. Traci Kennedy, PI of the proposed K23, is a clinical scientist whose long-term goal is to lead a program of research on developing and testing interventions to reduce problematic alcohol use among vulnerable young people, especially young adults with Attention Deficit/Hyperactivity Disorder (ADHD). Problematic alcohol use among young adults (ages 18-25) has severe individual and societal consequences, yet most go untreated. ADHD significantly elevates risk and limits the effectiveness of existing treatments. Inhibitory control is a key transdiagnostic and modifiable risk factor underlying both ADHD and problematic alcohol use. This K23 project aims to develop and test the feasibility and preliminary efficacy of a novel, accessible mobile-health (mHealth) intervention that targets in-the-moment inhibitory control to reduce problematic drinking among young adults with ADHD. Text messages will prompt the use of behavioral strategies to enhance inhibitory control throughout the day and in high-risk moments. To motivate behavioral strategy use, ecological momentary assessment (EMA) of ADHD symptoms and personalized, adaptive feedback will boost self-awareness of inhibitory control deficits. Aim 1 is to develop feasible and acceptable behavioral strategy prompts. First, strategy content will be developed in a subsample (n=10) of young adult drinkers with ADHD from an in-progress pilot study (Study 1a). Next, strategy prompt content and delivery timing and frequency will be refined in a new pilot sample (n=16) of young adults with ADHD who consume 4+/5+ drinks/occasion (female/male) weekly (i.e., heavy episodic drinkers) with input from a panel of key stakeholders (Study 1b). Aim 2 is to examine the feasibility and acceptability of the resulting intervention among heavy episodic drinkers (N=70) with ADHD, half randomly assigned to the intervention and half to an alcohol monitoring control condition for 3 weeks (Study 2). The utility of passively sensed smartphone indices of inhibitory control (e.g., screen unlock rate) will be explored to inform future personalization. Aim 3 is to test preliminary intervention effects, including dynamic transactions among alcohol use, inhibitory control, and life impairments. This innovative, scalable intervention addresses a critical need to help young adults with ADHD curb problematic alcohol use. Outcomes will lead to a future fully-powered efficacy trial. The proposed research and training (didactics, conferences, mentor-directed training) will equip the PI with the requisite skills to launch an independent research career in alcohol interventions: competence in momentary drinking capture; expertise in intervention science focused on mHealth; and in-depth knowledge of inhibitory control. Dr. Sarah Pedersen (mentor), expert in momentary drinking processes, EMA, and inhibitory control, and Dr. Brooke Molina (co-mentor), expert in intervention science with emphasis on ADHD and addictions, will guide the PI’s training and research. A team of consultants will complement training (statistical analysis, alcohol mHealth interventions development and evaluation, and passive sensing). This K23 has direct public health implications and addresses NIAAA priorities on developing alcohol treatments for comorbid conditions.