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N-Acetylcysteine and Contingency Management for Youth Cannabis Use Disorder

N-乙酰半胱氨酸和青少年大麻使用障碍的应急管理

基本信息

批准号：
10087909
负责人：
Kevin M Gray
金额：
$ 51.32万
依托单位：
MEDICAL UNIVERSITY OF SOUTH CAROLINA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-03-15 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10087909
关键词：
Abstinence Academic achievement Acetylcysteine Achievement Acute Address Adult Adverse effects Aftercare Antioxidants Attention Behavior Therapy Brain Cannabinoids Cannabis Cognition Cognitive Counseling Development Double-Blind Method Evidence based treatment General Population Impaired cognition Integrative Therapy Life Medication Management Memory Modality Outcome Participant Performance Pharmaceutical Preparations Phase Placebos Positioning Attribute Program Development Randomized Research Personnel Role Task Performances Testing Translating Translations Urine Work Youth active method cannabis cessation clinical practice cognitive control cognitive task comparative efficacy contingency management design efficacy outcomes experience improved learning ability marijuana use marijuana use disorder novel strategies overtreatment processing speed response treatment group trial design

项目摘要

Abstract Cannabis use is particularly prevalent and problematic amount youth. Compared with only one in eleven cannabis-exposed adults, one in six cannabis-exposed youth develops cannabis use disorder. Moreover, youth are more prone than adults to potentially lasting adverse effects of cannabis use, including cognitive impairment, altered brain development, poor educational outcome, and diminished life achievement. Despite this, relatively little work has focused on developing optimally efficacious cannabis use disorder treatments, particularly among youth. Current evidence-based treatments convey generally small to modest effect sizes, and novel approaches are critically needed. Among the most promising approaches are the over-the-counter antioxidant medication N-acetylcysteine (NAC) and the behavioral treatment contingency management (CM). Our team previously demonstrated superior NAC versus placebo (PBO) abstinence outcomes in youth with CUD who concurrently received CM. Further work is now needed to disentangle the effects of NAC and CM. It is possible that they are synergistic, with their combination being critical to maximizing abstinence outcomes. Alternatively, NAC may be efficacious independent of CM, but this has not been formally evaluated. In order to optimally translate NAC and CM findings to real-world clinical practice, their relative contributions to cessation outcomes must be formally evaluated. We propose a 12-week 2 x 2 factorial design trial of NAC and CM for CUD in youth (N=336). Participants will be randomized to double-blind NAC or PBO and to CM or no CM, yielding four equally-allocated treatment groups: NAC + CM, NAC + No CM, PBO + CM, and PBO + No CM. All participants will receive brief weekly cannabis cessation counseling and medication management. The primary efficacy outcome will be the proportion of negative urine cannabinoid tests during the 12-week active treatment, compared between groups. We will also serially assess cognitive task performance, examining changes in performance among participants who achieve abstinence versus those that do not. This proposed trial is the clear “next step” in the assessment of NAC and CM as extremely promising youth CUD treatment modalities, and is positioned to inform researchers, clinicians, and the general public, addressing a critical need for optimization of youth CUD treatments.

抽象的吸食大麻在青少年中尤为普遍且成问题。相比之下，只有十一分之一的人接触大麻的成年人中，六分之一的接触大麻的青少年患有大麻使用障碍。而且，青少年比成年人更容易受到大麻使用的潜在持久不利影响，包括认知损伤、大脑发育改变、教育成果不佳以及生活成就下降。尽管相对较少的工作集中在开发最有效的大麻使用障碍治疗方法上，尤其是在年轻人中。目前基于证据的治疗方法通常表现出较小到中等的效果，迫切需要新颖的方法。最有前途的方法之一是非处方药抗氧化剂药物 N-乙酰半胱氨酸 (NAC) 和行为治疗应急管理 (CM)。我们的团队之前证明了 NAC 与安慰剂 (PBO) 相比，在患有以下疾病的青少年中具有更好的戒断效果： CUD 同时接受 CM。现在需要进一步的工作来阐明 NAC 和 CM 的影响。它们可能具有协同作用，它们的组合对于最大限度地提高禁欲效果至关重要。或者，NAC 可能独立于 CM 有效，但这尚未经过正式评估。为了将 NAC 和 CM 研究结果最佳地转化为现实世界的临床实践，以及它们对戒烟的相对贡献必须对结果进行正式评估。我们建议对 NAC 和 CM 进行为期 12 周的 2 x 2 析因设计试验青少年 CUD（N=336）。参与者将被随机分配至双盲 NAC 或 PBO 以及 CM 或无 CM，产生四个均等分配的治疗组：NAC + CM、NAC + 无 CM、PBO + CM 和 PBO + 无 CM。所有参与者将每周接受简短的大麻戒烟咨询和药物管理。这主要疗效结果是在 12 周的活动期间尿液大麻素测试呈阴性的比例治疗、组间比较。我们还将连续评估认知任务表现，检查实现禁欲的参与者与未实现禁欲的参与者的表现变化。这个提议试验是评估 NAC 和 CM 作为极有前途的青少年 CUD 治疗的明确“下一步” 模式，旨在向研究人员、临床医生和公众提供信息，解决关键问题需要优化青少年 CUD 治疗。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Cannabis Use Disorder in Adolescents.

青少年大麻使用障碍。

DOI：
10.1016/j.chc.2022.06.001
发表时间：
2023
期刊：
Child and adolescent psychiatric clinics of North America
影响因子：
2.4
作者：
Hashemi,Daniel;Gray,Kevin
通讯作者：
Gray,Kevin

Methods to reduce the incidence of false negative trial results in substance use treatment research.

减少物质使用治疗研究中假阴性试验结果发生率的方法。

DOI：
10.1016/j.copsyc.2019.01.009
发表时间：
2019
期刊：
Current opinion in psychology
影响因子：
5.9
作者：
Tomko,RachelL;McClure,ErinA;Squeglia,LindsayM;TreloarPadovano,Hayley;McRae-Clark,AimeeL;Baker,NathanielL;Carpenter,MatthewJ;Gray,KevinM
通讯作者：
Gray,KevinM

Impact of cannabis legalization on treatment and research priorities for cannabis use disorder.