Reaching and Motivating Change in Teen Marijuana Smokers

描述（由申请人提供）：项目概述。这是2008年11月为响应NIDA的行为和综合治疗发展项目（PA-07-111）而提交的竞争性延续申请（5 RO1 DA14296；青少年大麻吸烟者的影响和激励变化）的重新提交。本试验的目的是评估一种增强的青少年大麻检查方案的有效性，以达到和干预非治疗寻求严重使用大麻的青少年。250名重度吸食大麻的青少年将接受两期的个人动机增强治疗。所有参与者还将有机会在12个月的时间里反复重新开始大麻咨询。参与者将被随机分配接受两种定期随访联系中的一种：基于动机访谈的大麻检查（MCI）或教育反馈控制（EFC）会议。所有参与者将在入组3、6、9、12和15个月纪念日进行重新评估。在他们最初的动机增强治疗之后，125名实验条件的参与者将在入组的4、7和10个月纪念日与他们的辅导员进行动机增强治疗的“登记”会议，旨在加强治疗成果的维持和激励持续的成功，增加没有达到大麻使用目标的参与者改变的动机。和/或根据需要及时使用认知行为治疗（CBT）。125名对照参与者将在相同的时间间隔内接受大麻教育，以作为注意力控制。实验条件的基本原理是：A)我们目前的试验结果表明，在3个月的随访中，MET反馈会议在促进减少大麻使用和相关后果方面表现出明显的效果；B)在12个月的随访中，干预的效果不再明显；C)额外的认知行为疗法的使用很少，但可能有帮助，D)最近的研究表明，持续的护理检查会议在促使未能从咨询中受益的参与者重新接受治疗方面是有效的。具体目标是：(1)在初始干预后的9个月内，通过制定和实施定期大麻检查（MCI）来增强TMCU MET干预的效果；(2)评估MET/MCI方法是否比MET/教育条件下更能减少大麻使用和提高治疗参与度；(3)评估MCI条件下参与者对CBT治疗的更多利用是否部分介导了大麻使用频率和其他结果的影响；(4)检查其他潜在的中介，包括自我效能、感知描述性规范和成本/收益分析。干预对大麻使用结果的影响。干预青少年促进大麻行为改变的增强模型，维持这种改变，并促使个人在需要时进行咨询，可能会延长青少年的行为改变结果，否则他们将得不到治疗。

DESCRIPTION (provided by applicant): Project Summary. This is a resubmission of a competing continuation application (5 RO1 DA14296;Reaching and Motivating Change in Teen Marijuana Smokers) originally submitted November 2008 in response to NIDA's Behavioral and Integrative Treatment Development Program (PA-07-111). The goal of this trial is to evaluate the efficacy of an enhanced Teen Marijuana Check-Up protocol to reach and intervene with non- treatment seeking adolescents who use marijuana heavily. Two hundred fifty adolescents who use marijuana heavily will receive a 2-session individual motivational enhancement therapy. All participants will also be offered the opportunity, over a 12-month period, to repeatedly reinitiate marijuana counseling. Participants will be randomly assigned to receive one of two types of periodic follow-up contacts: Motivational interviewing- based Marijuana Check-Ins (MCI) or Educational Feedback Control (EFC) sessions. All participants will be reassessed at the 3, 6, 9, 12, and 15-month anniversaries of enrollment. Following their initial motivational enhancement therapy, the 125 experimental condition participants will additionally have a motivational enhancement treatment "check-in" session with their counselor at the 4, 7, and 10-month anniversaries of enrollment intended to reinforce the maintenance of treatment gains and motivate continued success, increase motivation to change for participants who did not meet their marijuana use goals, and/or prompt utilization of cognitive-behavioral treatment (CBT) sessions as needed. The 125 comparison participants will receive marijuana education at the same time intervals to serve as an attentional control. The experimental condition's rationale is based on: A) findings from our current trial that demonstrated MET feedback sessions showed clear efficacy in fostering reductions in marijuana use and associated consequences at a 3-month follow-up, B) the effects of the intervention were no longer evident at a 12-month follow-up, C) utilization of additional cognitive behavior therapy was minimal but potentially helpful and D) recent research demonstrating the efficacy of continuing care check-up sessions in prompting treatment reengagement by participants who failed to benefit from counseling. The specific aims are: (1) to enhance the effects of the TMCU MET intervention by developing and implementing periodic marijuana check-ins (MCI) over a 9-month period following the initial intervention; (2) to assess whether the MET/MCI approach results in greater reductions in marijuana use and increased treatment engagement than an MET/Educational condition, (3) to assess whether greater utilization of the CBT therapy sessions by MCI condition participants partially mediates the effect on frequency of marijuana use and other outcomes, and (4) to examine other potential mediators, including self-efficacy, perceived descriptive norms, and cost/benefit analyses, of the effect of the intervention on marijuana use outcomes. An enhanced model of intervening with adolescents that promotes marijuana behavior change, the maintenance of such change and prompts the individual to engage in counseling when needed, will likely extend behavior change outcomes in adolescents who would otherwise go untreated. PUBLIC HEALTH RELEVANCE: Project Narrative. Marijuana continues to be the most common illicit drug used by adolescents. Early and frequent marijuana use in adolescence is associated with a host of health and psychological consequences. Two national epidemiological surveys conducted 10 years apart indicate that the prevalence of DSM-IV marijuana abuse and dependence diagnoses has significantly increased despite rates of past year use having remained stable. Treatment admissions for primary marijuana abuse have more than doubled between 1993 (7%) and 2003 (16%). Given that the great majority of adults with one or more marijuana use disorder symptoms report they began smoking before age 18, early intervention efforts with adolescents, particularly those who are using heavily, becomes an important public health objective in order to prevent later problems.