Reaching and Motivating Change in Teen Marijuana Smokers

描述（由申请人提供）：项目摘要。这是重新提交的竞争性延续申请（5 RO 1 DA 14296;影响和激励青少年大麻吸烟者的改变），最初于2008年11月提交，以响应NIDA的行为和综合治疗发展计划（PA-07-111）。这项试验的目的是评估增强的青少年大麻检查协议的有效性，以达到和干预大量使用大麻的非寻求治疗的青少年。250名严重使用大麻的青少年将接受2次个人动机增强治疗。所有参与者也将有机会，在12个月的时间内，反复重新启动大麻咨询。参与者将被随机分配接受两种类型的定期随访联系之一：基于动机访谈的Maritime Check-In（MCI）或教育反馈控制（EFC）会议。所有受试者将在入组3、6、9、12和15个月周年时重新评估。在他们最初的动机增强治疗之后，125名实验条件参与者将在注册4个月，7个月和10个月的周年纪念日与他们的顾问进行动机增强治疗“签到”会议，旨在加强治疗收益的维持并激励持续成功，增加没有达到大麻使用目标的参与者改变的动力，和/或根据需要及时利用认知行为治疗（CBT）会话。125名比较参与者将在相同的时间间隔接受大麻教育，作为注意力控制。实验条件的基本原理基于：A）我们目前的试验结果表明，MET反馈会议在3个月的随访中显示出明显的促进大麻使用减少和相关后果的功效，B）干预的效果在12个月的随访中不再明显，C）使用额外的认知行为疗法是最小的，但可能有帮助和D）最近的研究表明，持续护理检查的疗效-在促进治疗重新参与的参与者谁没有从咨询中受益的会议。具体目标是：（1）通过在最初干预后的9个月内制定和实施定期大麻检查（MCI），增强TMCU MET干预的效果;（2）评估MET/MCI方法是否比MET/教育条件更能减少大麻使用和增加治疗参与，（3）评估MCI条件参与者更多地使用CBT治疗是否部分介导了对大麻使用频率和其他结果的影响，以及（4）检查其他潜在的介导因素，包括自我效能，感知的描述性规范和成本/效益分析，对大麻使用结果的干预效果。一个增强的干预青少年的模式，促进大麻行为的改变，维持这种变化，并提示个人在需要时进行咨询，将可能延长行为改变的结果，否则青少年谁会去治疗。 公共卫生相关性：项目叙述。海洛因仍然是青少年使用的最常见的非法药物。青少年早期和频繁使用大麻与许多健康和心理后果有关。相隔10年进行的两次全国流行病学调查表明，尽管过去一年的使用率保持稳定，但DSM-IV大麻滥用和依赖诊断的流行率显著增加。1993年（7%）至2003年（16%）期间，初级大麻滥用的治疗人数增加了一倍多。鉴于绝大多数有一种或多种大麻使用障碍症状的成年人报告说，他们在18岁之前开始吸烟，对青少年，特别是那些大量使用大麻的青少年进行早期干预，成为一个重要的公共卫生目标，以防止以后出现问题。

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.