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

项目摘要/摘要 背景资料。青少年大麻使用障碍(CUD)干预显示出好坏参半的效果， 强调了改善治疗的必要性。确定治疗主持人(即个体差异)，如 以及导致行为改变的机制，可以增加治疗成功率。几乎所有的证据- 基于心理社会干预利用社会学习理论(SLT)的各个方面，包括社会、行为、 和认知因素。在治疗的背景下，SLT的一个研究不足的方面是结果预期， 已知会影响大麻的使用和主观效果。研究表明，结果是 期望值可以作为治疗结果的调节器和中介器；然而，细粒度 方法尚未阐明它们在青少年CUD干预中的作用。明确的目标。这是F32 支持综合研究和培训目标，将生态瞬时评估(EMA)应用于 检查SLT因素，例如结果预期，如何调节青少年CUD治疗结果 并与行为改变的机制有关。方法：研究方法。提议的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 66例，年龄15~24岁。这项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)托吡酯是否影响更大的变化 相对于安慰剂，在整个治疗过程中的主观效果和预期，以及3)基线 期望值可能会缓和托吡酯对主观效果和大麻使用量的影响。长- 学期目标。这项研究计划提供了一个指导培训的机会，以确定主持人 青少年CUD治疗中的行为改变机制及清洁分析高级训练 复杂的均线数据。选定的辅导团队包括青少年CUD治疗领域的专家， 行为改变研究、临床试验研究和EMA数据收集和分析的机制。 此外，培训环境还包括国际公认的物质依赖研究。 中心和全国领先的儿童精神病院。通过此F32获得的培训将提供 促进向独立临床科学家过渡的必要经验。此外，它还 将利用EMA数据来研究社会、认知和行为个体差异对 青春期CUD治疗，从而支持未来的赠款申请。因此，这一F32有助于NIDA的研究 确定与物质使用障碍有关的心理社会因素的优先事项。

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.