Improving Decision Making to Prevent Substance Misuse among Adolescents from Traditionally Underserved Communities

幼儿期逆境与参与有问题的物质使用的重大风险有关， 寿命生活在低收入社区的青少年更有可能经历不利的 儿童期事件和不太可能获得循证预防性药物使用干预措施。 因此，迫切需要确定能够有效防止吸毒升级的干预措施 在弱势青年中开展宣传，并在资源匮乏、传统上得不到充分服务的社区切实传播。延迟 贴现已出现在文献中作为一个关键的病因学标记的物质使用的风险和潜在的 从早年生活不利到酗酒和吸毒的途径。高延迟折扣是 以选择立即可获得的奖励的夸张倾向为特点。更高（更多） 青少年时期的延迟折扣率与更严重和更频繁的 物质使用，并预测酒精，大麻和烟草使用的急剧上升。工作 记忆是一种存储和处理决策信息的能力，它与延迟密切相关 贴现和一个合理的神经认知机制，将早期不利的环境与问题联系起来， 折扣倾向和随后的物质使用。在实验治疗学框架的指导下， 我们自己的研究小组和其他人最近的研究结果表明，利用基于计算机的 工作记忆训练计划，以改善中年人的折扣。计算机辅助培训 这些方案可能特别适合在资源匮乏的社区为高危青少年实施。 具体来说，青春期是工作记忆和延迟折扣发展的关键时期， 并且在这个生命阶段针对工作记忆的干预已经证明了有利的临床结果。 此外，计算机化干预措施需要有限的工作人员和空间资源，使其既可行， 在传统上服务不足的社区中可扩展。基于调查小组的有希望的发现， 形成性研究，这项申请提出试点基于计算机的工作记忆干预， 在密歇根州底特律的低资源社区，青少年暴露于早期生活逆境。主要目标 包括确定初步的可行性、可接受性和适当性， 在社区环境中进行计算机化工作记忆干预，为低收入青少年提供服务 进行小规模的第一阶段随机对照试验，以检查这种干预的有效性， 降低延迟折扣率。这种干预对青少年变化的后续影响 作为一项探索性目标，还将对三个月随访期内的药物使用情况进行审查。拟议 研究将提供有价值的洞察力的效用，针对特定的途径，从早期的逆境， 并将建立一个模式，在资源匮乏的地区传播干预措施， 社区.这项研究的结果也将为未来的大规模（R01）预防研究奠定基础。

Early childhood adversity is associated with significant risk for engaging in problematic substance use across the lifespan. Adolescents living in low-income neighborhoods are both more likely to experience adverse childhood events and less likely to have access to evidence-based preventative substance use interventions. Thus, there is a critical need to identify interventions that can effectively prevent the escalation of substance use in vulnerable youth and be feasibly disseminated in low-resource, traditionally underserved communities. Delay discounting has emerged in the literature as a critical etiological marker of substance use risk and a potential pathway from early life disadvantage to problematic alcohol and drug use. Elevated delay discounting is characterized by an exaggerated tendency to select rewards that are immediately available. Higher (more problematic) rates of delay discounting during adolescence are associated with more severe and frequent substance use and are predictive of steeper escalations in alcohol, marijuana and tobacco use. Working memory, the capacity to store and manipulate information utilized in decision making, is closely linked to delay discounting and a plausible neurocognitive mechanism linking early adverse environments to problematic discounting tendencies and subsequent substance use. Guided by an experimental therapeutics framework, recent findings from our own research team and others suggests the efficacy of utilizing a computer-based working memory training program to improve discounting among mid-life adults. Computer-based training programs may be particularly suitable to implement in low-resource communities for at-risk adolescents. Specifically, adolescence is a critical period for the development of both working memory and delay discounting, and interventions targeting working memory during this life stage have evidenced favorable clinical results. Further, computerized interventions require limited staff and space resources, making them both feasible and scalable in traditionally underserved communities. Building on promising findings from the investigator team’s formative research, this application proposes to pilot a computer-based working memory intervention among adolescents exposed to early life adversity in the low-resource community of Detroit, Michigan. Primary aims include establishing the preliminary feasibility, acceptability and appropriateness of delivering a computerized working memory intervention in a community setting serving low-income adolescents as well as conducting a small-scale Stage I randomized control trial to examine the effectiveness of this intervention in reducing rates of delay discounting. The subsequent impact of this intervention on changes in adolescent substance use over a three-month follow-up period will also be examined as an exploratory aim. The proposed research will provide valuable insight into the utility of targeting a specific pathway from early adversity to later substance use during adolescence and will establish a model for disseminating interventions in low-resource communities. Results of this study will also set the stage for future large-scale (R01) prevention research.