Development and Efficacy Test of Computerized Treatment for Marijuana Dependence

描述(申请人提供)：美国居民对大麻的依赖比对任何其他非法药物的依赖都要多，登记接受大麻治疗的人数持续增加，现在与可卡因和海洛因的治疗人数相当。这项申请旨在推进我们的总体目标，即开发和传播成本效益高的大麻依赖治疗方法，以解决这一日益严重的问题。我们之前的研究表明，包含动机增强、认知行为和应急管理组件(MET/CBT/CM)的干预比之前证明的更能产生更高的成功率和持久的结果。然而，必须面对与其效力和最终传播有关的三个问题。首先，所取得的结果只能说是温和的；许多人对治疗没有反应，复发率仍然存在问题。其次，受过培训的提供者的可获得性受到限制。第三，提供治疗的成本比更传统的门诊干预更高。为解决这些问题，具体目标1是开发和测试MET/CBT/CM的计算机辅助版本。计算机化治疗有可能通过增加有效治疗的可获得性和可获得性，以及通过应用创新技术来改善结果，从而提高治疗服务的整体效力。在第一年，将开发干预措施并进行试点测试。在我们之前的阿片类药物依赖试验中显示出希望的互动计划将被修改和增强，以使用有效的计算机学习技术提供个性化的MET/CBT/CM。这些技术以及在治疗期间和治疗结束后通过互联网提供的MET/CBT/CM方案有可能促进更好的学习和更多地使用应对技能，这反过来又可以改善结果。在2-4年期间，一项随机试验将通过与简单治疗(MET)和治疗师提供的MET/CBT/CM进行比较，提供cMET/CBT/CM的初步疗效测试。具体目标2是通过关注先前试验中检查的两种假定的作用机制：自我效能/应对技能和冲动/延迟折扣，更多地了解MET/CBT/CM等行为治疗是如何起作用的。实验设计将提供一个独特的机会，在一个新的背景下探索这样的机制--治疗师是还是不是治疗的重要部分。拟议的项目将通过提供关于技术辅助治疗的研究来实现NIDA的行为和综合治疗发展计划的目标，该技术辅助治疗试图使治疗提供更简单、更容易获得和更低成本--同时保持或提高其有效性。调查结果将为未来的研究提供信息，这些研究旨在完善这项技术及其应用；进行更明确的有效性测试；测试对包括青少年在内的其他人群的普遍性；并进一步推动社区环境的翻译。

DESCRIPTION (provided by applicant): More US residents are dependent on marijuana than on any other illicit drug, and the number enrolled in treatment for marijuana continues to increase such that it is now comparable to that for cocaine and heroin. This application seeks to advance our overarching goal to develop and disseminate cost-effective treatments for marijuana dependence that can address this growing problem. Our previous research suggests that an intervention comprising motivational enhancement, cognitive-behavioral, and contingency-management components (MET/CBT/CM) produces greater rates of successful and durable outcomes than has been demonstrated previously. However, three issues relevant to its efficacy and eventual dissemination must be confronted. First, the outcomes achieved can only be characterized as modest; many individuals do not respond to the treatment and relapse rates remain problematic. Second, access is limited by the availability of trained providers. Third, the cost of delivering the treatment is higher than more traditional outpatient interventions. To address these issues, Specific Aim 1 is to develop and test a computer-assisted version of MET/CBT/CM. Computerized treatments have the potential to increase overall effectiveness of treatment services by increasing availability of and access to potent treatments, and by applying innovative technology to enhance outcomes. During Year 1, the intervention will be developed and pilot tested. An interactive program that showed promise in our previous trial for opioid dependence will be modified and enhanced to deliver individualized MET/CBT/CM using effective computer learning technologies. These technologies and access to the MET/CBT/CM program made available via the Internet between treatment sessions and after treatment ends have the potential to promote better learning and more use of coping skills, which in turn can improve outcomes. During Years 2-4 a randomized trial will provide an initial efficacy test of cMET/CBT/CM by comparing it with a brief treatment (MET) and with therapist-delivered MET/CBT/CM. Specific Aim 2 is to learn more about how behavioral treatments like MET/CBT/CM work by focusing on two putative mechanisms of action examined in prior trials: self-efficacy/coping skills and impulsivity/delay discounting. The experimental design will provide a unique opportunity to explore such mechanisms in a novel context- where the therapist is vs. is not a prominent part of the treatment. The proposed project will address the objectives of NIDA's Behavioral and Integrative Treatment Development Program by providing research on technology-assisted treatment that attempts to make treatment delivery less complex, easier to access, and less costly - while retaining or improving its effectiveness. Findings will inform future studies designed to refine the technology and how it is applied; conduct more definitive effectiveness testing; test generality to other populations including adolescents; and to further advance translation to community settings.