Cognitive Training in Adolescents during Treatment for Substance Use Disorders

描述(由申请人提供)：青少年中的物质使用障碍(SUD)是一种严重的发病率负担和社会成本。患有SUD的青少年表现出各种认知领域的损害。认知障碍除了可能影响学习成绩和发展里程碑外，还可能影响参与和受益于SUD治疗的能力。鉴于神经成熟在青春期持续，青少年可能更容易受到药物的神经认知后遗症的影响，但也可能在接受认知训练时更具可塑性。然而，据我们所知，认知训练还没有在患有SUD的青少年中进行测试。理论驱动的认知训练干预(工作记忆训练)以工作记忆(WM)为目标，已被证明可以增加WM技能较差的青少年和ADHD的工作记忆能力，并转移到其他认知领域，这在训练研究中很少观察到。WM是一位批评者 认知功能，其核心组成部分是“中央执行”(一组执行功能)，是执行其他功能的必要构件。西医培训支持了改善SUD治疗结果的潜力，减少了饮酒和延迟折扣(冲动性指标，预测青少年吸食大麻者的SUD结果)。在这项随机对照研究中，在山庄治疗中心接受治疗的以大麻为主要滥用物质的SUD青少年将被分配到执行计算机化WM训练(TRAIN)的试验组或执行不挑战WM(CON)的计算机化程序的控制版的积极控制组。30个疗程的干预将在标准的强化门诊治疗的基础上进行。将在培训前后进行一系列最先进的认知评估，并将SUD治疗结果测量作为次要结果。具体目标1是检验这样一种假设，即训练会在训练过程中改善训练后的工作记忆任务。具体目标2是检验这样一种假设，即相对于CON，TRAIN将在与药物使用/SUD治疗结果和学校表现相关的未经训练的认知任务上表现出更大的改善。具体目标3(次要)是检验这样一种假设，即与CON相比，TRAIN将显示出药物使用和相关的心理社会功能损害的减少，而治疗参与度的增加。学术科学家和以社区为基础的治疗计划之间的合作是创新的，是开发和测试这种置于标准SUD治疗之上的新型干预措施的理想选择，目标是在现实世界中实施/传播。除了在这一关键发育阶段改善认知功能的广泛意义外，建立训练对认知功能的影响是系统研究训练对功能性SUD治疗和学习成绩结果影响的第一步。机械论方法还将加强对特定认知过程的学习能力和延展性的科学理解，以应对培训。

DESCRIPTION (provided by applicant): Substance use disorders (SUD) in adolescents represent a significant burden of morbidity and cost to society. Adolescents with SUD exhibit impairment in a variety of cognitive domains. In addition to potentially affecting school performance and developmental milestones, cognitive impairment may affect the ability to participate in and benefit from SUD treatment. Given that neuromaturation continues during adolescence, adolescents may be more vulnerable to the neurocognitive sequelae of drugs but may also be more malleable in response to cognitive training. However, to our knowledge, cognitive training has not been tested in adolescents with SUD. The proposed theoretically driven cognitive training intervention (Working Memory Training) targets working memory (WM), and has been shown to increase WM capacity in youth with poor WM skills and ADHD, and to transfer to other cognitive domains, which is rarely observed in training studies. WM is a critical cognitive function whose core component is the 'central executive' (set of executive functions), and is a necessary building block for the performance of other functions. Supporting the potential to enhance SUD treatment outcomes, WM Training reduced drinking and decreased delay discounting (measure of impulsivity that predicts SUD outcomes in adolescent marijuana users) in adults with SUD. In this randomized controlled study, SUD adolescents with marijuana as the primary substance of abuse being treated at Mountain Manor Treatment Center will be assigned to an experimental group who perform computerized WM Training (TRAIN) or an active control group who perform a control version of the computerized program that does not challenge WM (CON). The 30-session intervention will be layered onto standard intensive outpatient treatment. A battery of state-of-the-art cognitive assessments will be administered before and after training, and SUD treatment outcome measures will be included as secondary outcomes. Specific Aim 1 is to test the hypothesis that TRAIN will improve on the trained working memory tasks across training sessions. Specific Aim 2 is to test the hypothesis that TRAIN will show greater improvement on non-trained cognitive tasks relevant to drug use/SUD treatment outcomes and school performance, relative to CON. Specific Aim 3 (secondary) is to test the hypothesis that TRAIN will show decreases in drug use and associated psychosocial functional impairment, and increased treatment engagement, relative to CON. The collaboration between an academic scientist and a community-based treatment program is innovative and ideal for developing and testing this novel intervention layered onto standard SUD treatment, with the goal of real-world implementation/dissemination. In addition to the broad implications of improved cognitive function during this critical developmental period, establishing the effects of training on cognitive functions is the first step in the systematic study of training effects on functional SUD treatment and academic achievement outcomes. The mechanistic approach will also enhance scientific understanding of learning capacity and malleability of specific cognitive processes in response to training.