Cognitive Training in Adolescents during Treatment for Substance Use Disorders

描述（由申请人提供）：青少年物质使用障碍（SUD）是一个重大的疾病负担和社会成本。SUD青少年在多个认知领域表现出障碍。除了可能影响学校表现和发育里程碑外，认知障碍还可能影响参与SUD治疗并从中受益的能力。鉴于神经成熟在青春期继续，青少年可能更容易受到药物的神经认知后遗症的影响，但也可能更容易对认知训练做出反应。然而，据我们所知，认知训练尚未在青少年SUD中进行过测试。提出的理论驱动的认知训练干预（工作记忆训练）的目标是工作记忆（WM），并已被证明可以提高WM技能差和ADHD的青少年的WM容量，并转移到其他认知领域，这在训练研究中很少观察到。WM是一个关键的 认知功能，其核心组成部分是“中央执行”（执行功能的集合），并且是执行其他功能的必要构建块。支持提高SUD治疗结果的潜力，WM培训减少了SUD成年人的饮酒和延迟折扣（预测青少年大麻使用者SUD结果的冲动性指标）。在这项随机对照研究中，在Mountain Manor治疗中心接受治疗的以大麻为主要滥用物质的SUD青少年将被分配到一个进行计算机化WM训练（TRAIN）的实验组或一个进行不挑战WM（CON）的计算机化程序控制版本的积极对照组。30次会议的干预将分层到标准的强化门诊治疗。在培训前后将进行一系列最先进的认知评估，SUD治疗结局指标将作为次要结局纳入。具体目标1是检验TRAIN将在训练过程中改善训练的工作记忆任务的假设。具体目标2是检验以下假设：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培训的认知任务方面显示出更大的改善。（次要）是检验TRAIN将显示药物使用和相关心理社会功能障碍减少以及治疗参与增加的假设，学术科学家和基于社区的治疗计划之间的合作是创新的，是开发和测试这种分层到标准SUD治疗的新干预的理想选择，其目标是在现实世界中实施/传播。除了在这一关键发育时期改善认知功能的广泛影响外，建立训练对认知功能的影响是系统研究训练对功能性SUD治疗和学业成绩结果影响的第一步。机械方法也将提高对学习能力和特定认知过程的可塑性的科学理解。

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.