Leveraging Ecological Momentary Assessment to Examine Peer Affiliations as a Mechanism of Behavior Change in Youth Alcohol Use Treatment

项目总结/摘要 背景酒精使用（Au）和滥用，包括酒精使用障碍（AUD）的发作， 青春期和成年期。尽管Au在年轻人中产生了不利影响， 对于物质使用障碍的发展和与酒精有关的死亡风险增加， 对AUD的心理社会干预在青年人中只产生适度的短期效益。一种改进的方法 治疗AUD和减少与青年相关的公共卫生负担Au是为了推进我们的 了解干预措施如何发挥作用。几乎所有基于证据的心理社会干预都强调 从饮酒的同龄人转向不饮酒的同龄人，因为青年Au主要发生在 的同龄人，并与Au使用同龄人隶属始终与复发的风险增加， 治疗效果更差。迄今为止，AUD治疗研究在很大程度上忽视了 青少年和新兴的成年人，这是特别令人关切的，因为未能考虑的中心地位， 青少年Au干预中的同伴关系导致减少，并且在某些情况下导致医源性影响。 具体目标。据我们所知，F32支持了第一项使用生态瞬时 评估（EMA），以检查在整个过程中，每日饮酒水平是否从使用酒精的同龄人转移到不使用酒精的同龄人 AUD治疗导致饮酒减少，并确定何时发生这些变化。方法.使用 一项临床试验的现有数据集，检查药物（托吡酯）和动机的影响， 与安慰剂+MET-CBT相比，使用EMA的MET-CBT（N =82;年龄14-24岁），该项目将研究1）青少年饮酒的时间， 在托吡酯和安慰剂条件下，从干预前到干预后的非使用同伴，2）托吡酯是否 通过减弱酒精存在下与同龄人之间的关系， 和随后的Au，以及3）是否使用较低水平的酒精，导致衰减的关系 在使用酒精的同龄人和随后的托吡酯条件下的Au之间，反过来， 导致更多的时间花在不喝酒的同龄人身上。长期目标。该研究计划提供了 有机会接受指导培训，以确定青少年AUD治疗的行为改变机制， 收集和分析复杂EMA数据的高级培训。已确定的指导团队包括 青少年成瘾治疗、行为改变研究机制、临床试验等领域的专家 研究和EMA数据收集和分析。并被安置在国际公认的临床和 成瘾研究中心目前的F32项目将促进向研究的成功过渡 独立性，并将支持未来的拨款申请，调查社会和生物学如何 流程影响AUD治疗，利用EMA设计。因此，F32有助于NIAAA的研究重点 确定药物治疗的作用机制和减少青年Au。

PROJECT SUMMARY/ABSTRACT BACKGROUND. Alcohol use (AU) and misuse, including the onset of alcohol use disorder (AUD), peak during adolescence and emerging adulthood. Despite the adverse effects of AU among youth, such as increased risk for the development of substance use disorders and increased risk of alcohol-related deaths, the best available psychosocial interventions for AUD yield only modest short term benefits among youth. One way to improve treatments for AUD and reduce the public health burden associated with youth AU is to advance our understanding of how interventions work. Virtually all evidence-based psychosocial interventions emphasize shifting from alcohol using peers to non-using peers because youth AU predominantly occurs in the presence of peers, and affiliating with AU using peers is consistently associated with increased risk for relapse and worse treatment outcomes. To date, AUD treatment research has largely neglected the peer context of adolescents and emerging adults and this is particularly concerning because failure to consider the centrality of peer relationships in adolescent AU interventions leads to diminished and, in some cases, iatrogenic effects. SPECIFIC AIMS. This F32 supports the first study, to our knowledge, to use ecological momentary assessment (EMA) to examine whether daily level shifts from alcohol using to non-using peers over the course of AUD treatment leads to reductions in drinking and identify when these shifts occur. METHODS. Using an existing data set of a clinical trial examining the effects of medication (topiramate) and motivational enhancement and cognitive behavioral therapies (MET-CBT) relative to placebo plus MET-CBT using EMA (N =82; ages 14-24 years), the project will examine 1) the amount of time youth spend with alcohol-using and non-using peers from pre to post intervention in topiramate and placebo conditions, 2) whether topiramate leads to reductions in AU by attenuating the relationship between being in the presence of alcohol using peers and subsequent AU, and 3) whether lower levels of alcohol use, resulting from the attenuated relationship between being in the presence of alcohol-using peers and subsequent AU in the topiramate condition, in turn, leads to greater time spent with non-alcohol using peers. LONG-TERM GOAL. This research plan provides the opportunity for mentored training in identifying mechanisms of behavior change for youth AUD treatments and advanced training in collecting and analyzing complex EMA data. The identified mentorship team includes experts in the fields of adolescent addiction treatment, mechanisms of behavior change research, clinical trials research, and EMA data collection and analysis., and is housed in internationally recognized clinical and addiction research centers. The current F32 project will facilitate a successful transition to research independence and will support future grant applications that will investigate how social and biological processes impact AUD treatment leveraging EMA designs. Thus, this F32 aids the NIAAA's research priorities of identifying mechanisms of action for pharmacotherapy and reducing youth AU.