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

儿童早期的逆境与从事有问题物质使用的重大风险有关 生命的长短。生活在低收入社区的青少年更有可能经历不利的环境 儿童事件和不太可能获得循证的预防性物质使用干预。 因此，迫切需要确定能够有效防止物质使用升级的干预措施。 在弱势青年中传播，并在低资源、传统上服务不足的社区传播是可行的。延迟 折扣已经在文献中作为药物使用风险的关键病因标记和潜在的 从早年的生活劣势到有问题的酒精和药物使用。提升延迟折扣是 以选择立即可用的奖励的夸张倾向为特征的。更高(更多 问题)青春期延迟打折的比率与更严重和更频繁相关 并预示着酒精、大麻和烟草使用的急剧上升。劳作 记忆，即存储和处理决策过程中使用的信息的能力，与延误密切相关 贴现和将早期不利环境与问题联系起来的貌似合理的神经认知机制 打折倾向和随后的物质使用。在实验治疗学框架的指导下， 我们自己的研究团队和其他人的最新发现表明，利用基于计算机的 工作记忆培训计划，以提高中年成年人的折扣。基于计算机的培训 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。 具体地说，青春期是工作记忆和延迟折扣发展的关键时期， 在这个生命阶段，针对工作记忆的干预措施已经证明了良好的临床效果。 此外，计算机化的干预需要有限的工作人员和空间资源，使其既可行又可行。 在传统上服务不足的社区中可扩展。建立在调查团队的有希望的发现的基础上 形成性研究，这项申请建议试点一种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，暴露在早期生活逆境中的青少年。主要目标 包括确定初步可行性、可接受性和适当性 也为低收入青少年服务的社区环境中的计算机化工作记忆干预 因为进行了一项小规模的第一阶段随机对照试验，以检查这项干预的有效性 在降低延迟贴现率方面。这项干预对青少年变化的后续影响 三个月随访期内的物质使用情况也将作为一项探索性目标进行审查。建议数 研究将为从早期逆境到后来的特定路径提供有价值的洞察力 在青春期使用药物，并将建立在低资源地区传播干预措施的模式 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.