Experimental Mediation Research Aimed at Enhancing Adolescent Substance Abuse Treatment

旨在加强青少年药物滥用治疗的实验性调解研究

• 批准号: 10198880
• 负责人: Michael R McCart
• 金额: $ 70.08万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198880
• 关键词: Address; Adolescent; Ambulatory Care Facilities; Behavioral; Child Rearing; Client; Complex; Coupled; Effectiveness; Etiology; Evidence based practice; Family; Goals; Intervention; Light; Measures; Mediating; Mediation; Mediator of activation protein; Methods; Modernization; Outcome; Outcome Measure; Outpatients; Parents; Problem behavior; Process; Public Health; Randomized; Regulation; Relapse; Research; Research Personnel; Specific qualifier value; Substance Use Disorder; Testing; Work; Youth; adolescent substance abuse; adolescent substance use; aged; base; common treatment; contingency management; cost; design; deviant peer; high risk; improved; improved outcome; informant; longitudinal analysis; peer; skills; substance abuse treatment; substance use treatment; success; treatment effect

PROJECT SUMMARY/ABSTRACT Adolescents with substance use disorders (SUD) are at high risk for significant deleterious outcomes. Although several evidence-based practices for adolescent SUD exist, they yield only small to medium effects that rapidly diminish (30-70% 6-month relapse rates). A promising approach for determining how to enhance treatment is experimental mediation research. In contrast to traditional correlational mediation approaches, experimental mediation permits causal inference and is comprised of key steps: (A) Identify the putative mediating variable for a treatment. (B) Enhance the treatment to target that mediator more intensely. (C) Randomize youth to conditions, with the standard and enhanced versions of the treatment targeting different “levels” of the same mediator. (D) Measure the mediator and outcomes longitudinally. (E) Perform modern mediation analyses, coupled with analyses evaluating causal inference, to determine if changes in the mediator are responsible for changes in outcomes. This experimental test of mediation, focused on causality, facilitates rapid improvement of treatments by specifying change mechanisms to target in order to improve outcomes. These steps will be followed to elucidate the mediating processes in treatment for adolescent SUD, with the ultimate goal of enhancing the strength and durability of SUD treatments. The three most common putative mediating variables in adolescent SUD treatments are parent management, behavioral regulation, and peer relations. For this study, parent management was chosen as the target because it has evidenced the most potential for yielding generalizable change in youth outcomes and also has been shown to indirectly improve youths’ behavioral regulation and peer relations. Of existing treatments for adolescent SUD, family-based Contingency Management (CM) was chosen as the treatment to enhance because it is highly amenable to an augmented focus on parenting, is less complex relative to other SUD treatments, and has amassed considerable support in terms of efficacy and dissemination potential. Thus, following experimental mediation steps, youth with SUD will be randomized to receive either standard CM or enhanced CM (i.e., CM+) that targets parenting more intensely. Repeated assessments for 12 months and longitudinal analyses will allow testing of mediating processes. We will examine whether parent management skills mediate the effect of treatment on youth substance use and behavior problems (Aim 1). In addition, we will determine whether parent management skills mediate the effect of treatment on youth behavioral regulation and deviant peer relations (Aim 2). Finally, we will test whether behavioral regulation and deviant peer relations mediate the effect of parent management on youth substance use and behavior problems (Aim 3). Findings could have broad impact across multiple adolescent SUD treatments.

项目摘要/摘要 患有药物使用障碍的青少年（SUD）有大量有害结果的高风险。 尽管存在几种基于循证的SUD的循证实践，但它们仅产生小到中等 迅速降低的影响（30-70％的6个月缓解率）。一种有希望的方法来确定如何 为了增强治疗是实验调解研究。与传统的相关性相反 调解方法，实验调解允许因果推理，并由关键步骤组成： （a）确定用于治疗的假定介导变量。 （b）增强对目标的治疗 调解器更加强烈。 （c）将年轻人随机以标准版本和增强版本的条件 针对同一调解人的不同“水平”的治疗。 （d）测量调解人和结果 纵向。 （e）进行现代调解分析，并与评估因果关系进行分析 推论，确定调解员的变化是否负责结果的变化。这 调解的实验测试，侧重于偶然性，促进了通过 为目标指定变更机制以改善结果。这些步骤将遵循 阐明青少年SUD治疗中的介导过程，其最终目标是增强 SUD治疗的强度和耐用性。三个最常见的假定中介变量 青少年的SUD治疗是父母管理，行为调节和同伴关系。为了这 研究，选择了父母管理作为目标，因为它证明了最大的潜力 在青年成果上产生可普遍的变化，并且已被证明可以间接改善青年 行为调节和同伴关系。基于家庭的青少年SUD的现有治疗方法 选择应急管理（CM）作为增强的治疗方法，因为它非常适合 增强对育儿的关注，相对于其他SUD治疗而言，不那么复杂，并且已经积累了 在效率和传播潜力方面的大量支持。在实验之后 调解步骤，具有SUD的青年将被随机接收标准的商业或增强商业（即 CM+）更诚实地针对育儿。重复评估12个月和纵向 分析将允许测试中介过程。我们将检查父母管理技能是否 调解治疗对青年物质使用和行为问题的影响（AIM 1）。另外，我们 将确定父母管理技能是否介导治疗对青年行为的影响 监管和异常同行关系（AIM 2）。最后，我们将测试行为法规和 异常的同伴关系调解父母管理对青年物质使用和行为的影响 问题（目标3）。发现可能会在多种青少年的SUD治疗中产生广泛的影响。