Behavioral Treatment of Adolescent Substance Use
Condition: Substance Use Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      This study will continue research designed to improve treatment outcomes for adolescent
      substance use disorders by integrating neuroscience- and behaviorally-based treatments. In
      particular, this project will be the first to evaluate whether Working Memory Training can
      enhance cognitive function and reduce impulsive decision making to improve abstinence
      outcomes. In addition, an adaptive abstinence-based incentive program will be evaluated as a
      new method for intervening with those who do not respond to their first-line treatment.
    

Detailed description: 
      The study will test two novel strategies to enhance outcomes. Working Memory Training (WMT),
      an efficacious method for strengthening specific cognitive processes, aims to improve factors
      (e.g., delay discounting / impulsive decision-making) that have shown a strong relation to
      substance use and treatment response. Second, more intensive and higher magnitude CM (ICM)
      will be used to motivate abstinence among teens who are not abstinent by Week 4. The
      investigators hypothesize that these strategies will improve outcomes by modifying a
      fundamental cognitive system involved in making choices to engage in risky behavior and by
      increasing motivation to abstain in early nonresponders. Aim 1 will pilot and refine the new
      procedures in a community clinic in preparation for the randomized trial. A sequential,
      multiple assignment randomized trial (SMART) will allow the study to determine the most
      effective first-line treatment and the most effective adaptive strategy (Aim 2). All teens
      will begin treatment with CM or CM/WMT. After 4 weeks, responders will continue in their
      first-line treatments, while nonresponders will be randomized to ICM or to continue with
      first-line treatment. Aim 3 will conduct mechanistic analyses to assess whether cognitive
      changes related to WMT engender increased abstinence, and whether specific tailoring
      variables moderate treatment effects. Aim 4 will gather formative data on implementation
      factors to inform future large-scale studies and dissemination efforts. Primary hypotheses
      are: (1) first-line treatment with WMT will improve abstinence outcomes and reduce relapse;
      (2) strategies with ICM for nonresponders will result in better outcomes than those without;
      (3) WMT will reduce delay discounting, which will predict outcome. The unique approach holds
      promise for reducing multiple types of risky behaviors by affecting basic mechanisms that
      determine impulsive decision-making.
    

Intervention name(s): Intensive Outpatient Treatment (IOP) + Contingency Management (CM); Working Memory Training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Multiple group sessions weekly, one individual counseling session weekly with teen to review and discuss contingency management abstinence-based incentives; 25 computer-delivered sessions of neurocognitive training
Other intervention name(s): Cogmed, Inc
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment