Mindfulness for at Risk Youth: Understanding Substance Use and Important Mechanisms of Change
Condition: Alcohol Use, Underage; Alcohol Problem Drinking; Substance Use
MeSH terms: Substance-Related Disorders; Alcohol-Related Disorders; Alcoholism; Underage Drinking
Study type: Interventional

Summary: 
      This study will be the first to explore mindfulness as a prevention intervention among
      transition age youth and those with previous involvement in the juvenile or criminal justice
      system with substance use problems and history of exposure to violence/trauma. The study will
      focus on preventing escalation of substance use (e.g., alcohol and marijuana), trauma
      symptoms, and recidivism by using an intervention to target self-regulation and executive
      functioning.

      Justice involved youth have higher rates of alcohol use and related consequences and higher
      rates of exposure to violence (Post Traumatic Stress Disorder) compared to their non-justice
      involved peers. Prior research has found aspects of self-regulation (emotion regulation,
      impulse control), stress, and craving to be important putative targets in reducing alcohol
      use. With high rates of recidivism and increased risk of long term problems associated with
      substance use, it is imperative to test interventions that can reach at risk youth and target
      both alcohol use and important psychological and neurocognitive self-regulation mechanisms.

      This study tests whether the use of Mindfulness-Based Relapse Prevention (MBRP) for at risk
      young adults results in changes in important self-regulation mechanisms and improved alcohol
      use outcomes. Individuals assigned to the experimental group will receive interventions
      normally provided at a community clinic and eight 1.5-hour group sessions of MBRP. Sessions
      will occur once per week. Each session will target a specific theme such as being aware of
      personal triggers, maintaining present focus, allowing or letting things be, responding to
      emotional and physical experiences in skillful ways, and recognizing intrusive thoughts.
      Further, each session will incorporate a mindfulness meditation technique.

      The central hypothesis will be tested through a focus on three specific aims: (1) Beta pilot
      testing and refining MBRP based on feedback from focus groups, (2) testing the efficacy of
      MBRP on substance use outcomes compared to an active control, and (3) assessing mechanisms of
      change for MBRP including self-regulation and neurocognitive facets such as working memory
      and inhibition.
    

Detailed description: 
      The long-term goal of this proposal is to improve alcohol use outcomes by targeting emotion
      regulation (ER), impulsivity (IMP), and executive functioning (EF) constructs among racially
      and ethnically diverse (primarily Hispanic and Black) at risk young adults. With a similar
      population, the investigators pilot tested a novel Mindfulness-Based Intervention (MBI),
      Mindfulness-Based Substance Abuse Treatment for Adolescents (MBRP) with with marginalized
      young adults. Findings from adolescent samples have found support for the intervention's
      effect on problem behaviors, decision making, and self-esteem. However, extent research in
      this area has not assessed substance use or self-regulation. In a sample of marginalized
      young adults receiving treatment at a residential treatment facility, MBRP was found to
      significantly decrease stress and substance use outcomes. In addition, only one study has
      investigated the effect of a MBI on neurocognitive functioning with justice-involved youth.
      Unfortunately, this was not a clinical intervention and did not assess EF as a mechanism of
      change. The current study proposes to recruit 70-80 young adults (aged 18-26) referred to one
      clinic in Los Angeles, CA. The study site has a wide range of referral sources ranging from
      self-referral to referrals from the justice system.

      Some young adults are referred to treatment by schools in lieu of engaging law enforcement or
      in lieu of expulsion, with many being self-referred.

      Participants will be randomly assigned to receive MBRP or attention control (CTL).
      Participants will engage in both self-report and task-based ER, IMP, and EF measures pre- and
      post-intervention. Participants will be followed for 3 months post-intervention to assess
      effects on alcohol use and behavioral health outcomes, and putative mechanisms of change.

      The central hypothesis is that MBRP, compared to CTL, will prompt change in ER, IMP, and EF.
      Further, it is hypothesized that these changes will be associated with better alcohol use
      outcomes 3 months post-intervention. The rationale for using a MBI with marginalized youth is
      that prior research has shown significantly worse self-regulation compared to community
      youth, and MBRP is specifically designed to aid in regulating emotions, decision making, and
      attention control. The unique strengths of this proposal are its use of an MBI; focus on a
      disadvantaged population of diverse racial and ethnic groups; focus on putative targets
      essential to behavioral health outcomes; and use of multiple neurocognitive tasks addressing
      important self-regulation components. The study objective is to test following three aims:

      Specific Aim 1: Determine feasibility and acceptability of abbreviated MBRP. An adapted MBRP
      protocol will be beta-tested with 15 transition age youth/young adults. Focus groups will be
      conducted to evaluate the feasibility and acceptability of an intervention focused on
      enhancing self-regulation, refine content based on feedback, and addressing issues that might
      affect the successful completion of pilot testing in Aim 2.

      Specific Aim 2: Pilot test MBRP intervention on putative targets by randomly assigning young
      adults who screen for past-month alcohol use/problems to MBRP or CTL. Determine the effect of
      the program on secondary outcomes of interest and putative targets for ER, IMP, and EF.

      Specific Aim 3: Assess MBRP mechanisms by exploring whether effects of the intervention on
      our substance use outcomes can be partially explained by changes in target mechanisms: ER,
      IMP, and EF.
    

Intervention name(s): Mindfulness Based Relapse Prevention; Control (CTL)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Individuals assigned to the experimental group will receive interventions normally provided at the clinic and eight 1.5-hour group sessions of MBRP. Each sessions will occur once per week and will target a specific theme such as being aware of personal triggers, maintaining present focus, allowing or letting things be, responding to emotional and physical experiences in skillful ways, and recognizing intrusive thoughts. Each session will incorporate a mindfulness meditation technique (e.g.,SOBER breathing space and "urge surfing"). Participants will receive materials (e.g., recordings) with which to perform practices and meditation during the intervention phase.; Individuals assigned to the CTL group will receive interventions provided at the clinic and up to eight CTL sessions. The CTL group will receive information (reading) and videos once per week on health behaviors (e.g., exercise, eating) and the neurobiology of addiction. This approach will reduce the possibility that intervention effects are solely due to the experimental group's receiving extra attention. In contrast to the active intervention, sessions will be educational in nature, with no motivational, cognitive, or behavioral components
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Trauma; Delinquency; Substance Use; Emotion Regulation; Impulsivity; Executive Functioning