Behavioral Treatment of Adolescent Substance Use

Study Overview
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Brief Summary
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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
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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.

Official Title
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Behavioral Treatment of Adolescent Marijuana Use

Conditions
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Substance Use Disorders

Intervention / Treatment
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* Behavioral: Intensive Outpatient Treatment (IOP) + Contingency Management (CM)
* Behavioral: Working Memory Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must be 12 to 26 years of age, must live at home with the parent who will participate, report using marijuana during the previous 30 days or provide a marijuana-positive urine test, meet criteria for cannabis abuse or dependence, and have a parent who can participate. Exclusion Criteria: DSM criteria for dependence (likely to be adjusted for DSM-5 Use Disorder) on alcohol or other drugs other than marijuana (use of or meeting criteria for abuse of other substances will not be an exclusion criterion), active psychosis, severe medical or psychiatric illness limiting participation, or pregnant or breast-feeding.

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intensive Outpatient Treatment (IOP) + Contingency Management (CM) + Working Memory Training (WMT)<br>IOP + CM + WMT | Behavioral: Intensive Outpatient Treatment (IOP) + Contingency Management (CM)<br>* Multiple group sessions weekly, one individual counseling session weekly with teen to review and discuss contingency management abstinence-based incentives<br>Behavioral: Working Memory Training<br>* 25 computer-delivered sessions of neurocognitive training<br>* Other names: Cogmed, Inc;|
| Active Comparator: IOP + CM<br>IOP + CM | Behavioral: Intensive Outpatient Treatment (IOP) + Contingency Management (CM)<br>* Multiple group sessions weekly, one individual counseling session weekly with teen to review and discuss contingency management abstinence-based incentives<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Any Cannabis Abstinence | Number of participants with any cannabis abstinence during treatment | Intervention weeks 1 to 14 | 
| Weeks of Continuous Cannabis Abstinence | Weeks of continuous abstinence during treatment | 14 week treatment period | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Any Days of Cannabis Use | Number of participants with any days of cannabis use during treatment | Intervention weeks 1 to 14 | 
| Days of Cannabis Use | Percent of Days Used During the Treatment Period | The intervention period between Week 1 and Week 14 | 
| Any Cannabis Abstinence Across Four Treatment Strategies | Number of participants who achieved at least one week of abstinence | Treatment period between week 1 and week 14 | 
| Weeks of Cannabis Abstinence Across Four Treatment Strategies | Mean weeks of continuous cannabis abstinence among those who achieved at least one week of abstinence | Treatment period between week 1 and week 14 |