Significant consequences associated with cannabis abuse have been identified, and rates of enrollment into treatment for adolescent substance abuse with cannabis as the primary substance continue to rise. Family- based and individual interventions show efficacy, yet, rates of sustained abstinence are low, and the majority fails to reduce substance use substantially. This renewal application proposes to extend our focus on developing efficacious treatments for teen substance use disorders. An initial Stage I project showed that an intervention comprising behavioral therapy (BT), contingency management via clinic- and parent-delivered abstinence incentives (CM), and behavioral parent training (BPT) improved abstinence rates during and post treatment. Findings from a Stage 2 trial indicate that (1) the intervention has a positive effect on abstinence, and (2) BPT does not enhance outcomes above that achieved with BT/CM. Although both studies indicate enhanced outcomes, a considerable proportion of teens did not achieve a substantial period of abstinence and relapse was common. Importantly, we observed that if teens achieved abstinence, this almost always occurred by Week 6. The goal of this proposal is to further develop this intervention to increase rates of abstinence and decrease relapse rates. We 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 6. We 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 us to determine the most effective first-line treatment and the most effective adaptive strategy (Aim 2). All teens wil begin treatment with BT/CM or BT/CM/WMT. After 6 weeks, responders will continue in their first-line treatments, while nonresponders will be randomized to ICM or to continue with first- lin 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.

Public Health Relevance

This renewal proposal will continue with 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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA015186-13
Application #
8675812
Study Section
Risk, Prevention and Intervention for Addictions Study Section (RPIA)
Program Officer
Chambers, Jessica Campbell
Project Start
2002-05-01
Project End
2018-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
13
Fiscal Year
2014
Total Cost
$586,302
Indirect Cost
$162,720
Name
Dartmouth College
Department
Psychiatry
Type
Schools of Medicine
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Babbin, Steven F; Stanger, Catherine; Scherer, Emily A et al. (2016) Identifying treatment response subgroups for adolescent cannabis use. Addict Behav 59:72-9
Stanger, Catherine; Lansing, Amy Hughes; Budney, Alan J (2016) Advances in Research on Contingency Management for Adolescent Substance Use. Child Adolesc Psychiatr Clin N Am 25:645-59
Lee, Dustin C; Stanger, Catherine; Budney, Alan J (2015) A comparison of delay discounting in adolescents and adults in treatment for cannabis use disorders. Exp Clin Psychopharmacol 23:130-7
Stanger, Catherine; Ryan, Stacy R; Scherer, Emily A et al. (2015) Clinic- and home-based contingency management plus parent training for adolescent cannabis use disorders. J Am Acad Child Adolesc Psychiatry 54:445-53.e2
Budney, Alan J; Sargent, James D; Lee, Dustin C (2015) Vaping cannabis (marijuana): parallel concerns to e-cigs? Addiction 110:1699-704
Stanger, Catherine; Elton, Amanda; Ryan, Stacy R et al. (2013) Neuroeconomics and adolescent substance abuse: individual differences in neural networks and delay discounting. J Am Acad Child Adolesc Psychiatry 52:747-755.e6
Stanger, Catherine; Budney, Alan J; Bickel, Warren K (2013) A developmental perspective on neuroeconomic mechanisms of contingency management. Psychol Addict Behav 27:403-15
Ryan, Stacy R; Stanger, Catherine; Thostenson, Jeff et al. (2013) The impact of disruptive behavior disorder on substance use treatment outcome in adolescents. J Subst Abuse Treat 44:506-14
Flórez-Salamanca, Ludwing; Secades-Villa, Roberto; Budney, Alan J et al. (2013) Probability and predictors of cannabis use disorders relapse: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 132:127-33
Brown, Pamela C; Budney, Alan J; Thostenson, Jeff D et al. (2013) Initiation of abstinence in adolescents treated for marijuana use disorders. J Subst Abuse Treat 44:384-90

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