Behavioral Treatment of Adolescent Substance Use

Behavioral Treatment of Adolescent Marijuana Use


Lead Sponsor: Dartmouth-Hitchcock Medical Center

Collaborator: National Institute on Drug Abuse (NIDA)
Mountain Manor Treatment Center
University of Pennsylvania
Johns Hopkins University
Spectrum Youth and Family Services

Source Dartmouth-Hitchcock Medical Center
Brief 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.

Overall Status Completed
Start Date 2013-11-01
Completion Date 2018-08-14
Primary Completion Date 2018-02-01
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
Any Cannabis Abstinence Intervention weeks 1 to 14
Weeks of Continuous Cannabis Abstinence 14 week treatment period
Secondary Outcome
Measure Time Frame
Any Days of Cannabis Use Intervention weeks 1 to 14
Days of Cannabis Use The intervention period between Week 1 and Week 14
Any Cannabis Abstinence Across Four Treatment Strategies Treatment period between week 1 and week 14
Weeks of Cannabis Abstinence Across Four Treatment Strategies Treatment period between week 1 and week 14
Enrollment 59

Intervention Type: Behavioral

Intervention Name: Intensive Outpatient Treatment (IOP) + Contingency Management (CM)

Description: Multiple group sessions weekly, one individual counseling session weekly with teen to review and discuss contingency management abstinence-based incentives

Intervention Type: Behavioral

Intervention Name: Working Memory Training

Description: 25 computer-delivered sessions of neurocognitive training

Arm Group Label: Intensive Outpatient Treatment (IOP) + Contingency Management (CM) + Working Memory Training (WMT)

Other Name: Cogmed, Inc



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.



Minimum Age:

12 Years

Maximum Age:

26 Years

Healthy Volunteers:


Overall Official
Last Name Role Affiliation
Alan J Budney, Ph.D Principal Investigator Dartmouth College
Facility: Mountain Manor Treatment Center
Location Countries

United States

Verification Date


Responsible Party

Type: Principal Investigator

Investigator Affiliation: Dartmouth-Hitchcock Medical Center

Investigator Full Name: Alan J. Budney

Investigator Title: Professor

Has Expanded Access No
Condition Browse
Number Of Arms 2
Arm Group

Label: Intensive Outpatient Treatment (IOP) + Contingency Management (CM) + Working Memory Training (WMT)

Type: Experimental

Description: IOP + CM + WMT

Label: IOP + CM

Type: Active Comparator

Description: IOP + CM

Acronym SMART
Study Design Info

Allocation: Randomized

Intervention Model: Parallel Assignment

Primary Purpose: Treatment

Masking: None (Open Label)

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