Behavioral Treatment of Adolescent Substance Use (SMART)

Behavioral Treatment of Adolescent Marijuana Use

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.

Study Overview

• Status: Completed
• Conditions: Substance Use Disorders
• Intervention / Treatment: Behavioral: Intensive Outpatient Treatment (IOP) + Contingency Management (CM); Behavioral: Working Memory Training

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.

• Study Type: Interventional
• Enrollment (Actual): 59
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Baltimore, Maryland, United States, 21229
      • Mountain Manor Treatment Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 26 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Dartmouth-Hitchcock Medical Center
• Collaborators: National Institute on Drug Abuse (NIDA); Johns Hopkins University; University of Pennsylvania; Mountain Manor Treatment Center; Spectrum Youth and Family Services
• Investigators: Principal Investigator: Alan J Budney, Ph.D, Dartmouth College

Publications and helpful links

General Publications

• Stanger C, Scherer EA, Vo HT, Babbin SF, Knapp AA, McKay JR, Budney AJ. Working memory training and high magnitude incentives for youth cannabis use: A SMART pilot trial. Psychol Addict Behav. 2020 Feb;34(1):31-39. doi: 10.1037/adb0000480. Epub 2019 Jun 27.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2013
• Primary Completion (Actual): February 1, 2018
• Study Completion (Actual): August 14, 2018

Study Registration Dates

• First Submitted: February 13, 2014
• First Submitted That Met QC Criteria: February 13, 2014
• First Posted (Estimate): February 17, 2014

Study Record Updates

• Last Update Posted (Actual): June 4, 2021
• Last Update Submitted That Met QC Criteria: May 9, 2021
• Last Verified: May 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: DA015186-DartmouthSpectrum; R01DA015186-12A1 (U.S. NIH Grant/Contract)