Computerized Intervention for Teen Substance Abuse

(CARS Trial)

Overseen By Austin M Hahn, Ph.D.

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Medical University of South Carolina

Disqualifiers: None

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 1 week

52 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new computerized treatment for teens dealing with alcohol and cannabis use. It tests whether a computer task called the modified Approach-Avoidance Task (mAAT) can change automatic reactions to these substances. Participants will divide into two groups: one will receive the actual treatment, and the other will engage in a similar but inactive task for comparison. Teens aged 13-17 who have used both alcohol and cannabis in the last three months and are seeking treatment can participate, provided they have a caregiver who agrees to be involved. Follow-up checks will occur at one and three months after the treatment. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could shape future treatments.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this computerized intervention is safe for teen substance abuse treatment?

Research shows that the modified Approach-Avoidance Task (mAAT) helps change automatic reactions to substances like alcohol and cannabis. Studies have examined how this training affects emotions and social relationships. Although these studies focus on effectiveness, they report no major safety issues. The absence of negative effects suggests that the treatment is generally safe.

This trial is labeled as "Not Applicable" for its phase, indicating a focus on understanding and measuring results rather than testing safety. This usually means the treatment has proven safe in other settings or similar trials. Therefore, participants can feel reasonably confident about the safety of the mAAT treatment. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the modified Approach-Avoidance Task (mAAT) for teen substance abuse because it offers a unique way to address automatic approach biases, which are subconscious tendencies that might contribute to substance use. Unlike traditional methods, such as counseling or medication, that address conscious decision-making or chemical imbalances, the mAAT targets these underlying biases directly. This technique uses computerized tasks to retrain the brain's automatic responses, potentially leading to more effective and lasting behavior change. By focusing on these deep-seated patterns, the mAAT aims to provide a new avenue for intervention that could complement existing treatments.

What evidence suggests that this trial's treatments could be effective for teen substance abuse?

Research has shown that the modified Approach-Avoidance Task (mAAT) might help reduce substance use in teens. In this trial, participants in Group A will receive the mAAT designed to modify automatic approach bias. Studies have found that this can change automatic habits leading to alcohol or cannabis use. One study showed that this version of the mAAT successfully altered these automatic behaviors, potentially helping teens avoid substances. These early results suggest that the mAAT could be a promising tool for teens who want to reduce drinking or cannabis use. Meanwhile, participants in Group B will receive a version of the mAAT that does not aim to modify automatic approach bias, serving as a control. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for young people aged 13-17 who are looking for help with alcohol or cannabis use and have used both in the past three months. They must be willing to seek treatment and have a caregiver who can consent to their participation. Pregnant or breastfeeding individuals cannot join.

Inclusion Criteria

Patients must be seeking treatment for either cannabis or alcohol use

I am between 13 and 17 years old.

Patients must report co-occurring alcohol and cannabis use during the past three months

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive a computerized intervention for reducing cannabis and alcohol use

1 week

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Follow-up assessments at one- and three-months

What Are the Treatments Tested in This Trial?

Interventions

• modified Approach-Avoidance Task (mAAT) that does not aim to modify automatic approach bias.
• modified Approach-Avoidance Task (mAAT), which aims to modify automatic approach bias

Trial Overview The study tests a computerized task called modified Approach-Avoidance Task (mAAT) designed to change automatic tendencies towards substance use. Participants will either receive mAAT that aims to modify this bias or one that does not, assessing its effectiveness over time.

How Is the Trial Designed?

Group I: Group A: Treatment Group Experimental Treatment 1 Intervention

Group II: Group B: Control Group Placebo Group 1 Intervention

Who Is Running the Clinical Trial?

Medical University of South Carolina

Lead Sponsor

Trials

994

Recruited

7,408,000+

National Institute on Drug Abuse (NIDA)

Collaborator

Trials

2,658

Recruited

3,409,000+

Published Research Related to This Trial

In a study involving 105 adult smokers, adding Approach-Avoidance Modification Training (AAMT) to standard treatment did not lead to a significant reduction in daily cigarette consumption compared to a sham training group.

The study found no consistent evidence that AAMT changed biases in information processing related to smoking, suggesting that future research should explore improved training methods for better outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Approach-avoidance modification as an add-on in smoking cessation: A randomized-controlled study. Wittekind, CE., Reibert, E., Takano, K., et al.[2020]

Heavy cannabis users show a significant approach-bias towards cannabis-related images, indicating a tendency to seek out drug-related stimuli compared to non-users.

This approach-bias is predictive of increased cannabis use over a six-month period, suggesting it could be a useful indicator for identifying individuals at risk of escalating their cannabis consumption.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reaching out towards cannabis: approach-bias in heavy cannabis users predicts changes in cannabis use. Cousijn, J., Goudriaan, AE., Wiers, RW.[2021]

Cognitive Bias Modification through Approach Avoidance Training (CAAT) showed a trend towards reducing cannabis approach bias in a study of 41 cannabis-using youth, suggesting potential for altering automatic responses to drug cues.

While CAAT-training was associated with decreased activation in brain areas like the amygdala and medial prefrontal cortex in response to cannabis cues, it did not significantly change neural reactivity compared to a sham training, indicating the need for further research on the neural mechanisms involved.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Preliminary evidence that computerized approach avoidance training is not associated with changes in fMRI cannabis cue reactivity in non-treatment-seeking adolescent cannabis users. Karoly, HC., Schacht, JP., Jacobus, J., et al.[2020]

The study aims to evaluate the feasibility and acceptability of 'SWIPE,' a personalized and gamified smartphone app designed to help individuals with hazardous drinking habits reduce their alcohol consumption through approach bias modification (ABM).

By recruiting 500 participants who wish to reduce their drinking, the study will assess changes in alcohol consumption and cravings over four weeks, potentially providing a convenient and accessible intervention for those who may not seek traditional treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Personalized Approach Bias Modification Smartphone App ("SWIPE") to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study. Manning, V., Piercy, H., Garfield, JBB., et al.[2020]

A pilot study involving 1082 participants using a mobile app for alcohol avoidance training showed a significant reduction in alcohol consumption, with an average decrease of 7.8 units per week after 3 weeks and an additional reduction of 6.2 units at 3 months.

The app was well-received, with 79% of participants completing the recommended sessions and positive feedback on its user-friendly design, indicating that mobile cognitive bias modification could be a promising tool for helping individuals reduce alcohol use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Alcohol Avoidance Training as a Mobile App for Problem Drinkers: Longitudinal Feasibility Study. Laurens, MC., Pieterse, ME., Brusse-Keizer, M., et al.[2021]

Motivational Interviewing is an effective, person-centered approach that helps individuals explore their ambivalence and activate their motivation for making positive lifestyle changes, particularly in managing conditions like diabetes and obesity.

The technique has been adapted for use in pediatric settings, addressing the unique challenges of engaging families with children at different developmental stages, showing its versatility across age groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Christie, D., Channon, S.[2022]

This study will compare the effectiveness of a standard comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention for adults seeking outpatient addiction treatment, involving 150 participants (75 in each group).

The trial aims to assess whether the MI approach can improve client engagement in treatment, as well as its feasibility and sustainability within addiction treatment programs, potentially reducing the high attrition rates seen during initial intakes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol. Hurlocker, MC., Moyers, TB., Hatch, M., et al.[2023]

Motivational Enhancement Therapy (MET), which incorporates Motivational Interviewing (MI), has been shown to effectively help adolescents consider and maintain changes to reduce harmful behaviors, such as smoking.

The structured approach of MET, which includes personalized feedback and follow-up, makes it a suitable brief intervention for adolescents, enhancing the likelihood of positive treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A motivational intervention for adolescent smokers. Lawendowski, LA.[2022]

Motivational interviewing (MI) is a client-centered counseling approach that aims to promote behavior change, particularly in areas like diet and physical activity, and has its origins in addiction treatment.

While MI shows promise in helping patients make lifestyle changes, research results are mixed, indicating a need for further investigation into its implementation and effectiveness across different patient populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of motivational interviewing to improve chronic condition self-management: what does the research show us? Coyne, N., Correnti, D.[2019]

Motivational interviewing (MI) showed some effectiveness in reducing the number of cigarettes smoked per day among adolescents, with significant decreases reported at the 1-month follow-up, although overall abstinence rates were low and did not differ significantly from brief advice (BA).

MI was effective in changing adolescents' perceptions of peer and adult smoking norms, which could be beneficial for future smoking interventions, but it did not lead to higher motivation or self-efficacy to quit smoking compared to BA.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial. Colby, SM., Nargiso, J., Tevyaw, TO., et al.[2022]

Citations

1. sciencedirect.com sciencedirect.com/science/article/pii/S2451865425000092

Approach Bias Modification for reducing Co-Occurring ... This protocol paper describes a NIDA-funded randomized control trial (RCT) to evaluate an integrated mobile ApBM intervention to target co-occurring alcohol ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6635134/

PMC CBM interventions such as Approach Avoidance Training (AAT) are designed to alter automatic tendencies to approach drugs or drug-related cues.

3. withpower.com withpower.com/trial/computerized-intervention-for-teen-substance-abuse-3e7cf

Computerized Intervention for Teen Substance Abuse (CARS Trial) Trial Overview The study tests a computerized task called modified Approach-Avoidance Task (mAAT) designed to change automatic tendencies towards substance use.

4. researchgate.net researchgate.net/publication/388394418_Approach_Bias_Modification_for_Reducing_Co-Occurring_Alcohol_and_Cannabis_Use_among_Treatment-Seeking_Adolescents_Protocol_of_a_Randomized_Controlled_Trial

Approach Bias Modification for Reducing Co-Occurring ... Developing and testing interventions that target both alcohol and cannabis use during adolescence are vital to decreasing costly consequences.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6053264/

A Multi-Site Proof-of-Concept Investigation ... This pilot study aimed to test Approach Avoidance Training to reduce cannabis use with non-treatment seeking adolescents.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6299832/

Implicit Alcohol Approach and Avoidance Tendencies ... Faster alcohol approach was associated with greater overall drinking at outcome, and faster alcohol avoidance predicted fewer drinking days per week at outcome.

7. sciencedirect.com sciencedirect.com/science/article/pii/S0165032722014136

Randomized controlled trial of computerized approach ... We evaluated the effects of an approach avoidance training procedure on positive emotions, social relationship outcomes, clinical symptoms, and neural indices.

8. frontiersin.org frontiersin.org/journals/behavioral-neuroscience/articles/10.3389/fnbeh.2022.1098343/full

Adolescent alcohol exposure alters threat avoidance in ... Adolescent binge-like alcohol exposure impairs cognitive function and decision making in adulthood and may be associated with dysfunction of threat avoidance.

9. researchgate.net researchgate.net/publication/337999370_A_personalized_approach-avoidance_modification_intervention_to_reduce_negative_body_image_A_placebo-controlled_pilot_study

A personalized approach-avoidance modification ... Results: The experimental training procedure did not show an effect on self-reported body satisfaction or drive for thinness after one session, four sessions, ...