The purpose of the current study was to identify predictors of delay discounting among adolescents receiving treatment for marijuana abuse or dependence, and to test delay discounting as a predictor of treatment outcome. Participants for this study were 165 adolescents (88% male) between the ages of 12 and 18 (M =15.8; SD = 1.3) who enrolled in a clinical trial comparing three behavioral treatments for adolescent marijuana abuse or dependence. Participants completed a delay discounting task at treatment onset for $100 and $1,000 of hypothetical money and marijuana. Overall, smaller magnitude rewards were discounted more than larger magnitude rewards. Delay discounting rates were concurrently related to demographic variables (SES, race). Delay discounting of $1,000 of money predicted during treatment abstinence outcomes among adolescent marijuana abusers, over and above the effects of type of treatment received. Teens who show higher levels of discounting of the future may be an important subgroup to identify at treatment onset. Youth with a greater tendency to discount the future may require different intervention strategies that address their impulsivity (e.g., targeting executive function or inhibitory control) and/or different schedules of reinforcement to address their degree of preference for immediate rewards.

Objective To conduct a randomized test comparing two multicomponent, contingency management interventions, one with and one without a full parent training curriculum, and an individual treatment for adolescent cannabis use disorders. Method 153 adolescents who met DSM-IV criteria for cannabis abuse or dependence were randomized to motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), MET/CBT+abstinence-based contingency management (CM), or MET/CBT+CM+Parent Training (PT). Results Overall, during treatment, abstinence was greater for youth receiving clinic- and home-based CM without PT compared to those who received individual MET/CBT. There was no additional benefit of the full parent training curriculum on marijuana use, youth externalizing problems, or parenting. Conclusion These results suggest that clinic- plus home-based CM for cannabis use disorders can increase rates of abstinence during treatment over and above an evidence-based treatment (individual MET/CBT), but the addition of a comprehensive parenting training curriculum did not further enhance efficacy.

Objective Many adolescents with substance use problems show poor response to evidence based treatments. Treatment outcome has been associated with individual differences in impulsive decision making as reflected by delay discounting (DD) rates (preference for immediate rewards). Adolescents with higher rates of DD were expected to show greater neural activation in brain regions mediating impulsive/habitual behavioral choices and less activation in regions that mediate reflective/executive behavioral choices. Method Thirty adolescents being treated for substance abuse completed a DD task optimized to balance choices of immediate versus delayed rewards and a control condition accounted for activation during magnitude valuation. A group independent component analysis on functional magnetic resonance imaging (fMRI) time courses identified neural networks engaged during DD. Network activity was correlated with individual differences in discounting rate. Results Higher discounting rates were associated with diminished engagement of an executive attention control network involving the dorsolateral prefrontal cortex, dorsomedial prefrontal cortex, inferior parietal cortex, cingulate cortex, and precuneus. Higher discounting rates were also associated with less deactivation in a “bottom up” reward valuation network involving the amygdala, hippocampus, insula, and ventromedial prefrontal cortex. These 2 networks were significantly negatively correlated. Conclusions Results support relations between competing executive and reward valuation neural networks and temporal decision making, an important potentially modifiable risk factor relevant for prevention and treatment of adolescent substance abuse. Clinical trial registration information—The Neuroeconomics of Behavioral Therapies for Adolescent Substance Abuse; http://clinicaltrials.gov/; NCT01093898.

The magnitude of improvements in the frequency of BGM and glycemic control in adolescents with type 1 diabetes is encouraging and will be tested in a randomized controlled trial.

Background Youth with family histories of substance use disorders (FH+) are at increased risk for developing substance use disorders relative to those without such histories (FH−). FH+ individuals show deficits in impulse control that parallel those in individuals with substance use disorders. Elucidating how specific components of impulse control are affected in FH+ pre-adolescents would advance our understanding of how deficits in impulse control relate to risk of substance use disorders. Method A total of 386 children (305 FH+, 81 FH−; ages 10-12) with no histories of regular alcohol or other drug use were compared on measures of delay discounting (Kirby), response inhibition (GoStop Impulsivity Paradigm), and response initiation impulsivity (Immediate Memory Task). The independent associations between these three behavioral measures of impulsivity and FH status were analyzed using logistic regression models. Result FH+ pre-adolescents performed more impulsively on measures of delay discounting and response inhibition impulsivity, but there were no significant group differences on response initiation impulsivity. When the behavioral impulsivity measures were examined simultaneously, delay discounting was most robustly associated with FH status. Conclusions These results identify deficits in impulse control present in FH+ pre-adolescents before the onset of regular substance use, and suggest that increased delay discounting may be an important behavioral phenotype for pre-adolescents at risk for substance use involvement.

A number of studies have associated impulsivity and sensation seeking with level of substance use and risk for developing a substance use disorder. These relationships may be particularly apparent during adolescence, when developmental changes in impulsivity and sensation seeking occur at the same time as increased opportunities for substance use. To examine this, the current study measured impulsivity and sensation seeking from pre-adolescence to mid-adolescence in a sample of youth, the majority of whom were identified as being at risk for developing a substance use disorder based on their family history of substance use disorders. Youth were separated into those who did (n = 117) and did not (n = 269) initiate substance use by mid-adolescence. Results showed that substance users were more impulsive and more sensation seeking during pre-adolescence, prior to any significant substance use, and that greater sensation seeking in pre-adolescence was related to heavier substance use by mid-adolescence. In addition, developmental trajectories for substance-using youth showed a greater increase in sensation seeking but a more modest decrease in impulsivity from pre-adolescence to mid-adolescence. Taken together, these results indicate that increased impulsivity and sensation seeking is apparent in adolescent substance users as early as pre-adolescence, that the difference between substance users and non-users becomes larger across early adolescence as their developmental trajectories diverge, and that greater sensation seeking in pre-adolescence may predict increased substance use by mid-adolescence.

Background Youths with family histories of alcohol and other drug use disorders (FH+) are at increased susceptibility for developing substance use disorders relative to those without such histories (FH−). This vulnerability may be related to impaired adolescent development of impulse control and elevated risk-taking. However, no previous studies have prospectively examined impulse control and risk-taking in FH+ youth across adolescence. Methods A total of 386 pre-adolescents (305 FH+, 81 FH−; ages 10–12) with no histories of regular alcohol or other drug use were compared on behavioral measures of impulsivity including delay discounting, response initiation (Immediate Memory Task), response inhibition impulsivity (GoStop Impulsivity Paradigm), and risk-taking (Balloon Analogue Risk Task-Youth). Youths completed these laboratory tasks every 6 months, allowing for examination of 10–15 year olds. Hierarchical linear modeling was used to characterize the development of impulse control and risk-taking as shown in performance of these tasks throughout adolescence. Results We found that: (1) FH+ youths had increased levels of delay discounting and response inhibition impulsivity at study entry; (2) regardless of FH status, all youths had relatively stable delay discounting across time, improvements in response inhibition and response initiation impulsivity, and increased risk-taking; and (3) although FH+ youths had increased response inhibition impulsivity at pre-adolescence, these differences were negligible by mid-adolescence. Conclusions Heightened delay discounting in FH+ pre-adolescents coupled with normal adolescent increases in risk-taking may contribute to their increased susceptibility towards problem substance use in adolescence.

The purpose of this study was to conduct a randomized test of clinic and home-based incentives plus parent training for adolescent problem alcohol use. Adolescents (N=75) with alcohol misuse, with or without other substance misuse were enrolled. All youth received individual Motivational Enhancement Therapy/Cognitive Behavior Therapy and weekly urine drug testing. The experimental condition (EXP) included Abstinence Incentives (ABI; clinic-based incentives for abstinence from all substances) plus weekly behavioral parent training that included a parent-delivered, abstinence-based, substance monitoring contract. The comparison condition (CONTROL) included Attendance Incentives (ATTI). All adolescents met DSM-IV criteria for alcohol abuse or dependence or reported recent binge drinking, and 77% (N=58) met criteria for a cannabis use disorder or had recent cannabis use at baseline. Alcohol and cannabis use outcomes were compared across treatment conditions. A similar percentage of youth maintained complete alcohol abstinence across the 36-week follow up in both conditions. However, among youth not entirely abstinent from alcohol, EXP resulted in a lower percentage of days using alcohol during the 36 weeks after the end of treatment than CONTROL. Among youth who also used cannabis at baseline, results showed similar benefits of EXP on cannabis use days. Combined individual and family based treatment, plus abstinence based incentives can reduce substance use days during and after treatment over and above individual evidence-based psychosocial treatment plus attendance incentives. Future research should focus on identifying cost-effective components and incentive levels and delivery via technology to facilitate dissemination.