Mechanisms of behavior change in adolescent substance use treatment: A systematic review of treatment mediators and recommendations for advancing future research.

Abstract

Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines. Public Health Significance StatementThe current study offers some support for self-regulatory and treatment engagement and adherence mediators of adolescent substance use treatment, however, heterogeneity in the sample of studies precludes any firm conclusions. A concerted effort to examine key processes of evidence-based adolescent substance use treatments can yield enhanced knowledge to guide practice, as well as intervention refinement and implementation within the community.

Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research

“…This critical review briefly details the major challenges to mechanism research in addiction science. Given other recent reviews (e.g., Meisel et al., 2022; Witkiewitz et al., 2022), we will not reiterate the evidence for and against specific mechanisms. Rather, to advance research on behavior change and identify viable next steps in elucidating how efficacious interventions yield beneficial effects, we offer an etiologically informed precision medicine approach to study behavior change in AUD treatment.…”

“…Prior reviews of studies examining why AUD interventions result in behavior change note that most studies examined mediators rather than mechanisms (Magill et al, 2020;Meisel et al, 2022).…”

“…Criteria for establishing a mechanism are (1) strong associations, (2) specificity in the association between a behavior change ingredient and a mechanism and the associations between the mechanism and outcome(s) of interest (i.e., a and b paths, respectively, in Figures 1 and 2), (3) a gradient (i.e., dose response), (4) temporal relations (i.e., intervention affects the mechanism, which affects the outcomes), (5) consistency, or replication, of associations, (6) experimental designs, and (7) plausibility and coherence of the proposed mechanism (Hill, 1965; Kazdin & Nock, 2003). Prior reviews of studies examining why AUD interventions result in behavior change note that most studies examined mediators rather than mechanisms (Magill et al., 2020; Meisel et al., 2022).…”

“…Going further, understanding which treatment components are most effective for whom is likely even more beneficial for maximizing treatment effects (Boness & Witkiewitz, 2023). Yet, despite decades of research, the specific MOBC for most treatments remain largely unknown (Cuijpers et al., 2019; Magill et al., 2020; Meisel et al., 2022; Witkiewitz et al., 2022).…”

Evidence-Based Assessment of Substance Use Disorder

“…Negative valence/emotionality mechanisms include punishment sensitivity, coping, negative emotionality, and negative expectancies (Boness et al, 2022;Kwako et al, 2016). Although not consistently included in modern conceptualizations, social and environmental factors, such as racism-related stress (Jordan et al, 2020) and family functioning (Meisel et al, 2022), are also relevant to SUD etiology. However, it remains unclear whether these social and environmental factors are truly mechanisms or whether they might be better described as risk factors or moderators (Boness et al, 2021).…”