An episode-based paradigm for studying family dynamics in adolescent substance use

About This Grant

PROJECT SUMMARY/ABSTRACT Family processes such as parental monitoring of the teens’ whereabouts or provision of discipline are core treatment targets in our most potent clinical interventions to reduce or prevent adolescent substance use, but we know relatively little about how family processes drive change. The dominant paradigm for studying the role of family processes consists of examining cross-sectional or longitudinal covariation between multiitem rating scales measuring “typical” parenting behavior over an extended recall period and teen reports of substance use over the past year/month. Because this data collection paradigm aggregates heavily across behaviors, time, and context, it precludes a precise, nuanced, or temporally sensitive understanding of how family processes drive changes in drinking and drug use, limiting translation relevance. To remedy this gap, we will develop a novel paradigm for collecting real-time, real-world intensive longitudinal data on the sequence of discrete parent and youth behaviors before and after episodes of substance use (i.e., antecedents and consequences). N=90 teens who use substances will complete 28 consecutive days of 4x/day EMA surveys, yielding ~120 observations of family processes per family over a 1-month period. Using this rich data, we pursue two aims. First, we will obtain validity, feasibility, and acceptability evidence for the novel paradigm and refine it for large-scale data collection (Aim 1). Validity evidence will be gathered by linking our momentary- and day-level assessments to pre-existing measures from the field’s standard paradigm. Usability, acceptability, and feasibility data for the paradigm will be gathered through structured interviews at baseline and exit assessments. Data from survey responses and interviews will be used to refine the paradigm in anticipation of future large-scale data collection (e.g., delete or replace poorly performing items, adjust schedule/frequency of surveys). Second, to demonstrate the value of the new paradigm, we will test 6 substantive hypotheses about which specific antecedent/consequent parent behaviors, performed when, for how long, and in which contexts, lead to changes in substance use and intent to use. Results will be proof-of-concept that the episode-based paradigm can reveal clinically useful insights not accessible with traditional, aggregated parenting rating scales. The expected outcome of this project is a new paradigm for studying which specific parenting behaviors, performed when and in which contexts, reduce risk for adolescent substance use over what timescale and for how long. If successful, findings obtained in a research program employing the new paradigm will replace the generic parenting advice offered in existing clinical interventions with precise, concrete, actionable recommendations on how busy and burdened parents can achieve greater impact with less effort. This developmental/exploratory (R21) proposal is expected to lead to a R01 submission to collect larger-scale data that will probe additional family processes, longer-term effects, and changes during clinical treatment.