Mobile Technology to Reduce Teen Substance Misuse

This project will test the newly expanded WisePath for Teens (WPT), a paired mobile app to support parents delivering, and youth receiving, evidence-based practices to reduce youth's substance abuse (SA) and other significant behavioral health problems that commonly co-occur with SA, exacerbate SA, and/or interfere with youth's treatment. Through a collaborative "discussion" with a chatbot, WPT will collect information about the youth's substance use and other behavioral health problems, utilizing methods designed to enhance motivation and engagement. Using a shared decision-making process, WPT will configure to address the youth's specific SA triggers and functions and other identified top problems (e.g., depression, stress, insomnia). The platform will generate recommended parent- and family-focused strategies for the parent app and will use the parent-teen interactive card system to deliver evidence-based family therapy tasks, tailoring parent notifications to match specific teen risks.

This study includes a 12-week randomized controlled trial (RCT) with 300 youth participants aged 13-17 years and their primary caregiver (dyads). Dyads will be randomly assigned to use WisePath for Teens (WPT; n=100 dyads), WisePath for Teens plus parental support by an assigned peer support specialist (WPT+PSS; n=100 dyads), or an active control condition involving access to a webpage of resources relating to substance use and general stress reduction; presented resources are updated every 2-3 days (Control; n=100 dyads). We will also provide simple instructions on how to save the webpage to their phone's home screen (similar to an app icon) to make access easier and more like accessing an installed mobile app. Youth participants will be matched across condition on age and substance use severity. Participants will be assessed at three time points: baseline, one intermediate time point (at either 4 weeks or 8 weeks), and 12 weeks.

The study uses a Planned Missingness Design that assesses change over time for each participant across three time points spread across four assessment opportunities lasting a total of 12 weeks. Specifically, each study participant will complete measures at baseline and also at 12 weeks; each family dyad will be randomly assigned to also complete one additional assessment at either week 4 or week 8. We predict that participants in both WPT conditions will report significantly greater decreases in substance use and associated risky behaviors, greater decreases in stress, greater increases in capacity for coping with distress, and superior satisfaction ratings compared to control participants. We predict in comparison to WPT use alone, those in the enhanced condition will have superior outcomes across all measures.

Primary youth-reported outcomes include: substance use and related problems (school and crime/violence); recovery environment quality; mental health (internalizing and externalizing symptoms), and family functioning (conflict, involvement). Primary caregiver-reported outcome variables include: family functioning (conflict, involvement), parenting skills (monitoring/supervision, discipline consistency, positivity), and parenting cognitions (perceived stress and efficacy). Caregivers will also report on youth mental health symptoms. App satisfaction and use of technology outcomes (i.e., degree of app usage, features used) will be examined as between-groups differences for WPT vs. WPT+PSS arms, as well as potential predictors of changes across time in caregiver and youth outcomes.

Inclusion criteria

Youth:

• Resides in United States
• 13-17 years of age
• Fluent in English
• Possesses and is the primary user of an Android or iPhone-based smartphone with a data plan that they use on a daily basis
• Currently residing in the same household with the linked caregiver/legal guardian participant at least five days a week
• Meets criteria for mild-moderate or severe SA (for any drug or alcohol) on the Screening to Brief Intervention (S2BI), indicated by answering that they have used any substance at least once per month within the past 90 days.
• Possesses and is the primary user of an Android or iPhone-based smartphone with a data plan

Caregivers:

• Resides in United States
• 18 years or older
• Fluent in English
• Owns and is the primary user of an Android or iPhone-based smartphone with a data plan that they use on a daily basis
• Able and willing to receive and send several (1-3 times/week) text messages from study staff during study participation
• Is the primary caregiver of a youth aged 13-17 years who lives in the caregiver's home at least five days a week
• Caregiver indicates a substance concern for the target youth, defined as either a+b OR c:

• uses alcohol, marijuana, and/or another substance, AND
• expresses that they are concerned (a score of 3 or higher) about that use on a 5-pt Likert scale (3 = concerned, 4 = very concerned, 5 = extremely concerned).

OR

• The target youth participated in counseling or another form of treatment (e.g., medication assisted treatment) because of a concern about alcohol, marijuana, or other substance use.

Exclusion criteria

Youth:

• Participated in previous iKinnect or WisePath for Teens research in the past 2 years

Caregivers:

• Participated in previous iKinnect or WisePath for Teens research in the past 2 years
• Currently involved with the child protective service system due to a concern about child maltreatment (i.e., abuse or neglect).