Two Major Grants For Teen Substance Use Treatment

Sarah Feldstein Ewing, Vice Chair for Research in UConn School of Medicine's psychiatry department, is fascinated by teen psychology. Why do teens make the choices they make? What factors influence their decision-making? And how can caregivers and counselors help support them in making healthy decisions?

Her research into these questions has spanned an impressive early career across multiple institutions. Now, Feldstein Ewing is the enthusiastic recipient of two major federal grants.

Pain and Teen Substance Use

Feldstein Ewing leads one of two sites receiving a combined $3,355,184 over five years from the National Institute on Drug Abuse (NIDA) for a project exploring young adult use of cannabis and opioids. As an expert in adolescent substance use, Feldstein Ewing is partnering with Anna C. Wilson, a pediatric pain specialist. Wilson is a colleague at Feldstein Ewing's former institution, Oregon Health & Science University (OHSU).

The study follows young people in Oregon, where underage cannabis use saw a significant uptick following state legalization of recreational adult cannabis use in 2015.

"Kids in Oregon were starting to make choices not to drink, but instead to use cannabis, because they were under the impression that it would not have been legalized if cannabis wasn't safe," says Feldstein Ewing.

At the same time, many teens and young adults are prescribed opioids at some point, whether due to a major injury or a routine procedure like wisdom teeth extraction. This means that co-use of cannabis and opioids is likely occurring for this age group.

But little is understood about the potential harms of using these two types of substances simultaneously, especially for young people. It is also unclear how effective and safe cannabis is for relieving pain in this age group, even though many young people report self-medicating pain with cannabis.

The research team will be alerted to new opioid prescriptions for emerging adults via local medical record updates. From there, they can follow up with the patients to assess their pain and substance use history, as well as personal risk factors for substance use and related problems.

Patients will be monitored closely for two weeks after their initial opioid prescription, and will receive follow-up check-ins at regular intervals over the next two years. Throughout this time, the researchers will track their outcomes in terms of pain, mental health, and substance use. The central hypothesis is that pain experiences, as well as patterns of opioid and cannabis use in the acute pain period (immediately after the inciting medical event), will influence opioid use, cannabis use, and related problems over time.

"Often, for people who have opioid addiction later on, they talk about how they started when they got a prescription after a broken bone or some other medical event during their teen years," Feldstein Ewing says.

The team will also explore psychosocial risk factors for substance use and related problems, like loneliness and depression.

"We just don't know what goes into the choice around who uses what [substances]," Feldstein Ewing explains. "We do know that if you're struggling with sadness and loneliness, you're more likely to use cannabis and other substances, so we want to know, is that also true for prescription pain medication?"

Into the Hyperscanner

From the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Feldstein Ewing has received a five-year grant totaling $2,737,888 to help determine the efficacy of group therapy for adolescents who are in counseling for alcohol use.

"Most kids get group therapy," Feldstein Ewing says, "but even though group therapy is widely used, the data on how well it works and why are ambiguous at best."

Part of the problem is that teens are uniquely influenced by what others think and say about them. Socially, this is a gift, Feldstein Ewing points out - it allows them to adapt to a variety of social environments, with greater ease than most adults - but it can be a hindrance in the context of group healing.

The research team is looking for iatrogenic effects, meaning effects that occur in the context of treatment.

Like an infection picked up at a hospital, harmful statements from peers in group therapy may lead to poorer therapeutic outcomes for teens. On the flip side, though, hearing positive encouragement from peers may provide a healing boost for this age group that is even greater than what adults would experience in the same type of behavioral treatment.

To test this hypothesis, the researchers are using a technique called hyperscanning, where MRI units are connected side by side so that two patients can interact with each other and be scanned simultaneously. The equipment is located at the University of Texas at Dallas, where Feldstein Ewing's longtime neuroimaging collaborator and co-PI, Francesca Filbey, is a neuroscience professor.

In the scanner, each patient will hear negative and positive statements about their capacity to reduce or stop their drinking, in the voice of the other patient. These statements will come directly from their group therapy session, which will be recorded.

Then, the researchers can observe the real-time changes in the brain as the patients actively select each type of statement for their co-participating peer.

How does it feel to hear a disparaging remark about your perceived ability to stop drinking - even when it's something you've heard countless times before? How does it feel to be encouraged by someone whose opinion you value? How much does that make you feel like you can change your drinking? Feldstein Ewing will be able to examine how these peer statements impact patients' brains, as well as how these statements impact patients' own perceived ability to change their behavior.

The researchers will also track the participants following their group therapy experiences to see how their drinking behavior changes or stays the same over the course of 12 months.

Toward Effective Interventions for Teens

Both these projects are geared toward designing better interventions for teens who are struggling with alcohol and substance use.

Currently, many young people receive the same therapy as adults. But Feldstein Ewing's research has shown that this may be a "square peg, round hole" approach - what works for adults may be ineffective or even discouraging for adolescents.

With the insight gained from these projects, Feldstein Ewing will help pioneer new clinical strategies to revolutionize the field of teen substance use treatment.