# Experimental Mediation Research Aimed at Enhancing Adolescent Substance Abuse Treatment

> **NIH NIH R01** · OREGON SOCIAL LEARNING CENTER, INC. · 2021 · $700,810

## Abstract

PROJECT SUMMARY/ABSTRACT
Adolescents with substance use disorders (SUD) are at high risk for significant deleterious outcomes.
Although several evidence-based practices for adolescent SUD exist, they yield only small to medium
effects that rapidly diminish (30-70% 6-month relapse rates). A promising approach for determining how
to enhance treatment is experimental mediation research. In contrast to traditional correlational
mediation approaches, experimental mediation permits causal inference and is comprised of key steps:
(A) Identify the putative mediating variable for a treatment. (B) Enhance the treatment to target that
mediator more intensely. (C) Randomize youth to conditions, with the standard and enhanced versions of
the treatment targeting different “levels” of the same mediator. (D) Measure the mediator and outcomes
longitudinally. (E) Perform modern mediation analyses, coupled with analyses evaluating causal
inference, to determine if changes in the mediator are responsible for changes in outcomes. This
experimental test of mediation, focused on causality, facilitates rapid improvement of treatments by
specifying change mechanisms to target in order to improve outcomes. These steps will be followed to
elucidate the mediating processes in treatment for adolescent SUD, with the ultimate goal of enhancing
the strength and durability of SUD treatments. The three most common putative mediating variables in
adolescent SUD treatments are parent management, behavioral regulation, and peer relations. For this
study, parent management was chosen as the target because it has evidenced the most potential for
yielding generalizable change in youth outcomes and also has been shown to indirectly improve youths’
behavioral regulation and peer relations. Of existing treatments for adolescent SUD, family-based
Contingency Management (CM) was chosen as the treatment to enhance because it is highly amenable
to an augmented focus on parenting, is less complex relative to other SUD treatments, and has amassed
considerable support in terms of efficacy and dissemination potential. Thus, following experimental
mediation steps, youth with SUD will be randomized to receive either standard CM or enhanced CM (i.e.,
CM+) that targets parenting more intensely. Repeated assessments for 12 months and longitudinal
analyses will allow testing of mediating processes. We will examine whether parent management skills
mediate the effect of treatment on youth substance use and behavior problems (Aim 1). In addition, we
will determine whether parent management skills mediate the effect of treatment on youth behavioral
regulation and deviant peer relations (Aim 2). Finally, we will test whether behavioral regulation and
deviant peer relations mediate the effect of parent management on youth substance use and behavior
problems (Aim 3). Findings could have broad impact across multiple adolescent SUD treatments.

## Key facts

- **NIH application ID:** 10198880
- **Project number:** 5R01DA043578-05
- **Recipient organization:** OREGON SOCIAL LEARNING CENTER, INC.
- **Principal Investigator:** Michael R McCart
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $700,810
- **Award type:** 5
- **Project period:** 2017-09-01 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10198880

## Citation

> US National Institutes of Health, RePORTER application 10198880, Experimental Mediation Research Aimed at Enhancing Adolescent Substance Abuse Treatment (5R01DA043578-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10198880. Licensed CC0.

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