Time for a paradigm shift: The adolescent brain in addiction treatment

Abstract

Objective: One route to improve adolescent addiction treatment outcomes is to use translational approaches to help identify developmental neuroscience mechanisms that undergird active treatment ingredients and advance adolescent behavior change.

Methods: This sample included 163 adolescents (ages 15-19) randomized to motivational interviewing (MI) vs. brief adolescent mindfulness (BAM). Youth completed an fMRI paradigm assessing adolescent brain response to therapist language (complex reflection vs. mindful; complex reflection vs. confront; mindful vs. confront) at pre- (prior to the completion of the full intervention) and post-treatment (at 3-month follow-up) and behavioral measures at 3, 6 and 12 months.

Results: Youth in both treatment groups showed significant problem drinking reductions at 3 and 6 months, but MI youth demonstrated significantly better treatment outcomes than BAM youth at 12 months. We observed several significant treatment group differences (MI > BAM) in neural response to therapist language, including at pre-treatment when examining complex reflection vs. mindful, and complex reflection vs. confront (e.g., superior temporal gyrus, lingual gyrus); and at post-treatment when examining mindful vs. confront (e.g., supplementary motor area; middle frontal gyrus). When collapsed across treatment groups (MI + BAM), we observed significant differences by time, with youth showing a pattern of brain change in response to complex reflection vs. mindful, and complex reflection vs. confront (e.g., precuneus; postcentral gyrus). There was no evidence of a significant group × time interaction. However, brain change in response to therapist language (complex reflection vs. confront) in regions such as middle frontal gyrus, was associated with reductions in problem drinking at 12 months. Yet, few treatment group differences were observed.

Conclusions: These data underscore the need to better understand therapist language and it's impact on the developing brain, in order to inform and aggregate the most impactful elements of addiction treatment for future treatment development for adolescents.

Keywords: Addiction; Adolescent; MRI; Therapist language; Treatment.

Fig. 1

fMRI Paradigm Examining Task Conditions. Neural In-Session Language Examination (NILE).

Fig. 2

Adolescent Treatment Outcomes. Youth problem drinking outcomes at 3, 6, and 12 months by intervention type. There was a significant Time × Group interaction (F(2,288) = 3.96, p = .020) wherein youth in the MI and BAM groups demonstrated comparable problem drinking outcomes at 3 and 6 months, but MI youth had significantly better treatment outcomes at 12 months post-treatment as compared with BAM youth (t (124.44) = -2.42, p = .0173). This figure represents raw means (not adjusted for baseline levels). Error bars represent standard error. MI = motivational interviewing. BAM = brief adolescent mindfulness.

Fig. 3

Pre-to-Post Treatment Change in Adolescents’ Brain Response to Task Conditions. Percent signal change (post-treatment - pre-treatment) for each task condition included in the contrast (examined across treatment groups); p < .01, corrected at p < .05. R = right. L = left. IPL = inferior parietal lobule. aMedFG = anterior medial frontal gyrus. MedFG = medial frontal gyrus. Talairach coordinates.(A) Adolescents’ response to complex reflection as compared with mindful . (B) Adolescents’ response to complex reflection as compared with confront . (C)* Adolescents’ response to mindful as compared with confront is not included as there were no significant findings for this contrast.

Fig. 4

Plots of Change in Adolescent Brain Response to Task Conditions. Plots of individual peak z-score in activation to each task (complex reflection, mindful, and confront) at pre-treatment and post-treatment for significant right precuneus activation in the contrast of A) complex reflection compared to mindful and B) complex reflection compared to confront. Values were extracted for the main effect of Time (pre-treatment, post-treatment) from multivariate modeling, and represent results that were significant for each treatment group. Voxel level p < .01, whole-brain correction of p < .05. CR = complex reflection. MF = mindful. CF = confront. MI = motivational interviewing. BAM = brief adolescent mindfulness. R = right. Talairach coordinates.

Fig. 5

Correlations between Adolescents’ Brain Response to Task Conditions and 12 month Treatment Outcomes. These are the primary areas of brain-behavior correlations for each of the 3 language contrasts. Figure shows associations between neural change in activation to task conditions associated with long term behavior change, measured as adolescent problem drinking outcomes at 12 months post-treatment (examined across treatment groups). p < .05, uncorrected. R = right. L = left. PCC = posterior cingulate cortex. MFG = middle frontal gyrus. IFG = inferior frontal gyrus. STG = superior temporal gyrus. Talairach coordinates.