Integrating brain and behavior: Evaluating adolescents’ response to a cannabis intervention.

Abstract

Client language (change talk [CT] and counterchange talk [CCT]) is gaining increasing support as an active ingredient of psychosocial interventions. Preliminary work with adults suggests that there may be a neural basis for this. With a diverse sample of adolescent cannabis users, we evaluated the influence of CT and CCT on blood oxygen level dependent (BOLD) response during an fMRI cannabis cue-exposure paradigm. We also investigated how BOLD activation related to treatment outcomes. Adolescent cannabis users (N = 43; 83.7% male; 53.5% Hispanic; M age = 16 years) were presented with CT and CCT derived from their prescan intervention session during the fMRI paradigm. Additionally, BOLD activation during CT (vs. CCT) was tested as a predictor of 1-month follow-up cannabis use behavior (frequency of cannabis use, cannabis problems, cannabis dependence). We observed a significant interaction, with greater activation during CT (vs. CCT) during the cannabis (but not control) cues in several areas key to self-referential processes (uncorrected p < 0.001; medial frontal gyrus, insula). Furthermore, BOLD activation during CT (vs. CCT) during cannabis (but not control) cues in areas that underlie introspection (posterior cingulate, precuneus) was significantly related to youths' 1-month follow-up cannabis use behavior (frequency of cannabis use, cannabis problems, cannabis dependence; uncorrected p < 0.001). These data indicate a unique interaction pattern, whereby CT (vs. CCT) during the cannabis (but not control) cues was associated with significantly greater activation in brain areas involved in introspection. Further, this activation was related to significantly better treatment outcomes for youth.

Functional connectivity and cannabis use in high-risk adolescents

“…Fronto-temporal regions have been broadly linked to working memory and attention (88–90), functions that are essential to academic and vocational performance, and also shown to be suppressed among adults who are heavy users of cannabis (91,92). In addition, psychosocial interventions for a range of problem health behaviors have been shown to modulate activity in mesial temporal lobe (24,93,94), which may suggest a role for this region in treatment response. Given the effects of cannabis use in early adolescence on cognitive function (4,5), it remains possible that the relationship between cannabis dependence and activity in the fronto-temporal network observed in the present study reflects the near-term sequelae of cannabis use.…”

“…This variability in treatment outcomes may be due, in part, to our limited understanding of how psychotherapy works (21), especially for adolescents (22,23). Evaluations of basic biological factors hold great promise for deconstructing adolescents' patterns of intervention response (24–26). The measurement of these factors, such as resting brain activity, may ultimately yield better-targeted interventions.…”

Binge drinking impacts dorsal striatal response during decision making in adolescents

“…Understanding which regions of cognitive control and reward-related circuitry are disrupted prior to initiation of alcohol use, and which are disrupted by alcohol use itself, potentially further perpetuating intake, is crucial for identifying targets for future prevention and intervention strategies. In fact, recent studies have begun to use such findings, alongside behavioral intervention strategies, to elicit functional changes in the brain of substance users (Feldstein Ewing et al, 2013), highlighting the importance of these neuroimaging findings for future translational research.…”

Considering Cannabis: The Effects of Regular Cannabis Use on Neurocognition in Adolescents and Young Adults

“…In the most integrated translational project to date, Feldstein Ewing and colleagues (2013) utilized fMRI to measure the impacts of psychological treatment (change talk versus counterchange talk) on brain activation to cannabis cues following treatment in teenage cannabis-users. They found that change talk increased BOLD activation in areas that underlie introspection (posterior cingulate, precuneaus) during exposure to cannabis cues, and this increase in activation was associated with superior one-month treatment outcomes (frequency of cannabis use, MJ-related problems, CUD symptoms).…”