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Video Game Targeting Relapse Prevention in Youth with Substance Use Disorders


Objective This topic addresses the need for improved relapse rates among adolescent substance abusers. A video game should be designed for substance using adolescents in a commercializable and compelling package, for the purpose of reinforcing and maintaining behavior changes (e.g., skills development) accomplished through a theory-driven and evidence-based therapy. The video game may be compatible with an off the shelf commercially available gaming system. The project may, depending on the console selected, also involve development of peripherals for use with the system. The technology used must be familiar and accessible to youth, and developmentally appropriate. Background Despite advances in the development of treatments for adolescents with substance use disorders, relapse remains a significant concern. Although approaches to adolescent substance abuse almost exclusively focus on abstinence, relapse is likely to occur for one third to one half of youth, within 12 months of treatment completion (Grella, Joshi & Hser, 2004; Winters, Botzet, & Fahnhorst, 2011). Some studies report that less than half of adolescents are abstinent 3 months after discharge from outpatient treatment programs (Brown et al., 2001, Dennis et al., 2004, Kaminer et al., 2002, Winters, 2003). In the study of adolescent relapse risk, continuing care and aftercare have repeatedly been shown to reduce the likelihood of relapse and enhance the maintenance of treatment gains (Burleson, Kaminer, & Burke, 2012; Winters et al., 2011). Digital media and communication technology is pervasive in youth culture. Developing a video game for the purpose of maintaining treatment gains, using technology that is appealing, accessible and familiar to youth, and developmentally-appropriate, has the potential to greatly improve relapse rates in this population. This technology could improve engagement and reach, as well as reduce the cost and time burden of implementation on community treatment providers. Recent research by Girard et al (2009) has shown that participating in video game sessions that included behaviors that were incompatible with smoking cigarettes (crushing virtual cigarettes), within a virtual environment was more efficacious for smoking cessation than a similar game in which patients found and crushed virtual balls. The mechanism of this treatment is not well understood and it may be a form of extinction, counter conditioning, exposure with response prevention, or re-evaluative conditioning. Nonetheless, such practice in a “game” environment may be uniquely helpful because it can deliver a large “dose” of alternative practice in a manner that people not just tolerate but also enjoy. The fact Girard et al’s short duration gaming experience could improve outcomes in comparison with a “placebo” control suggests that video games may hold great promise for treating addiction. Phase I Activities and Expected Deliverables • Modification of an existing game or development of a new therapeutic game for use by one or several players (e.g., internet based, social networking opportunity) • Development of peripherals to interact with the game as needed • The game should provide opportunities for participants to practice skills learned in treatment or other opportunities that reinforce behavior changes/gains made through treatment • The game should allow for personalization when appropriate (e.g., selection of drug of choice, or multiple drugs) • The game should include a variety of difficulty levels of increasing intensity, with opportunities for participants to refine skills • The game should be able to recognize and keep track of the participant’s performance over time so the participant can experience improvement in game play • The game should record, store, and provide for downloading into a database, information regarding system use by each player such as time played, used to determine the extent of adherence and the “dose” required • The game may allow for cooperation and interaction with other participants when the game is played as a group exercise • A pilot study with a small group of adolescent substance abuse treatment completers (N=9) o The study will expose participants to the game weekly for 30 minutes a session, for 4 weeks o Measures collected at baseline will include drugs of choice, and timeline follow-back o Measures collected following each game exposure session will include acceptability, suggestions for improvement, AES/SAES, craving ratings, urine drug screening and cotinine screening (for smokers) and treatment engagement data o Measures collected 1 month after treatment entry will include timeline follow-back o The pilot testing may be done in an iterative fashion so that multiple small focus groups are exposed to the program and it is modified in response to their comments Phase II Activities and Expected Deliverables Modification of program developed in Phase I, in response to customer feedback followed by an RCT Pilot clinical study evaluating the effectiveness of the newly developed video game (TAU + 1 month of access to the video game vs. TAU alone). Outcomes collected will include AEs, SAEs, system use information (durations, preferred contexts/levels, times accessed), initial abstinence/use via urine screening, follow up abstinence/use via time-line follow back.
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