Professor Michael Mason’s idea for communicating with 18- to 25-year-olds with identified cannabis-use disorders is to text them. The texts ask questions like “How is your mood today?” and “What is your stress level?”
At the start of 2020, Mason—the Betsey R. Bush Endowed Professor in Children and Families at Risk in the University of Tennessee, Knoxville’s College of Social Work—received a grant from the National Institute for Drug Abuse to conduct a randomized clinical trial to test the effectiveness of texting as an intervention for problematic marijuana use. Over a four-week span, the project is testing 500 subjects with identified cannabis-use disorders in Knoxville, where marijuana is illegal, and 500 in Fort Collins, Colorado, where it is legal. It will be the largest study ever to look at whether this kind of intervention works, and a broad range of UT students—from undergraduates to postdoctoral students—are assisting on it.
“Text-based intervention is an accessible way to meet young adults where they are and help them meet their goals regarding reducing or stopping their cannabis use,” said PhD student Dorothy Wallis. “As a team member, I have gotten to be involved in every aspect of the study. I have helped with survey development, putting some of the information into our texting mechanisms, and background research for different measures we use throughout the intervention. It is definitely one big team in the Mason lab, where everyone’s strengths are utilized and opinions are heard.”
“Our original planning timeline was for about a year of preparation for launching the study,” said Mason, who says he’s attracted to research that’s creative and helps people. “This would include hiring and training staff and developing protocols for the technical testing of texting intervention.”
Then came the pandemic. “When we realized COVID-19’s influence on our original plans for on-campus recruitment and on-site enrollment,” said Mason, “we had to completely rethink our recruitment and enrollment plans. We made these processes completely virtual. All recruitment is now focused on social media, radio, press rather than our on-campus flyers, digital signs in dorms, gyms, libraries, and recruitment tables on the pedestrian walkways.
“Next we had to develop processes for screening, drug testing, and enrollment all to be completed virtually. We created videos to explain the study, developed sequential screening for eligibility, and are now mailing drug tests to participants. Participants complete the drug test (urine screen), take a photo of the results, and upload the picture directly into the web-based survey. All of this required rethinking staffing, budgets, and oversight management plans. UT’s institutional review board had to review all our new procedures prior to our launching recruitment.
“We are just now about to launch a targeted professionally developed social media recruitment campaign. With the help of a social media expert, we now have a plan to systematically evaluate our recruiting, responses, and engagement with very fine-grained detail. We will be able to make objective decisions regarding the placement and expenditures of each study recruitment advertisement. We currently have 19 participants and are looking to enroll 1,000 young adults ages 18 to 25, with 500 from Tennessee and 500 from Colorado.”
Mason has received national attention for his research, which sees substance use as a social practice within the routine social environment of individuals’ lives. If substance use exists in the social environment, that is a good context for addressing it. And text-delivered counseling has been shown to be effective.
“It feels very natural,” said Mason. “Ten texts every other day for 16 days. Our texts are full of evidence-based messaging, asking questions like ‘Tell us how you’re doing,’ ‘Reflect on your current use,’ and ‘What are your goals after graduation?’
“Some want to stop. We have them develop modification or reduction plans to reach their goals. It provides motivation and ways and structures to handle the stresses and strains of their lives. It’s important for our communications to be nonjudgmental. There’s a body of research showing that the more I tell you to stop, the worse results you have. It works better to be more accepting.
“When you ask questions like ‘What do you like about using?’ they articulate the reasons why they want to use and why they want change their behavior in the future. We try to activate their own motivation, their own observations about how much they’re using compared to others.
“A big focus is on peer relationships—who you hang out with, when you hang out, where you hang out. It seems to be potent for them to reflect on these things and, perhaps, realize for themselves ‘I guess I am hanging out only with daily users.’
“We might suggest small modifications—like hanging out with the same people in a different setting or maybe spending a little more time with nondaily users.”
Mason has also worked on an opioid prevention project with 69 Knox County teenagers and their parents, discussing risk factors, healthy lifestyle choices, and peer environments. Initial results showed reductions in depression and anxiety symptoms among adolescents and improved adolescent–parent relationships, all of which are protective factors against substance use.
When UT’s Center for Behavioral Health Research recruited him, Mason was an associate professor of psychiatry and director of the Commonwealth Institute on Child and Family Studies at Virginia Commonwealth University’s School of Medicine.
The Betsey Bush Endowed Professorship made UT’s job offer even more attractive since the endowment would allow Mason to be a full-time researcher. “It helped me do pilot studies at Tennessee that showed that our methods were effective,” said Mason. “We put those results in the next grant application, which led to the NIDA grant.” The professorship helps Mason in other ways, too. “It allows me some flexibility to support students to be part of the research. It also helps us develop and support pilot studies and purchase equipment in between grant funding.”
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