Outpatient Adolescent Treatment for Comorbid Substance Use and Internalizing Disorders
Condition: Substance-Related Disorders; Depressive Disorder; Anxiety Disorder
MeSH terms: Substance-Related Disorders; Depressive Disorder; Depression; Anxiety Disorders
Study type: Interventional
Phase: Phase 1

Summary: 
      Adolescent substance abuse results in significant negative outcomes and extraordinary costs
      for youths, their families, communities, and society. Moreover, rates of psychiatric
      comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual
      diagnosis have worse outcomes and are more than twice as costly to treat than their
      counterparts with no comorbidity. This project was a pilot test of a new treatment, OPTION-A,
      which was adapted from Multisystemic Therapist (MST) and other evidence-based interventions
      to specifically treat youth presenting for outpatient treatment of comorbid substance use and
      internalizing disorders. The project was a randomized controlled pilot trial comparing the
      experimental treatment to usual services in the community.
    

Detailed description: 
      Adolescent substance abuse results in significant negative outcomes and extraordinary costs
      for youths, their families, communities, and society. Moreover, rates of psychiatric
      comorbidity among substance abusing youth are high and youths with a dual diagnosis are more
      costly to treat. At the time of this study, however, no outpatient treatments had been tested
      specifically for treating youth with co-occurring substance use disorders and mental health
      diagnoses. The current project aimed to adapt and evaluate Multisystemic Therapy (MST), a
      well validated treatment for chronic behavioral problems or serious emotional disturbance in
      adolescents, to treat dually diagnosed youth using an outpatient model of service delivery.

      A pilot trial was conducted with 40 dually diagnosed youth randomly assigned to treatment
      conditions, with 20 receiving the experimental treatment (OPTION-A) and 20 receiving usual
      outpatient services. Specific aims were:

      Specific Aim 1: The primary aim of the present research was to adapt and test OPTION-A for
      use in outpatient settings to treat youth diagnosed with a substance use disorder and
      comorbid internalizing disorder. We hypothesized that youth receiving OPTION-A would exhibit
      significantly less drug use (e.g., youth self-reports and urine screens) than control youth
      who received usual services, and that youth receiving OPTION-A would exhibit significant
      improvement on indices of mental health (e.g., combined youth and caregiver reports on
      diagnostic interviews and youth, caregiver, and teacher reports of internalizing symptoms)
      compared to control youth Specific Aim 2: In addition to improved symptomatology, the current
      research aimed to test the effectiveness of OPTION-A to improve youth functioning in other
      domains pertinent to successful adolescent development. We hypothesized that youth receiving
      OPTION-A would evidence improved behavioral (e.g., youth, caregiver, and teacher reports of
      externalizing), school (e.g., school attendance), and family functioning (e.g., youth and
      caregiver reports of family adaptability and cohesion) compared to control youth who received
      usual services.

      Specific Aim 3: The final aim of the proposed research was to provide services that are more
      acceptable to consumers than are usual services provided in the community. We hypothesized
      that youth and families receiving OPTION-A would experience significantly greater consumer
      satisfaction than control youth and families who received usual services.
    

Intervention name(s): Outpatient MST/OPTION-A; Usual Services
Intervention type(s): Behavioral; Behavioral
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Substance-Related Disorders; Depressive Disorder; Anxiety Disorder; Adolescent; Behavior Therapy; Cognitive Therapy; Outpatients; Family Relations; Systems Theory