Learning Effective Approaches to Prevention
Condition: Adolescent Substance Abuse
MeSH terms: Substance-Related Disorders
Study type: Observational

Summary: 
      The objective of the study is to test the effectiveness, implementation quality, and cost
      effectiveness of family-based treatment services for adolescent substance abuse delivered in
      an agency setting.
    

Detailed description: 
      Despite the success of family-based ecological interventions (FBEI) in controlled trials,
      this highly promising services approach has not been tested under pure field conditions with
      ASA populations. Controlled effectiveness research invariably enhances training, supervision,
      and service delivery conditions in partnering sites in an effort to ensure treatment
      adherence and consistency. An alternative strategy for advancing dissemination science is
      rigorous naturalistic research on community clinics that already implement evidence-based
      practices in the course of routine care. The proposed study will follow this "bottom up"
      strategy by investigating the quality and impact of ASA services delivered by front-line
      therapists in a community-based mental health center that already features FBEI as the
      routine standard of care. The study will use a randomized design to compare naturalistic FBEI
      services to services as usual (SAU) for ASA. Participants (N = 260) will be recruited from
      local high schools, enrichment programs, and juvenile justice programs. Eligible adolescents
      will meet ASAM criteria for outpatient treatment. The SAU condition will contain the three
      most common service venues for ASA in urban communities: hospital-based ambulatory mental
      health clinics, drug counseling/addictions specialty clinics, and community mental health
      centers. The primary aims of the study are to examine the effectiveness of FBEI versus SAU
      and to compare the strength of FBEI adherence and outcomes to performance benchmarks set
      during a previous FBEI Stage II efficacy trial. The secondary aims are to compare cost
      effectiveness, services utilization, and consumer satisfaction in FBEI versus SAU. A
      multitrait, multimethod assessment design will include adolescent and parent interviews at
      baseline and 3, 6, and 12 months follow-up. Cost and service utilization data will be
      collected from self report and from provider agencies in both conditions. The study will
      yield the first evidence on whether a widely endorsed treatment approach for ASA is potent
      and feasible in real-world conditions and superior to SAU in outcomes and cost-benefit. An
      important secondary yield will be increasing the scarce knowledge base on commonly practiced
      community approaches in the SAU condition.
    

Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Adolescents screened for symptoms of substance abuse/dependence, and their families, will
        participate in the study. Participants will include 260 male and female adolescents who
        complete the enrollment process, meet eligibility criteria, and consent to be randomized
        into one of two study conditions. Youth will be referred primarily from two sources:
        juvenile justice agencies and local schools/community programs. Based on the demographics
        of adolescents currently participating in partner sites, youth are likely to be
        predominantly male (69%), Hispanic (68%), and African American (32%). Families are
        generally low income from disadvantaged neighborhoods, with high rates of family mental
        health and substance use problems.
      
Keywords: Adolescent; substance abuse