Relapse Prevention for Suicidal Dually Diagnosed Youths
Condition: Suicide, Attempted; Suicide, Ideation; Depression; Substance Abuse
MeSH terms: Substance-Related Disorders; Depression; Suicide; Suicide, Attempted
Study type: Interventional
Phase: Phase 1

Summary: 
      The purpose of this study is to develop, refine, and pilot test an augmenting cognitive
      behavior relapse prevention intervention (CBT-RP) for suicidal, depressed, and
      alcohol/substance abusing adolescents. No hypotheses are being tested, but it is expected
      that CBT-RP in addition to treatment as usual will result in improved outcomes relative to
      treatment as usual alone.
    

Detailed description: 
      Suicide attempts are not only associated with increased likelihood of eventual death by
      suicide (Lonnqvist & Ostano, 1991), increased risk of repeat suicidal behavior (Goldston et
      al., 1999; Leon et al., 1989), and risk of physical injury, but suicidality is also one of
      the primary reasons for psychiatric emergencies and psychiatric hospitalizations (Peterson et
      al., 1996). Suicide attempters, particularly repeat attempters, often have histories of both
      depression and substance abuse problems. Cognitive behavioral interventions have been shown
      to have promise in the treatment of depression (Brent et al., 1997), suicidality (Henriques,
      Beck, & Brown, 2002), and substance use disorders in youths (Dennis et al., in press; Kaminer
      et al., 2002). Relapse prevention approaches have been shown to have utility with substance
      abusing adults (Witkiewitz & Marlatt, 2004), and conceptually are well suited for the
      prevention of both suicidal behavior and substance use among young people. The purpose of the
      research outlined in this application is therefore to develop, refine, and test a cognitive
      behavioral relapse prevention intervention (CBT-RP) for dually diagnosed suicidal adolescents
      and young adults.

      The specific aims of this research are as follows:

        1. To develop and refine a cognitive behavioral relapse prevention treatment manual for
           suicidal adolescents and young adults with comorbid depressive and substance use
           disorders.

        2. To develop and pilot test procedures for training therapists to conduct CBT-RP. Methods
           for assessing therapist competence and adherence to the protocols, and certification
           standards will be developed and refined.

        3. To assess the feasibility of CBT-RP via monitoring of rates of recruitment and retention
           of subjects, monitoring of therapist adherence and deviation from the protocols, and
           monitoring of adverse events.

        4. To assess the feasibility of the assessment methods and outcome measures to be used in
           this study as reflected in burden in completing assessments over the course of
           treatment.

        5. To estimate the degree of change and variability of response to CBT-RP relative to no
           CBT-RP as an add-on treatment to Treatment as Usual (TAU) in the community on the
           primary outcomes of suicidal ideation, depressive symptoms, and substance use problem
           severity.

        6. To assess the acceptability of CBT-RP relative to no CBT-RP as an add-on treatment to
           TAU in the community as assessed qualitatively via exit interviews and quantitatively
           via ratings of patient satisfaction

      There are four phases to this treatment development study: (1) initial manual and protocol
      development (not requiring human subject involvement); (2) piloting (and revision) of the
      manual by the investigators; (3) training and supervision of new therapists using the new
      intervention; and, (4) the pilot randomized controlled trial. We have completed the first
      phase of this study. Currently, we are involved in completing pilot testing and initiating
      training of new therapists with the protocol (n=12). A subsequent pilot randomized controlled
      trial will be used to examine feasibility and preliminary evidence of effects (and
      variability of effects) of CBT-RP as an augmenting intervention (n=36).
    

Intervention name(s): CBT-RP (relapse prevention) + Enhanced TAU; Enhanced TAU Alone
Intervention type(s): Behavioral; Behavioral
Intervention description(s): CBT-RP is an 20-week augmenting intervention. CBT-RP is based primarily on Alan Marlatt's cognitive behavioral relapse prevention model for substance abuse, but also includes motivational interviewing and mindfulness meditation approaches. Sessions are twice a week in first week, then weekly thereafter, with tapering to biweekly in the last 8 weeks depending on improvement. Participants also receive treatment as usual, and monthly check-ins regarding treatment use.; Treatment as usual in the community, monthly check-ins regarding treatment use or needs, and monitoring
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: adolescents; suicidal ideation and behavior; depression; substance abuse