Family Intervention for Teen Drinking in the ER
Condition: Alcohol Abuse
MeSH terms: Alcoholism; Underage Drinking
Study type: Interventional

Summary: 
      The investigators propose a randomized controlled trial with five aims: 1. To investigate the
      engagement potential and effectiveness of a family-centered intervention (MDFT) and Family
      Motivational Interviewing Intervention (FMII)/group for teens with alcohol-related crises; 2.
      To explore differential treatment effects with comorbid adolescents; 3. To examine the role
      of motivation and family factors as treatment mediators; 4. To examine long-term abstinence,
      patterns and predictors of relapse up to 18 months follow-up; and 5. To compare the total and
      net monetary benefits to society of MDFT, FMII/group, and standard care.
    

Detailed description: 
      Aim 1: To investigate in a randomized controlled trial the engagement potential and
      effectiveness of family-centered intervention (MDFT) and family-involved MI (FMII) for teens
      with alcohol problems

        -  Hypothesis 1a: Treatment engagement will be higher in MDFT and FMII than in standard
           care as evidenced by higher numbers of MDFT and FMII youth enrolled in substance abuse
           treatment.

        -  Hypothesis 1b: Treatment completion will be higher for MDFT than FMII/group and standard
           care as evidenced by more teens/families in MDFT completing a full course of treatment.

        -  Hypothesis 1c: Youth assigned to MDFT and FMII/group will show greater decreases in
           alcohol use and binge drinking than youth in standard care at the 3 month follow-up (end
           of treatment). MDFT participants will show greater decreases in alcohol use and binge
           drinking than FMII/group and standard care during the post-treatment period and up to 18
           month follow-up, and they will be less likely to meet diagnostic criteria for an AUD at
           18 months.

        -  Hypothesis 1d: Youth assigned to MDFT and FMII/group will show greater reductions than
           youth in standard care in problems related to alcohol use, including drug use, drinking
           and driving, alcohol-related injury, health and mental health problems, school problems,
           delinquency, and association with substance abusing peers at the 3 month follow-up (end
           of treatment). Youth in MDFT will show greater reductions in these problems than
           FMII/group and standard care in the post-treatment period and up to 18 month follow-up.

      Aim 2: To explore differential treatment effects with comorbid adolescents

        -  Hypothesis 2: For youth with low baseline levels of alcohol, drug, and psychiatric
           problems, MDFT and FMII/group will both be more effective than standard care. MDFT will
           reduce alcohol use more significantly than FMII/group for teens with more severe
           baseline alcohol, drug, and psychiatric problems.

      Aim 3: To examine the contribution of motivation and family factors as mediators of treatment
      effects

        -  Hypothesis 3a: In both MDFT and FMII/group, motivation to change at the end of the
           initial engagement sessions in both teen and parent will predict treatment participation
           and 3 month outcomes (end of treatment) to a greater extent than motivation in the teen
           or parent alone.

        -  Hypothesis 3b: In both MDFT and FMII/group, effective parenting practices and strong
           family relationships will predict better alcohol and related outcomes at 3 month
           follow-up.

      Aim 4: To examine long-term abstinence, patterns and predictors of relapse up to 18 months
      follow-up

        -  Hypothesis 4a: Four distinct patterns of relapse will emerge between 3 month and 18
           month follow-up: high abstinence, low abstinence, decreasing abstinence, and increasing
           abstinence.

        -  Hypothesis 4b: MDFT youth will be more likely to be in the high abstinence and
           increasing abstinence groups; youth in FMII/group will be more likely to be in the
           decreasing abstinence group; and youth in standard care will be more likely to be in the
           low abstinence group.

        -  Hypothesis 4c: Youth in MDFT will show more significant reductions in risk factors for
           alcohol relapse (family dysfunction, lack of abstinence motivation, positive alcohol
           expectancies, poor abstinence coping, lack of support for abstinence) than youth in
           FMII/group or standard care.

      Aim 5: To compare the total/net monetary benefits to society of MDFT, FMII/group, and
      standard care

        -  Hypothesis 5: MDFT and FMII/group will generate significantly higher total and net
           monetary benefits to society than youth in standard care at 18 months post-ER visit.

        -  Research Question 5: Will MDFT or FMII/group generate higher total/net benefits to
           society?
    

Intervention name(s): Standard Care; Multidimensional Family Therapy; Family Motivational Interviewing Intervention
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Clients attend two 90-minute group sessions per week.Treatment lasts for three months.; Multidimensional Family Therapy is an outpatient family-based treatment for troubled youth (Liddle, 2002). Treatment duration is 3 months, sessions last 60-90 minutes, with an average of 2 sessions per week and additional extrafamilial work and phone contacts as needed.; Youth and parents receive 2 FMII sessions in their homes within 72 hours of the ER incident, and youth will be linked with group treatment lasting 3 months.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment