Family-Based Drug Services for Young Disaster Victims
Condition: Substance Abuse; Families; Trauma
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      This protocol seizes this rare scientific opportunity to test an integrative family based
      model to address youths' coexisting substance abuse and trauma in the wake of Hurricane
      Katrina. The study would address a number of gaps in the current evidence base related to
      understanding and treating comorbid teen drug abuse and trauma that may be initiated or
      exacerbated in the wake of disasters such as Hurricane Katrina. This study would compare two
      promising interventions for youth with comorbid trauma and substance abuse, family-based
      treatment and group Cognitive Behavioral Therapy (CBT), potentially yielding new and vital
      information about effective treatment for substance abusing youth following traumatic events.
    

Detailed description: 
      This study is a 2 (treatments) by 5 (time points), repeated measures intent-to-treat
      randomized control design with multiple dependent variables. The sample includes a total of
      150 ethnically diverse adolescents who are clinically referred for substance abuse treatment
      throughout St. Charles Parish, a New Orleans area parish that was heavily impacted by
      Hurricane Katrina. The parish has high rates of teen substance abuse as documented in school
      surveys (State of Louisiana Office for Addictive Disorders, 2002, 2004). Eligible youth, who
      meet American Society of Addiction Medicine (ASAM) criteria for outpatient substance abuse
      treatment and report trauma symptoms related to Hurricane Katrina, will be randomized to a
      family-based treatment (MDFT) or group CBT. Both treatments will be delivered approximately
      twice weekly over 4 months. Assessments of youth and family functioning across several
      domains will be conducted at intake, 2, 4, 6, and 12 month follow-up. Measuring multiple
      domains at several assessment points within and following treatment (Brown, 2004) will enable
      investigators to examine trajectories of change as well as mediators and moderators of
      treatment effects.

      The study has four aims:

      Aim 1: To explore links between hurricane-related stress and trauma and youths' substance
      abuse.

      Hypothesis 1: Severity of youths' substance use at intake to treatment will be predicted by
      level of exposure to Hurricane Katrina, stressful life events following Katrina, trauma
      symptoms, and coping.

      Aim 2: To investigate in a community based randomized control trial the effectiveness of a
      family-based intervention (MDFT) vs. group CBT for teen substance abusers impacted by
      Hurricane Katrina.

      Hypothesis 2a: Family-based treatment (MDFT) will more effectively reduce youths' substance
      abuse, delinquency, trauma, and school problems up to one year post-intake than a group CBT
      approach.

      Hypothesis 2b: Family-based treatment (MDFT) will more effectively reduce parents' stress and
      family conflict up to one year post-intake than group CBT.

      Hypothesis 2c: Youth assigned to MDFT will be less likely to meet diagnostic criteria for
      PTSD at 12 month post-intake than group CBT.

      Aim 3: To examine teen and parent coping as mediators of treatment effects.

      Hypothesis 3a: Youth in MDFT will develop more effective coping strategies than those in
      group CBT through improved parental coping and parenting practices, and lower family
      conflict, as well as directly through intervention effects.

      Hypothesis 3b: Youth in MDFT will achieve greater reductions in substance abuse and trauma
      symptoms than those in group treatment through more effective coping during the 12 month
      follow-up period.

      Aim 4: To explore moderators of treatment effects based on post-Katrina stress and trauma
      symptoms.

      Hypothesis 4: The advantage of MDFT over group CBT in decreasing substance abuse will be more
      pronounced with youth who report higher levels of disaster-related stress and trauma symptoms
      at intake.
    

Intervention name(s): Multidimensional Family Therapy; Group CBT
Intervention type(s): Other; Other
Intervention description(s): MDFT assesses and intervenes in four domains to address comorbid substance abuse and trauma symptoms: 1) adolescent, 2) parent, 3) family, and 4) external systems. MDFT therapists will address trauma symptoms among both teens and parents, aiming to improve coping and reduce the impact of stress on the family. Consistent with a multidimensional approach, MDFT trauma-focused interventions address the needs of both youth and their parents, and MDFT therapists seek collaboration and advocacy from school and court personnel.; Trauma symptoms will be addressed using techniques designed to reduce cognitions that maintain anxiety and depressive symptoms and improve coping, such as cognitive restructuring, gradual exposure, and helping teens to understand and accept reminders of the event and ongoing stressors (Pynoos et al, 1998).
Other intervention name(s): MDFT
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Adolescents; Hurricane Katrina; Family-based treatment; Multidimensional Family Therapy; Group CBT