Family-Based Protocol for Medication Integration in Treatment of Comorbid ASU/ADHD in Routine Care
Condition: Adolescent Substance Abuse; Attention Deficit Hyperactivity Disorder
MeSH terms: Substance-Related Disorders; Attention Deficit Disorder with Hyperactivity
Study type: Interventional
Phase: Phase 1

Summary: 
      The goal of this proposal is to develop and pilot a brief protocol designed to systematically
      integrate pharmacological interventions for attention deficit hyperactivity disorder (ADHD)
      into behavioral treatment services for adolescent substance users with comorbid ADHD in
      everyday care. ADHD is a prevalent co-occurring condition for adolescent substance use (ASU)
      that can significantly impede successful ASU treatment but is vastly under-diagnosed and
      undertreated among ASU clients in agency settings. Moreover, ADHD medication acceptance and
      compliance is particularly difficult to achieve in high-risk adolescent populations.
    

Detailed description: 
      The goal of this proposal is to develop and pilot a brief protocol designed to systematically
      integrate pharmacological interventions for attention deficit hyperactivity disorder (ADHD)
      into behavioral treatment services for adolescent substance users with comorbid ADHD in
      everyday care. ADHD is a prevalent co-occurring condition for adolescent substance use (ASU)
      that can significantly impede successful ASU treatment but is vastly under-diagnosed and
      undertreated among ASU clients in agency settings. Moreover, ADHD medication acceptance and
      compliance is particularly difficult to achieve in high-risk adolescent populations. The
      proposed R21 study will use an interrupted time series design to test a brief protocol
      designed to promote integration of evidence-based ADHD pharmacotherapy into routine
      behavioral services for ASU: Medication Integration Protocol (MIP). MIP is a 5-session
      family-based protocol delivered during the early portion of ASU treatment that contains three
      research-based elements: (1) standardized psychiatric assessment and family-focused
      psychoeducation about adolescent ADHD; (2) an approved ADHD medication regimen (OROS-MPH)
      with demonstrated efficacy for ASU/ADHD clients; (3) family-based interventions to support
      medication acceptance (as indicated) and coordination of care between psychiatric and
      behavioral services. MIP will be integrated into existing family-based services at one
      partnering clinical site: 20 ASU/ADHD cases will be treated by site family therapists who
      will be newly trained and monitored in MIP. The partnering clinic provides family therapy as
      the routine standard of care for outpatient behavioral health and offers on-site child
      psychiatry services. Primary study aims will yield proof-of-concept data on MIP feasibility
      and fidelity in usual care and evidence of MIP impact on psychiatric and behavioral services
      utilization, medication acceptance and compliance, and satisfaction with treatment services.
      Exploratory analyses will generate effect sizes for the short-term impact of MIP on the main
      targets of ADHD medication: ADHD symptoms and executive cognitive functioning. New study
      products would include a standardized and piloted MIP protocol, clinician training and
      fidelity monitoring procedures, and an observational fidelity instrument. If validated, MIP
      could be utilized as a stand-alone intervention in everyday care, or, be combined with
      existing manualized treatments for ASU in an effort to develop fully integrated treatment
      models for ASU/ADHD. Also, MIP could be delivered in conjunction with either family-based
      treatments or individual treatments that can flexibly include caregivers in early sessions.
    

Intervention name(s): Medication integration protocol
Intervention type(s): Behavioral
Intervention description(s): MIP is a 5 session protocol. The first session consists of pretreatment assessment activities using measures administered during routine clinical intake. The following sessions, MIP Sessions 1-4, are meant to be delivered sequentially, commencing sometime after session 2 or 3 of treatment, that is, after completion of initial treatment contracting and engagement interventions that will usually be focused on ASU-related referral problems for this population. The proposed pilot work will shed light on the optimal timing for MIP Sessions 1-4.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Co-occurring adolescent substance use and ADHD