Family-based and Adolescent Residential Drug Treatment

Study Overview
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Brief Summary
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The fundamental objective of this study is to compare the effectiveness of an intensive in-home family-based treatment, Multidimensional Family Therapy, with a multifaceted residential treatment, Adolescent Residential Treatment, over 4 years post-intake and to delineate the mechanisms of change for each treatment. The study targets dually- diagnosed adolescent drug abusers recommended for residential treatment.

Detailed Description
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Aim 1: To compare the effectiveness of residential treatment with outpatient, family-based treatment multiple outcomes including substance use, mental health, school functioning, family function and delinquency among dually diagnosed adolescents. Hypothesis 1. From intake to 2 months, residential treatment will show better outcomes than the family based treatment. Between 2 months and 18 months, family based treatment will show better outcomes than residential. Between 18 months and four years post intake, outpatient family based treatment will maintain its treatment gains, while the residential treatment condition will show an increase in these same symptoms and behaviors. Aim 2: To examine the relationship between predictors (family, peer, educational/vocational functioning and involvement in post-treatment services), and outcomes (drug use, co-morbid symptoms, and criminal behavior) during the four-year post intake period. Hypothesis 2a. Family functioning, educational/vocational functioning, and peer relationships measured at discharge will predict drug use, co-morbid symptoms, and criminal behaviors though the four year longer term follow up period. Hypothesis 2b. Family functioning, educational/vocational functioning, peer relationships, and involvement in post-treatment services during the post treatment period will predict drug use, co-morbid symptoms, and criminal behavior through the longer term follow up period. Research Question 1. Is the rate of change in family functioning, educational/vocational functioning, peer relationships, and involvement in post-treatment services related to the rate of change in drug use, co-morbid symptoms, and criminal behavior?

Official Title
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Family-Based Versus Adolescent Residential Drug Treatment

Conditions
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Substance Use, Delinquency

Intervention / Treatment
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* Behavioral: Multidimensional Family Therapy (MDFT)
* Behavioral: Adolescent Residential Treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Youth between the ages of 13 and 17 Referred to ATP for residential substance abuse treatment in youth dual diagnosis program Dually diagnosed for substance abuse or dependence and at least one of the following co-morbid conditions: major depressive disorder, bipolar disorder, I conduct disorder, oppositional defiant disorder, At least one parent or parent-figure can be located at the time of referral. Obtain informed consent from a parent or formal guardian and assent from youth to participate in the study. Exclusion Criteria: Have any of the following disorders: Mental Retardation, Eating Disorders, Schizophrenia, or Pervasive Developmental Disorders. Current suicidality.

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multidimensional Family Therapy (MDFT)<br>MDFT is an intensive, in-home family-based drug abuse treatment for adolescent substance abusers. MDFT views family factors in their context -in terms of the network (individual, familial, peer, community) or multiplicity of influences on drug use and change. | Behavioral: Multidimensional Family Therapy (MDFT)<br>* MDFT assesses and intervenes in five domains: 1) Interventions with the adolescent, 2) interventions with the parent, 3) interventions to improve the parent-adolescent relationship, 4) interventions with other family members, and 5) interventions with external systems.<br>|
| Other: Adolescent Residential Treatment<br>The Adolescent Treatment Program (ATP) is a residential dual diagnosed substance abuse treatment program that is staff secure. It is based on a social learning approach which emphasizes positive reinforcement for appropriate coping behavior and social skills, and incorporates a levels system which allocates privileges and responsibilities according to the individual's behavioral capacities. | Behavioral: Adolescent Residential Treatment<br>* The Adolescent Treatment Program targets the adolescent's abuse or dependency on chemicals while simultaneously treating the comorbid symptomatology found in dual diagnosed patients. These goals are accomplished by using four primary forms of intervention: (1) Chemical Education; (2) Group, Individual and Family Counseling; (3) Twelve Step Work; and 4) Psychotropic Medication for Clinical Symptomatology Comorbid with Substance Abuse.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Personal Involvement with Chemicals | Scale from the Personal Experience Inventory (PEI) developed by Ken Winter. | Baseline, 2, 4, 12, 18, 24, 36 and 48 months after baseline | 
| Change in substance use consumption | Measure of substance use consumption as measured by the Timeline Follow-back Method. | Baseline, 2, 4, 12,18,24,36,48 months after intake | 
| Change in externalizing symptoms | Externalizing symptoms measured by the Youth Self Report | Baseline, 2, 4, 12, 18, 24, 36 and 48 months | 
| Change in delinquency | Measured by youth report on the Self Report Delinquency Scale. | Intake, 2, 4, 12, 18, 24, 35, 48 months after intake | 
| Change in internalzing symptoms | Measured by the Youth Self Report (YSR) | Intake, 2, 4, 12, 18, 24, 36, 48 months after baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in family conflict | Parent and youth report on their family conflict as measured by the Family Environment Scale. | Baseline, 2, 4, 12, 18, 24, 36, 48 months after baseline | 
| Change in parenting practices | Measures the extent to which parents monitor, set limits, and provide affection to their teens. | Baseline, 2, 4, 12, 18, 24,36, 48 months after baseline | 
| Change in family cohesion | Youth and parent reports of family closeness measured by the Family Environment Scale (FES) | Intake, 2, 4, 12, 18, 24, 26, 48 months after intake | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Adolescents, Residential Treatment, Outpatient Treatment, Substance Abuse, Delinquency, Family Therapy, Multidimensional Family therapy