Cognitive-Behavioral Intervention for Depressed, Substance-Abusing Adolescents: Development and Pilot Testing

doi:10.1097/01.CHI.0000046861.56865.6C

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 42, Issue 6, June 2003, Pages 656-665

https://doi.org/10.1097/01.CHI.0000046861.56865.6C Get rights and content

ABSTRACT

Objectives

To develop a cognitive-behavioral treatment for depressed, substance-abusing adolescents, determine its feasibility, and test its association with symptomatic improvement.

Method

Based on the efficacy of cognitive-behavioral interventions for either adolescent depression or substance abuse, an integrated group and family therapy intervention was developed for adolescents with both problems. The developers treated a group of six adolescents and families, and then trained experienced therapists to deliver the treatment to a second group of seven. Adolescents were 14 to 18 years of age. Measures of depression and substance abuse were collected before, during, and after treatment.

Results

High retention in treatment and attendance at sessions supported feasibility. Parent interviews demonstrated significant improvement in adolescent substance abuse, and adolescent measures demonstrated significant improvement in both domains.

Conclusions

Integrated outpatient cognitive-behavioral intervention is feasible and associated with improvement for depressed, substance-abusing adolescents. Controlled efficacy studies are needed. Additional treatment modalities will be required for a proportion of these adolescents.

Section snippets

Theoretical and Empirical Foundation

Our treatment program, Family and Coping Skills (FACS) therapy, is based in cognitive-behavioral family theory and research. Deficiencies in social cognitive processes have been identified in substance-abusing and in depressed adolescents and their families. Such deficiencies are targets of treatment in FACS therapy. Compared with other adolescents, substance abusers have less impulse control, poorer problem-solving skills, poorer affect regulation and assertion skills, and more positive

Subjects

Thirteen adolescents and one (n = 4) or both parents (n = 9) participated. The adolescents included one African-American male, five white females, and seven white males (mean age = 16.16 years, SD = 1.34 years). Nine adolescents lived with one parent and four with both parents. Socioeconomic status, based on the 7-point Hollingshead (1975) index of parents’ occupations, was middle class (mean = 3.3; range = 1–5). The first group included three white males, two white females, and one

Pretreatment Diagnoses

CAPA diagnoses based separately on the adolescent and on the parent interviews are included in Table 1. All 13 adolescents met full diagnostic criteria for definite or probable (one symptom less than definite) depression diagnosis on either the adolescent or parent interview, and 12 of 13 met criteria for a substance use disorder. The remaining subject was retained because of very strong evidence of substance abuse on the initial clinical interview.

Of the 16 diagnoses assessed by the CAPA

DISCUSSION

Results of this open pilot study suggest that outpatient cognitive-behavioral intervention is feasible and is associated with short-term improvement in target symptoms for depressed, substance-abusing adolescents. The intervention included group and family modalities, telephone contacts, and additional sessions as needed. Thus FACS therapy is an intensive outpatient form of treatment, requiring active therapist involvement and availability. Retention in treatment was in the very high range for

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This research was supported by grant DA08931 from the National Institute on Drug Abuse. The authors thank David Brent, M.D., Gregory Clarke, Ph.D., Thomas Dishion, Ph.D., Lorraine Collins, Ph.D., and Gayle Belsher, Ph.D., who consulted in treatment and manual development.

Article Plus (online only) materials for this article appear on the Journal's Web site: www.jaacap.com. Treatment manuals are available from Dr. Curry.

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ARTICLESCognitive-Behavioral Intervention for Depressed, Substance-Abusing Adolescents: Development and Pilot Testing

ABSTRACT

Objectives

Method

Results

Conclusions

Section snippets

Theoretical and Empirical Foundation

Subjects

Pretreatment Diagnoses

DISCUSSION

J Am Acad Child Adolesc Psychiatry

Biol Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Psychiatr Res

J Subst Abuse Treat

J Am Acad Child Adolesc Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

A test-retest reliability study of child-reported psychiatric symptoms and diagnoses using the Child and Adolescent Psychiatric Assessment

Psychol Med

Youth drug abuse treatment: a controlled outcome study

J Child Adolesc Subst Abuse

Cognitive Therapy for Substance Abuse

Life Skills Training

Long-term follow-up results of a randomized drug abuse prevention trial in a white middle-class population

JAMA

ARTICLES
Cognitive-Behavioral Intervention for Depressed, Substance-Abusing Adolescents: Development and Pilot Testing