A randomized trial of an integrated cognitive behavioral treatment protocol for adolescents receiving home-based services for co-occurring disorders

Highlights

• Community mental health clinic staff were trained and supervised in an integrated, cognitive-behavioral treatment (I-CBT) protocol addressing co-occurring substance use and psychiatric symptoms in adolescents referred for treatment.

• Preliminary results suggest there was a small, nonsignificant reduction in the percent days of heavy drinking and marijuana use days over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition.

• There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety favoring the I-CBT condition.

• An overall positive, significant effect across the three follow-up points was found on juvenile justice contacts favoring the I-CBT condition compared to standard community clinic care.

• A modified treatment and training protocol emphasizing working with parents may be necessary to achieve stronger outcomes for adolescents with co-occurring substance use and mental health problems treated in a community mental health setting.

Abstract

The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12–18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education–style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.