Learning Effective Approaches to Prevention

Despite the success of family-based ecological interventions (FBEI) in controlled trials,
this highly promising services approach has not been tested under pure field conditions with
ASA populations. Controlled effectiveness research invariably enhances training,
supervision, and service delivery conditions in partnering sites in an effort to ensure
treatment adherence and consistency. An alternative strategy for advancing dissemination
science is rigorous naturalistic research on community clinics that already implement
evidence-based practices in the course of routine care. The proposed study will follow this
"bottom up" strategy by investigating the quality and impact of ASA services delivered by
front-line therapists in a community-based mental health center that already features FBEI
as the routine standard of care. The study will use a randomized design to compare
naturalistic FBEI services to services as usual (SAU) for ASA. Participants (N = 260) will
be recruited from local high schools, enrichment programs, and juvenile justice programs.
Eligible adolescents will meet ASAM criteria for outpatient treatment. The SAU condition
will contain the three most common service venues for ASA in urban communities:
hospital-based ambulatory mental health clinics, drug counseling/addictions specialty
clinics, and community mental health centers. The primary aims of the study are to examine
the effectiveness of FBEI versus SAU and to compare the strength of FBEI adherence and
outcomes to performance benchmarks set during a previous FBEI Stage II efficacy trial. The
secondary aims are to compare cost effectiveness, services utilization, and consumer
satisfaction in FBEI versus SAU. A multitrait, multimethod assessment design will include
adolescent and parent interviews at baseline and 3, 6, and 12 months follow-up. Cost and
service utilization data will be collected from self report and from provider agencies in
both conditions. The study will yield the first evidence on whether a widely endorsed
treatment approach for ASA is potent and feasible in real-world conditions and superior to
SAU in outcomes and cost-benefit. An important secondary yield will be increasing the scarce
knowledge base on commonly practiced community approaches in the SAU condition.

Inclusion Criteria:

1. ages 13 and 17,

2. have a caregiver willing to participate in treatment,

3. meet ASAM criteria for outpatient or intensive outpatient substance abuse treatment,

4. not receiving any other behavioral treatment, and

5. have public or private health benefits that meet standard community clinic
registration requirements.

Exclusion Criteria:

1. mental retardation,

2. pervasive developmental disorder,

3. medical or psychiatric illness requiring hospitalization,

4. current psychotic features, or

5. current suicidality (Ideation + Plan + High Intention).