Youth Drug Abuse Family and Cognitive-Behavioral Therapy

This Stage II study is in response to NIDA's Behavioral Therapies Development Program
(PA-99-107). A randomized clinical trial is proposed to evaluate the direct, mediated, and
moderated effects of Integrated Family and Cognitive-Behavioral Therapy (IFCBT), a
multisystems treatment for adolescent drug abuse with promising efficacy results. In the
first study aim, we seek to evaluate the separate and possibly synergistic effects of family
systems and cognitive-behavioral IFCBT components on posttreatment drug abuse problem
severity, problem behavior, psychiatric distress, and academic achievement of adolescent
drug abusers. Innovative analytic strategies are subsequently used to evaluate the degree to
which successful outcomes are attributable to specific familial and cognitive-behavioral
change processes targeted by IFCBT components. The possibility of effect-modification also
is considered, with a focus on neurocognitive, psychiatric comorbidity, and demographic
factors. Namely, we seek to understand how variations in specific client characteristics,
such as executive dysfunctions or psychiatric comorbidity, might explain why treatments work
for some drug abusing youths but not others. In addition to promising findings on IFCBT
efficacy, this Stage II proposal benefits from the development and Stage I study application
of (a) treatment manuals; (b) therapist training procedures; (c) therapist adherence and
competence tools; (d) a neuropsychological battery to assess cognitive functions; (e) a
psychodiagnostic battery to assess comorbid psychiatric disorders; and (f) a study
assessment battery comprised of therapeutic process and outcome measures. This revised
application has sought to address well-taken concerns cited by the reviewers while
maintaining proposal strengths. The lack of adolescent drug treatment research continues to
be a serious gap in the addictions literature despite alarmingly high rates of drug abuse
among youth and the range of morbidities and mortality that result nationwide. If
successful, this project should help to identify specific behavior change processes targeted
by family systems and cognitive-behavioral treatments that foster subsequent reductions in
drug use and problem behavior among recovering youth. Neurocognitive and psychiatric
influences on adolescent drug treatment outcomes appear to be significant yet are poorly
understood. Increasing our understanding of relationships between client characteristics,
skill development during treatments, and subsequent outcomes should also help to improve
adolescent drug treatments.