Research on Outpatient Adolescent Treatment for Comorbid Substance Use and Internalizing Disorders

Adolescent substance abuse results in significant negative outcomes and extraordinary costs
for youths, their families, communities, and society. Moreover, rates of psychiatric
comorbidity among substance abusing youth range from 25% up to 82%, and youths with a dual
diagnosis are more than twice as costly to treat compared to those with no comorbidity. The
applicant principal investigator recently completed a pilot project funded by the National
Institute on Drug Abuse focused on developing and piloting a psychosocial treatment
specifically for youth presenting for outpatient treatment with co-occurring substance use
and internalizing (i.e., mood and/or anxiety) problems. Results were promising with the
experimental group exhibiting significantly less substance use and more rapid reductions in
anxiety and depressive symptoms compared to the control group. The proposed research is a
randomized clinical trial (RCT) to compare the experimental treatment (OutPatient Treatment
for Adolescents; OPT-A) to an "active placebo" on key clinical indices from pre-treatment
through 18 months. The proposed RCT (n = 160) employs the treatment manual, quality
assurance protocol, and therapist training protocol developed and successfully tested in the
pilot study, to evaluate the efficacy of OPT-A for youth referred to outpatient treatment of
co-occurring substance use and internalizing problems. The following outcomes will be
evaluated: drug use; mental health; behavioral, school, peer, and family functioning; and
consumer satisfaction. The intervention addresses one of the more prevalent and most
challenging, costly, and understudied presenting problems among adolescent outpatients. If
successful, this research could provide a considerable contribution in the treatment field
for youth with co-occurring substance use and internalizing disorders.