Skills and Motivation at the Rhode Island Training School (Project SMART) - 1

This proposal is in response to RFA-DA-04-008, Group Treatment for Individuals in Drug Abuse
or Alcoholism Treatment. Of particular interest to the agencies are group therapies for
Conduct Disordered adolescents, reducing the spread of infectious disease, and mechanisms of
action. This proposal targets these areas of interest. This study will focus on treating
substance abusing incarcerated teens using 2 individually administered Motivational
Interviewing (MI) sessions followed by 10 group sessions of Cognitive Behavior Therapy
(CBT). MI is conceptualized as preparation for group CBT. The control group receives
individualized Relaxation Training (RT) followed by group Treatment as Usual (TU).
Currently, there is little research regarding effective group treatments for incarcerated
teens and this study will address this gap in our knowledge base.

In this proposed randomized trial, a one-way design (MI/CBT vs. RT/TU) will be used to
determine whether MI/CBT enhances group therapy participation and reduces substance use and
related problems (such as crime, injuries and unprotected sex) post discharge in
substance-involved juvenile delinquents. RT/TU is based on the 12-step model and includes
psycho-educational components. Participants are followed during incarceration and for 12
months post incarceration. Primary outcome variables include alcohol and marijuana use, as
well as related behaviors (illegal activity, sex or injuries while drunk or high). It is
hypothesized that in comparison to teens in RT/TU, youth receiving MI/CBT will participate
more in therapy (according to teen, facility staff, and counselor ratings) and will show
lower levels of substance use and related problems after discharge.

Frequently, substance abuse treatment is unavailable to youths in the juvenile justice
system, and when treatment is available, it may be provided in group format using untested
therapies. A motivation/skills-based intervention (delivered in group format) may prove
efficacious in enhancing motivation and in reducing substance abuse and related problems.
This study extends previous research by rigorously evaluating group treatment for
incarcerated teens. We will examine processes contributing to the efficacy of group MI/CBT,
and the influence of race and ethnicity on treatment effects. The development of effective
interventions for substance using juvenile offenders has the potential to reduce substance
abuse and crime in this population.

Inclusion Criteria:

Teens will be included if they meet any of the following criteria: 1) in the year prior to
incarceration they used marijuana regularly (at least monthly); 2) in the year prior to
incarceration they drank regularly (at least monthly) or binged (>=5 for boys; >=4 for
girls); 3) they used marijuana or drank in the 4 weeks before the offense for which they
were incarcerated; or 4) they used marijuana or drank in the 4 weeks before they were
incarcerated.

Exclusion Criteria:

Those teens sentenced for less than 4 months or greater than 12 months will be excluded
from participation.