Community-Based Integrated Treatment for Adolescents

Studies have consistently shown that alcohol use disorders (AUDs) and mental health disorders
are related in adolescence. For example, in a community sample, teens who reported a history
of AUD were almost four times as likely to have a history of Major Depressive Disorder (MDD)
than teens with no history of AUD. The scientific community has only recently begun to
examine how to treat adolescents with both AUD and MDD. Reviews have concluded that
depression negatively affects treatment for substance abuse. At the same time, substance use
issues are often not assessed or addressed in outpatient psychotherapy. Thus, we believe that
protocols are needed to specifically address substance abusing, depressed adolescents. This
study is designed to determine if an integrated (CBT-I) protocol designed to treat both
substance use and depression in adolescents aged 12 to 18 years with AUD/MDD will produce
better treatment outcomes compared to standard care (CBT-SC). Both the integrated CBT-I and
CBT-SC conditions will be delivered by licensed mental health workers at a community mental
health clinic - Gateway - that uses an Intensive Outpatient Program (IOP) model to treat
adolescents with AUD and mental health disorders. Two hundred adolescents (50 per year for 4
years) will be recruited from Gateway's Dual Diagnosis IOP. If an adolescent screens in by
reporting both depressed mood and substance abuse, these eligible families will complete a
thorough baseline assessment and will then be assigned to either CBT-I or CBT-SC. The
baseline battery will be repeated at the end of treatment, and 6 and 12 months after
treatment completion to determine how families in the study do over time.

Inclusion Criteria:

- English speaking adolescent and parent

- Current substance use disorder

- Co-occurring psychiatric symptomatology

Exclusion Criteria:

- IQ < 80

- Diagnosis of psychotic disorder, pervasive developmental disorder,
obsessive-compulsive disorder, bulimia nervosa or anorexia nervosa

- Adolescent use of illicit "hard" substances such as cocaine, heroine, and opiates 13
or more times over the prior 90 days