Individual vs. Group Community Reinforcement Training to Help Parents of Substance-using Treatment-refusing Youth

Very few youth with drug abuse or dependence in the United States receive treatment. This
population of untreated youth represents a massive "treatment gap" in adolescent health care
that renders impotent a potentially important avenue for preventing chronic drug abuse and
related difficulties. The lack of motivation for treatment characterizing most adolescent
drug abusers significantly decreases the likelihood these youth will enter treatment,
barring mandates from the legal system or other social institutions. Efficacy studies have
demonstrated that Community Reinforcement Training (CRT), an approach that involves teaching
parents how to engage their youth into treatment, can work to recruit 60-80% of these
treatment-elusive youth. CRT is traditionally provided in an individual therapy format to
one or both parents. This study will improve upon our prior work by using a group format to
provide a less costly procedure for engaging youth into treatment and to make it more
portable to treatment agencies, schools, juvenile justice, and other community organizations
seeking to offer support to parents or engage youth in treatment, thus significantly
increasing the adoption and sustainability of the approach.

This study will examine the efficacy of the group format (G-CRT) for helping parents engage
their unmotivated, resistant youth in treatment compared to the traditional individual
format (I-CRT). Parents (n = 60) will be randomly assigned to G-CRT or to I-CRT. We will
evaluate the differential efficacy of G-CRT, relative to I-CRT, on rates of adolescent
engagement in treatment. We expect that G-CRT, compared to I-CRT, will also be associated
with greater parent encouragement of adolescent sobriety, perceived social support, and
family functioning. We also predict that changes on these process variables will predict
increased success in engaging adolescents. We will also examine treatment outcomes for youth
engaged in Cognitive Behavioral Therapy as a function of parental involvement in G-CRT or
I-CRT. We predict enhanced support received by parents in G-CRT will result in greater
reductions in drug use and lower levels of HIV-risk behaviors, outcomes hypothesized to be
mediated by motivation to change and sessions attendance. Finally, we will conduct an
informal cost-effectiveness analysis to derive preliminary estimates of the relative costs
of each treatment modality per outcome unit and hypothesize that G-CRT will be more cost
effective than I-CRT by virtue of having higher clinical effectiveness and lower costs.
Successful outcomes here will provide the basis for a full clinical trial with larger
samples.

Inclusion Criteria:

- Parents have an adolescent between 15-20 years

- Parents have had contact with the adolescent on at least 40% of the past 12 weeks

- Parents have some knowledge or evidence that the adolescent would meet DSM-IV
diagnostic criteria for a substance use disorder

- Adolescent has explicitly refused to attend any intake or therapy sessions

- Adolescent is not under a current court mandate for treatment or has refused to
comply with the mandate

- English-speaking capability (parents and adolescents)

Exclusion Criteria:

- Evidence of adolescent psychotic or organic state of sufficient severity to interfere
with understanding of study instruments and procedures

- Adolescent had received drug treatment (except detoxification) in the past 12 weeks.