Multisystemic Therapy-Emerging Adults (MST-EA) for Substance Abuse

Prevalence of alcohol and other drug (AOD) abuse and criminal activity is highest during
emerging adulthood compared to any other developmental period, and causes extraordinary costs
to society. Emerging Adults (EAs; ages 17-21) with AOD abuse have greater incarceration rates
than EAs without AOD abuse, and AOD-abusing offenders have significantly more recidivism,
severe offending, and incarceration than other offenders. Such serious behavior interferes
with successful transition into adulthood in areas such as school completion, employment and
housing. Thus, there is a strong public health need for effective treatment to reduce AOD
abuse and justice involvement in EAs. Surprisingly, there are no interventions with
established efficacy to reduce criminal activity among EAs, with or without AOD abuse. Among
younger adolescents, the comprehensive causes of antisocial behavior are addressed by
effective interventions (e.g., Multisystemic Therapy [MST]; Treatment Foster Care Oregon
[TFCO]), and the present investigative team has developed and evaluated a well-defined
age-tailored intervention for EAs with criminal behavior. The developed intervention is an
adaptation of MST and integrates a skills coaching component from TFCO, both well-established
effective juvenile justice interventions. Initial MST-EA research focused on justice-involved
young adults who had mental health problems, a high-risk subpopulation of offenders, but AOD
abuse quickly became a primary problem the MST-EA team treated. As a single-source
intervention, MST-EA targets the EA correlates of criminal activity and AOD abuse, including
gainful EA activities (positive relationships, school, work, and housing) and reduced AOD
abuse—in part by targeting the proximal mechanism of poor self-regulation. In a successfully
completed community-based open trial, the safety, feasibility, and preliminary efficacy of
the intervention were established.

The proposed study will evaluate the effectiveness of MST-EA for reducing justice involvement
and AOD abuse. EAs (n = 240) with AOD abuse and justice involvement (recent arrests or
release from justice facilities) will be randomized to receive MST-EA or Enhanced Treatment
as Usual (E-TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with
confirmation of outcome data using collateral reports and official records. Aims will be to
evaluate the effect over time of MST-EA for reducing AOD abuse and criminal activity, as well
as to evaluate the effect of MST-EA on the key proximal target of treatment (self-regulation)
and intermediate outcomes of treatment (gainful activities). A final aim of the study will be
to investigate if the direct effect of treatment on criminal activity is mediated by its
effect on self-regulation, AOD abuse, and gainful activities. In this specific age group,
there is a complete absence of AOD abuse and recidivism reduction treatments with
demonstrated effectiveness. The ultimate effect of the proposed research would be decreased
AOD abuse and justice involvement in a high-risk population, as well as improved outcomes
that have significant societal impact (e.g., reduced homelessness and unemployment).

Inclusion Criteria:

- Age 17 to 21 years

- Recent arrest or release from jail/prison/detention (within the past 18 months but
excluding arrest for parole/probation violations)

- Presence of alcohol or drug (AOD) abuse disorder and recent AOD use (within the past
90 days)

- Able to reside in a stable community setting (not currently homeless, not currently
in-patient; can include individuals ready for discharge to the community)

Exclusion Criteria:

- Actively psychotic, suicidal, or homicidal

- Pervasive Development Disorders (PDD) or mental retardation

- Sex offending as the primary offense type