Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths,their families, communities, and society. Moreover, rates of psychiatric comorbidity among substanceabusing youth range from 25% up to 82%, and youths with a dual diagnosis are more than twice as costlyto treat compared to those with no comorbidity. Community-based treatment for these youth most often isdisjointed, with youth and families having to navigate separate treatment systems for the disorders or onlyreceiving treatment for a single disorder. Notably, multiple studies have shown that youth with co-occurringproblems have worse outcomes and return to pre-treatment levels of substance use more often and morerapidly than those without a psychiatric diagnosis. The applicant principal investigator, a new investigator,recently completed a NIDA-funded Stage I project focused on developing and piloting a psychosocialtreatment specifically for youth presenting for outpatient treatment with co-occurring substance use andinternalizing (i.e., mood and/or anxiety) problems. Results were promising with the experimental groupexhibiting significantly less substance use and more rapid reductions in anxiety and depressive symptomscompared to the control group. In addition, extensive treatment and therapist training manuals weregenerated. The proposed research is a Stage II randomized clinical trial (RCT) to compare theexperimental treatment (OutPatient Treatment for Adolescents; OPT-A) to an 'active placebo' on keyclinical indices from pre-treatment through 18 months. The proposed RCT (n = 160) employs the treatmentmanual, quality assurance protocol, and therapist training protocol developed and successfully piloted inthe Stage I 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. In addition toproviding a strong test of treatment efficacy, the proposed project will leverage the data collection of theRCT to provide a preliminary evaluation of putative mechanisms of action. In summary, this study willadvance a promising treatment developed through the Stage I behavioral therapies development programto a Stage II controlled trial. It builds on the treatment manual, therapist training materials, and qualityassurance system already developed. The intervention addresses one of the more prevalent and mostchallenging, 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-occurringsubstance use and internalizing disorders.

Public Health Relevance

Adolescent substance abuse results in significant negative outcomes and extraordinary costs for youths; theirfamilies; communities; and society. Moreover; rates of psychiatric comorbidity among substance abusing youthrange from 25% up to 82%; and youths with a dual diagnosis have worse outcomes and are more than twiceas costly to treat than their counterparts with no comorbidity. This project evaluates OPT-A; a treatment thathad promising results in NIDA-funded pilot testing; in a rigorous clinical trial.1

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Chambers, Jessica Campbell
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Oregon Social Learning Center, Inc.
United States
Zip Code
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