Child Sexual Abuse (CSA) is one of the strongest and most consistent predictors of adolescent problems. Youth who have experienced CSA are at significant risk for early initiation, use, and abuse of substances. For example. research has indicated that adolescent CSA victims are over 3.5 times more likely to report marijuana abuse/dependence compared to non-CSA victims. Other negative sequelae, such as posttraumatic stress disorder (PTSD) and HIV sexual risk behaviors, also have been clearly linked with CSA. Remarkably, no behavioral interventions have been developed and rigorously evaluated for this population that: a) take an integrated approach to targeting such sequelae through use of existing empirically supported interventions;and b) incorporate risk reduction for less symptomatic youth. Risk reduction and treatment tailored to adolescent CSA victims, which addresses the individual, family, and community risk and resiliency factors for adolescent substance use problems and incorporates exposure-based treatment for PTSD symptoms, as well as evidence based prevention interventions for HIV-related sexual behaviors, and is warranted. Risk Reduction through Family Therapy (RRFT) has been developed by the PI, a NIDA-K awardee (K23DA018686) and Early Stage Investigator, for this purpose. Preliminary findings from a Stage 1a feasibility trial and a Stage 1b pilot randomized controlled trial (RCT) are promising, indicating that RRFT can be readily learned and implemented with fidelity, and that it can lead to improvements in drug use and drug use-related risk and protective factors, PTSD symptoms, and HIV sexual risk behaviors (Danielson et al., 2010). In following NIDA's recommended stage model of behavioral therapy development, the overall goal of this application is to conduct a Stage II RCT to more rigorously evaluate the efficacy of RRFT (vs. Treatment As Usual) from pre-treatment through 18 months. The first specific aim of the proposed study is to evaluate the efficacy of RRFT in reducing substance use problems and prognostic factors among CSA victims experiencing trauma-related symptoms. The second specific aim is to evaluate the efficacy of RRFT in reducing PTSD and HIV sexual risk behaviors among this population. In order to better make maximum use of the data from this proposed efficacy trial and to inform potential next steps in this line of treatment research (per NOT-DA-019), preliminary investigation on mechanisms of action in RRFT also will be pursued as an exploratory aim. Specifically, intermediate targets of RRFT, such as parenting practices and emotional reactivity, as putative mechanisms of action for improvements in substance use and PTSD and risky sexual behaviors will be explored. The results of the proposed study will have a significant impact on public health by informing intervention efforts for the multifaceted clinical needs of adolescent CSA victims, who are at high risk for drug use, HIV infection, other problems in adolescence and adulthood. Demonstrating the efficacy of this promising risk reduction and treatment approach could provide a valuable clinical tool for community-based therapists.
Given the high prevalence of adolescent substance abuse and the costly, debilitating impact of substance use problems, including increased engagement in HIV sexual risk behaviors, for which adolescent CSA victims are at heightened vulnerability, the proposed work is highly relevant to public health needs. The current study will improve clinical practice by offering: 1) a more efficient alternative to the current compartmentalized approach to treatment of this population;and 2) a risk reduction option for youth who are at elevated risk for substance abuse, HIV infection, and related mental health problems in the future, but may not be currently meeting diagnostic threshold.
|Danielson, Carla Kmett; Cohen, Joseph R; Adams, Zachary W et al. (2017) Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents. J Abnorm Child Psychol 45:117-129|
|W Adams, Zachary; McClure, Erin A; Gray, Kevin M et al. (2017) Mobile devices for the remote acquisition of physiological and behavioral biomarkers in psychiatric clinical research. J Psychiatr Res 85:1-14|
|Danielson, Carla Kmett; Sumner, Jennifer A; Adams, Zachary W et al. (2017) Adolescent Substance Use Following a Deadly U.S. Tornado Outbreak: A Population-Based Study of 2,000 Families. J Clin Child Adolesc Psychol 46:732-745|
|Bountress, Kaitlin; Adams, Zachary W; Gilmore, Amanda K et al. (2017) Associations among impulsivity, trauma history, and alcohol misuse within a young adult sample. Addict Behav 64:179-184|
|Cohen, Joseph R; Adams, Zachary W; Menon, Suvarna V et al. (2016) How should we screen for depression following a natural disaster? An ROC approach to post-disaster screening in adolescents and adults. J Affect Disord 202:102-9|
|Cohen, Joseph R; Danielson, Carla Kmett; Adams, Zachary W et al. (2016) Distress Tolerance and Social Support in Adolescence: Predicting Risk for Internalizing and Externalizing Symptoms Following a Natural Disaster. J Psychopathol Behav Assess 38:538-546|
|Danielson, Carla Kmett; McCauley, Jenna L; Gros, Kirstin Stauffacher et al. (2016) SiHLEWeb.com: Development and usability testing of an evidence-based HIV prevention website for female African-American adolescents. Health Informatics J 22:194-208|
|Adams, Zachary W; McCauley, Jenna L; Back, Sudie E et al. (2016) Clinician Perspectives on Treating Adolescents with Co-occurring Post-Traumatic Stress Disorder, Substance Use, and Other Problems. J Child Adolesc Subst Abuse 25:575-583|
|Ruggiero, Kenneth J; Bunnell, Brian E; Andrews Iii, Arthur R et al. (2015) Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment. JMIR Res Protoc 4:e143|
|Adams, Zachary W; Danielson, Carla Kmett; Sumner, Jennifer A et al. (2015) Comorbidity of PTSD, Major Depression, and Substance Use Disorder Among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri. Psychiatry 78:170-85|
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