Adolescent drug abusers are particularly at high risk for a host of problems, such as HIV-related behaviors, for themselves and their families. Unfortunately, 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. While the juvenile justice system represents a prominent path linking drug-abusing adolescents with treatment services, only one fifth of the adolescents who need treatment each year are apprehended by the legal system. As a result, large numbers of youth in need of treatment go undetected by the most typical entry way into the system. Moreover, 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. These adolescents represent a sizeable and, heretofore, overlooked population of treatment-elusive youth. 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. The proposed study will improve upon our prior work by using a group format to provide a less costly procedure for engaging youth into treatment 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. The proposed pilot research 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 CBT 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 session 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.
There is a profound gap in treatment services for adolescents abusing or dependent on illicit drugs with a risk of HIV or other sexually transmitted diseases given that over 92% of them do did not receive treatment. The proposed study is designed to teach family members to recruit such adolescents into treatment, an innovative strategy that has both short and long term positive implications for public health.