Disruptive behavior disorders (DBDs), which include Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder, are among the most robust risk factors for the development of the early onset type of substance abuse and dependence. However, manualized treatments that target early substance use and abuse, as well as the symptoms and impairments of the DBDs collectively, remain to be developed. The current Development/Exploratory (R21) research proposal seeks to develop a home-based behavioral intervention or Home Based Therapy (HBT) for early adolescents that halts the progressive development of the early onset substance abuse that is often associated with the DBDs. The proposal is composed of two study phases. Preliminary treatment development and standardization activities will occur in Phase I of the protocol in pilot work with 12 adolescents and their families. In Phase II, 36 patients with a DBD and sub-diagnostic use or abuse of one or more substances will be randomly assigned to treatment using either standard treatment for DBDs in this age group or the newly developed intervention. Treatment outcomes for the 24 patients assigned to receive the study intervention will then be compared to outcomes for the 12 patients assigned to receive standard treatment. The intervention includes three major components: (1) parent training in skills which have been shown to reduce oppositional behavior and conduct problems, including parent-adolescent communication skills, parent discipline practices and increased monitoring of adolescent behaviors; (2) home-based interventions with the adolescent designed to improve a range of skills typically deficient among teens with conduct, ADHD, and substance abuse problems (e.g., organizational skills, communication skills, problem-solving skills, relapse prevention, etc.); and (3) parent-teenager negotiation training in family-based sessions to improve communication and problem-solving skills between parents and adolescent. These components will be administered through weekly sessions over 12 weeks with 3 monthly booster sessions over 12 subsequent weeks. These interventions are expected to improve not only substance abuse outcomes, but a range of impairments and symptoms associated with the DBDs and high risk for the early onset type of substance use disorder.
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