This is an application for a Scientist Development Award for Clinicians to enhance the applicant's skills in the development and testing of promising new approaches for the treatment of adolescent substance abusers (ASA) with comorbid psychiatric disorders. Studying more homogeneous subpopulations of ASA, such as dually diagnosed adolescents (DDA), should help to broaden knowledge concerning subtypes of ASA. It may also enhance research focusing on the special treatment needs of DDA, a large underserved segment of the ASA population. As a child and adolescent psychiatrist specializing in ASA, the applicant is experienced in clinical interventions and small scale clinical research. However, to achieve the applicant's long-term goal of research that encompasses patient-treatment matching, additional training is sought from preceptors specialized in the conduct of psychosocial and pharmacological treatment research, and specifically, empirical data management, analysis, and interpretation. The candidate will pursue this goal by administering a sequential set of studies examining ASA treated with psychosocial or pharmacological methods. The applicant proposes an approach that combines two strategies that have been successfully applied to adult substance abusers, and which have been adapted to the needs of ASA. The first strategy is the """"""""technology model"""""""" of psychotherapy research, which calls for the use of manual-guided psychosocial interventions. The second strategy involves the administration of psychotropic medications to DDA either exclusively or adjunct to psychosocial interventions. Three separate studies are proposed to evaluate these strategies. The psychosocial intervention research will involve two studies, which will enroll about 90 patients. Manuals for cognitive-behavioral coping skills (CBT) and for modified dynamic short- term interactional therapy (STI) in groups will be tested and refined in the first study, and then finalized and retested in the second study. The pharmacological study, which will involve 30 patients, will test the feasibility, safety, and potential efficacy of pharmacotherapy in DDA--in particular, those with major depressive disorder. In addition, two data sets obtained from a population of ASA and a cohort of adolescents with high family risk for alcohol dependence will be analyzed to formulate adolescent subtyping.
