This application is being submitted in response to NIAAA PA-02-067 """"""""Treatment of Alcohol Abuse/Dependent Patients With Psychiatric Comorbidity"""""""". Adolescent alcohol abuse/dependence is a serious public health problem associated with life threatening outcomes. Among adolescents in alcohol/substance treatment, up to 67% exhibit suicidal ideation and 30% suicidal behavior. Integrated interventions that incorporate treatment of these co-occurring problems have not been tested with adolescents. The primary purpose of this proposal is to conduct a randomized Stage I trial to evaluate a manualized cognitive behavioral treatment protocol for adolescents with alcohol use disorder and co-occurring suicidality. Our long term objective is to yield a more effective and feasible outpatient treatment approach for adolescents with these co-occurring conditions. There are three primary aims in this project: 1) pilot and refine the manualized cognitive behavioral treatment protocol for adolescents with alcohol use disorders and co-occurring suicidality; 2) test this intervention in a small randomized trial to calculate an effect size for a future Stage II clinical trial; and 3) demonstrate feasibility and acceptability of this intervention relative to non-integrated treatment. To accomplish these aims, a two step sequence of treatment development is proposed. In Phase I therapists will be trained, cases will be piloted, and manual revisions will be made. Phase II will include a small randomized trial. Adolescents discharged from a psychiatric inpatient unit will be randomly assigned to the integrated cognitive behavioral treatment or the non-integrated treatment for their outpatient care, both provided by project staff. The integrated treatment will include 20 sessions of cognitive behavioral therapy, provided by one therapist, which integrates treatment of alcohol use and suicidality. The non-integrated treatment will include 12 sessions of cognitive behavioral therapy targeting suicidality and 8 sessions of psycho-educational group therapy targeting alcohol use, each provided by different therapists. Outcome will be assessed at the end of treatment and 6 months post-treatment. The proposed treatment is designed to address objectives18-10 and 18-2 of Healthy People 2010 to """"""""increase the proportion of persons with co-occurring substance abuse and mental disorders who receive treatment of both disorders"""""""" and """"""""reduce the rate of suicide attempts by adolescents"""""""".
| Esposito-Smythers, Christianne; Walsh, Adam; Spirito, Anthony et al. (2012) Working With the Suicidal Client Who Also Abuses Substances. Cogn Behav Pract 19:245-255 |
| Esposito-Smythers, Christianne; Spirito, Anthony; Kahler, Christopher W et al. (2011) Treatment of co-occurring substance abuse and suicidality among adolescents: a randomized trial. J Consult Clin Psychol 79:728-39 |
| Esposito-Smythers, Christianne; Goldston, David B (2008) Challenges and opportunities in the treatment of adolescents with substance use disorder and suicidal behavior. Subst Abus 29:5-17 |
| Esposito-Smythers, Christianne; Spirito, Anthony; Uth, Rebecca et al. (2006) Cognitive behavioral treatment for suicidal alcohol abusing adolescents: development and pilot testing. Am J Addict 15 Suppl 1:126-30 |
