The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: results of a small randomized controlled trial

Abstract

Objective: The purpose of this randomized trial was to investigate the efficacy of 2 behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs.

Methods: Forty adolescents 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for borderline personality disorder and substance use disorders were randomized to integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) or individual drug counseling. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and estimate treatment effect sizes.

Results: Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youths were the only group to show reductions in substance use, but they only did so if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population.

Conclusions and implications for practice: Results highlight the intensive treatment needs of juvenile justice-involved youths with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family-oriented approach, particularly for youths with severe symptoms and co-occurring depression. (PsycINFO Database Record

Figure 1

CONSORT participant flow diagram. Analysis of clinically significant change used multiple imputation for cases with data missing at the 12-month follow-up.

Figure 2

Estimated number of outpatient sessions and residential sessions during the treatment and follow-up phases. (N=40)

Figure 3

Estimated proportions of cases with clinically significant change in borderline behavior. Recovered = clinically significant improvement in behavior from baseline to 12 months and, functioning in the “normal” range at 12 months. Improved = clinically significant improvement in behavior from baseline to 12 months and, but functioning in the “impaired” range at 12 months. Unchanged, non-clinical = no statistically reliable change in behavior from baseline and 12 months, and scores in non-clinical range at 12 months. Unchanged, clinical = no statistically reliable change in behavior from baseline and 12 months, and scores in clinical range at 12 months. Deterioration = clinically significant worsening in behavior from baseline to 12 months. I-BAFT − = adolescents without co-morbid depression in I-BAFT. I-BAFT + = adolescents with co-morbid depression in I-BAFT. IDC − = adolescents without co-morbid depression in IDC. IDC + = adolescents with co-morbid depression in IDC. (N=40)

Figure 4

Estimated proportions of cases with clinically significant change in substance use. Recovered = reduced use from baseline to 12 months and abstinence at 12 months. Improved = reduced use from baseline to 12 months, but not abstinent at 12 months. Unchanged, clean = no use at either baseline and 12 months. Unchanged, dirty = same level of use at baseline and 12 months. Deterioration = increased use from baseline to 12 months. I-BAFT − = adolescents without co-morbid depression in I-BAFT. I-BAFT + = adolescents with co-morbid depression in I-BAFT. IDC− = adolescents without co-morbid depression in IDC. IDC + = adolescents with co-morbid depression in IDC. (N=40)