Research That Matters (January 17 - 20, 2008)

The treatment of dually diagnosed adolescents is challenging for many reasons, including complex treatment needs, poor treatment engagement and retention, and a lack of sustainable treatment outcomes. While a large percentage of adolescents are diagnosed with both substance abuse and mental health diagnoses, research is only beginning to identify effective treatments for this population. The current study systematically reviewed randomized clinical trials of interventions for dually diagnosed adolescents. Specifically, this study aimed to answer: 1) What is the evidence in support of each intervention as an effective treatment for dually diagnosed adolescents? 2) What degree of change is associated with each intervention? and 3) Examining the common factors among treatments with demonstrated effectiveness, what are preliminary guidelines for treatment?

Methods:

The current study involved a comprehensive database search of ERIC, PsycINFO, MedLine, Social Services Abstracts, and Social Work Abstracts, searching the following terms: adolescent, youth, teen, juvenile, substance abuse, drug abuse, treatment outcome, intervention, efficacy, mental health, co-occurring, dual diagnosis, and comorbid. Review criteria included randomized clinical trials of treatments for dually diagnosed disordered youth peer-reviewed in the past 10 years. Independent groups pretest-posttest effect sizes were used to examine differences between treatment and control groups, and repeated measure effect sizes were used to examine individual change. These analyses were conducted for three outcomes: externalizing problems, internalizing problems, and substance use problems.

Results:

Results examining both between group effect sizes as well as clinically significant change indicate the efficacy of several treatment modalities in improving specific aspects of treatment needs. For example, Multisystemic Therapy had a large within group effect size for externalizing problems (d=.81), and Cognitive Behavior Therapy had large within group effect sizes for internalizing problems (d=1.14) and substance abuse (d=.88). However, two treatments are highlighted – Family Behavior Therapy (FBT) and Individual Cognitive Problem-Solving Therapy (ICPS) – as showing large within group effect sizes (d >.80) across externalizing, internalizing, and substance abuse outcomes in dually diagnosed youth. Furthermore, both FBT and ICPS demonstrated sustainability of large effects at 9-months post treatment across outcomes.

Discussion:

The current study reviewed therapeutic interventions for their effectiveness in changing dually diagnosed adolescents' internalizing, externalizing and substance use problems. Results highlight FBT and ICPS as particularly effective in changing individuals' behaviors across all three of these outcomes. Recognizing that dually diagnosed youth are likely struggling with two or more of these problems simultaneously, FBT and ICPS offer evidence of successful interventions for treating this complex and vulnerable population. With few existing clear guidelines for treating dually diagnosed youth, the current study identified common threads across effective treatment modalities, thereby creating preliminary data-driven guidelines. Examples of such guidelines include: strategically enhancing engagement and retention, integrating mental health and substance abuse approaches concurrently, including important others such as family, friends, and school personnel, and using goal directed and here-and-now focused interventions. Finally, the current study discusses the complexities of systematically evaluating the currently limited state of research on dually diagnosed youth.