Predictors and moderators of marijuana and heavy alcohol use outcomes in adolescents treated for co-occurring substance use and psychiatric disorders in a randomized controlled trial.

Abstract

BACKGROUND\nThe current study identifies predictors and moderators of substance use outcomes for 111 adolescents with co-occurring substance use and psychiatric disorders who participated in a randomized controlled trial that compared the effectiveness of two home-based treatments: an integrated cognitive behavioral therapy (I-CBT) protocol, in which masters-level clinic staff received intensive training and ongoing supervision in the use of this protocol versus a treatment-as-usual (TAU) comparison condition in which therapists received a continuing education-style CBT workshop in the same protocol.\n\n\nMETHOD\nThe study conducted exploratory predictor and moderator analyses of marijuana and heavy alcohol use outcomes using candidate variables across four domains of psychological characteristics: adolescent substance use, adolescent psychiatric symptoms, parent, and family.\n\n\nRESULTS\nRegardless of treatment condition, low parental monitoring at baseline, as assessed by a videotaped interaction task, but not self-report, predicted greater percentage of marijuana use and heavy alcohol use days over the 6-month follow-up period. If parents entered treatment with low levels of parental monitoring, adolescents in the I-CBT condition reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU over the 6-month follow-up period. Greater adolescent aggression and parental emotion dysregulation at baseline also predicted greater percentage of marijuana use days over the 6-month follow-up period for the sample as a whole. Adolescents in the I-CBT condition who reported low positive urgency at baseline reduced their percentage of heavy alcohol use days significantly more than adolescents in TAU care over the 6-month follow-up period.\n\n\nCONCLUSION\nThe article discusses implications for clinical decision-making, improving treatment effectiveness, and tailoring interventions for adolescents with co-occurring substance use and psychiatric disorders.