Category: Comorbidity - Substance Use and Other
Substance use disorders (SUDs) and psychiatric disorders (e.g., major depressive disorder (MDD)/dysthymia, generalized anxiety disorder (GAD), ADHD) frequently co-occur in adolescents. Conventional treatment models entail separate treatment of substance use and psychiatric disorders, increasing burden on patients and the healthcare system and often resulting in incomplete or inadequate treatment. Integrated treatments that concurrently address substance use and psychiatric disorders by the same therapist or clinical team appear to be effective in reducing symptoms and impairment across diagnoses, but evaluation of these evidence-based models in multiple real-world settings is lacking. The current project involved evaluation of ENCOMPASS (Riggs et al., 2007; Riggs et al., 2008), a weekly outpatient treatment that draws on well-established evidence based substance use interventions including motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), contingency management (CM), and family therapy, as well as a research-based approach to integrating treatment of co-occuring psychiatric disorders. Rates of treatment completion, compliance/attendance, and clinical outcomes were assessed across three community sites (N=322; 16-week treatment) and three school-based sites (N=51; 8-week treatment). Participants were adolescents (mean age = 16.5 years; 70.9% male) who presented with co-occurring SUDs (67.6% cannabis use disorder; 40.2% alcohol use disorder; 17.4% opiate use disorder) and psychiatric disorders (42.4% depression; 20.7% GAD; 39.7% ADHD). Average baseline substance use was 11.3 of the last 28 days assessed via timeline follow-back. Completion rates (community: 61.2%; schools: 78.4%) and compliance rates (community: 93.9%; school: 96.8%) were high across sites. Intent-to-treat analysis revealed significant reductions in past-month substance using days (community: -3.2 days; school: -13.0 days) and high rates of abstinence by end of treatment defined as 1 or more negative urine screen in last month of treatment (community: 58.9%; school: 42.3%). Large and significant reductions in depression, GAD, and ADHD symptoms were also observed across sites per scores on standardized assessment instruments (Cohen’s d range: .60 - .95; all ps < .0001). Across real-world settings, ENCOMPASS was associated with high compliance rates and large effect sizes in treating co-occurring substance use and psychiatric disorders in adolescents. The magnitude of clinical effects observed across these sites was similar to or greater than those reported for other evidence-based practices. ENCOMPASS appears to be well suited for treating co-occurring SUDs and psychiatric disorders in diverse settings, including community- and school-based clinics. Additional research should investigate optimal dissemination and implementation strategies for integrated treatments beyond traditional clinical settings.
Zachary Adams– Assistant Professor, Indiana University School of Medicine, Indianapolis, Indiana
Jesse Hinckley– Psychiatry Resident, University of Colorado-Denver
Bryan McNair– Research Instructor, University of Colorado-Denver
Leslie Hulvershorn– Assistant Professor, Indiana University School of Medicine
Paula Riggs– Professor, University of Colorado-Denver
Indiana University School of Medicine