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Marlene Busko
Medscape Medical News 2007. © 2007 Medscape
December 13, 2007 — An experimental outpatient substance-abuse treatment program for adolescents with coexisting internalizing disorders (mood and/or anxiety problems) shows promise in a preliminary evaluation.
Findings from a pilot study comparing an experimental treatment vs usual treatment were conveyed in an oral paper presented at the American Academy of Addiction Psychiatry 18th Annual Meeting & Symposium by Ashli J. Sheidow, PhD, and Lisa Saldana, PhD, from the Medical University of South Carolina, in Charleston.
Among youth with concurrent internalizing and substance-use disorders, it is extremely important to "treat the anxiety and depression — not just the substance use," Dr. Sheidow told Medscape Psychiatry. They found that improvement in symptoms of internalizing disorders predicted improvement in substance use, but improvement in substance use was unrelated to changes in depressive and anxiety symptoms, she noted.
Depressed Teen Addicts
A recent study found that 51% of youth in outpatient substance-use treatment had a coexisting internalizing disorder, and these rates increase among studies of inpatient adolescents, said Dr. Sheidow. Previous studies showed that compared with treating young substance abusers without psychiatric problems, it takes longer to treat those with psychiatric comorbidities (72 weeks vs 10 weeks) and it costs more than twice as much.
Clinical studies that are used to develop evidence-based treatments for substance abuse generally exclude patients with comorbid conditions, Dr. Sheidow noted, adding that these patients might benefit from different treatment approaches.
The group aimed to investigate this by performing a pilot study comparing short-term outcomes from 2 types of treatments for adolescents who abused marijuana, another drug, alcohol, or multiple substances and had comorbid mood and/or anxiety disorders.
The experimental treatment was a primarily office-based, multisystemic therapy that integrated cognitive behavior, behavior modification, and family-therapy approaches and required intensive engagement by parents and their children.
The comparison treatment was outpatient "treatment as usual," available in the community.
A total of 43 adolescents (63% males), aged 13 to 17 years, with coexisting mood and/or anxiety disorders were randomized to the 2 treatment types. More than half of the adolescents (26) had both anxiety and depression.
"Treat the Anxiety and Depression"
Overall results support the experimental treatment, since the patients in this group had significantly less drug use and more rapid improvement, Dr. Saldana reported. Teens who received the experimental treatment had significantly improved anxiety and depression symptoms (P = .03) compared with teens who received existing treatment.
Self-reports of substance use at 3 and 6 months were significantly lower (P < .001) for all types of substances among teens who had been randomized to receive the experimental treatment vs regular treatment.
In addition, more teens in the experimental group than in the regular treatment group recovered from substance abuse at 6 months, based on negative urine drug test results. Positive parenting change predicted recovery, said Dr. Saldana.
These findings illustrate the potential benefit of the new treatment, the group concludes, adding that their research is ongoing.


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