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A Promising Intervention for Suicidal, Substance-Abusing Adolescents

A modified CBT protocol involving patients and their families is more effective than enhanced treatment as usual.

Suicidal, substance-abusing adolescents challenge the best treatment programs. Most interventions have addressed suicide and substance abuse in parallel care or sequentially, with only a few focusing on these frequently co-occurring conditions in an integrated fashion. This first-of-its-kind, randomized, controlled, 1-year study compared integrated cognitive-behavioral therapy (I-CBT) with enhanced treatment as usual in 36 nonpsychotic, nonbipolar, nonhomicidal, non–developmentally delayed adolescent participants with suicidality and substance abuse (mean age, 15.7; mean duration of prior treatments, 3 years; 78% taking medications at baseline).

Medication management was provided as needed. Patients abused alcohol, cannabis, or both, but no other substances; all lived at home with a parent or guardian willing to participate in treatment. CBT included motivational interviewing, individual and family CBT, and parent training. For 6 months, I-CBT involved weekly sessions for adolescents and biweekly sessions for parents; frequency of visits decreased in the continuation and maintenance phases (each 3 months). Community-based treatment as usual was enhanced with a diagnostic assessment, medication management, advice on community resources, and availability of psychiatric emergency and non-emergency appointments.

At 18 months, compared with the control group, the I-CBT group showed fewer heavy drinking days, days of marijuana use, suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests; and less self-reported anxiety and global impairment. Suicidal ideation and depressed mood improved similarly in the two groups.

Comment: This small study didn't control for medication use and involved only adolescents with restricted psychopathology whose families participated in ongoing treatment. Before generalizing from the results, researchers need to study the program in adolescents who use other substances or who have more-severe psychiatric disorders. Nevertheless, the findings resemble those reported for dialectical behavior therapy programs in adult patients with parasuicidal behaviors. Consistently applied programs incorporating CBT techniques and involving patients' families show promise for addressing the difficult comorbidities of suicidality and substance abuse in adolescents.

— Joel Yager, MD

Published in Journal Watch Psychiatry December 22, 2011

Citation(s):

Esposito-Smythers C et al. Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial. J Consult Clin Psychol 2011 Dec; 79:728.

• Medline abstract (Free)

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