A pilot randomized clinical trial testing integrated 12‐Step facilitation (iTSF) treatment for adolescent substance use disorder

Abstract

Background and Aims Integration of 12-step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. Design Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n=30) or a novel integrated TSF (iTSF; n=29) with follow-up assessments at 3-, 6-, and 9-months following treatment entry. Setting Outpatient addiction clinic in the USA. Participants Adolescents (N=59; M age=16.8 [1.7]; range 14-21; 27% female; 78% White). Intervention and comparator The iTSF integrated 12-step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. Measurements Primary outcome: percent days abstinent (PDA); Secondary outcomes: 12-step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. Findings Primary Outcome: PDA was not significantly different across treatments (b=0.08,CI95%-0.08 to 0.24, p=.33; Bayes Factor=0.28). Secondary Outcomes: During treatment, iTSF patients had substantially greater 12-step attendance, but this advantage declined thereafter (b=-0.87; CI95% -1.67 to 0.07, p=.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b=-0.42; CI95% -0.80 to -0.04, ps <.05; effect size range d=0.26 to 0.71). Other secondary outcomes did not differ significantly between treatments but effect sizes tended to favor iTSF. Across the entire sample, greater 12-step meeting attendance was associated significantly with longer abstinence during (r=0.39, p=.008), and early following (r=0.30, p=.049), treatment. Conclusion Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but did show benefits in terms of 12-step attendance and consequences. Given widespread use of combinations of 12-step, MET, and CBT in adolescent community outpatient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.

Oxytocin Blocks Opioid Withdrawal Symptoms Only When Combined with Group Therapy: A Double-Blind, Randomized Controlled Clinical Trial

“…In our four-month follow-up, we found that in participants receiving combination of oxytocin and group activity that had fewer withdrawal symptoms, continued ab-stinence was more common. This pattern resembles the same effect of narcotics self-help groups on abstinence (41,42), where regular attendance results in higher abstinence. Given that the participants who received the combined package of oxytocin and group activity were the same group with higher participation in regular group sessions, the four-month follow-up of the study further revealed the impact of the package on relapse prevention (Table 3).…”

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

“…Recent evidence continues to support multicomponent psychosocial treatments, as combinations of family-based therapy, cognitive behavioral therapy, motivational interviewing, and contingency management can be effectively utilized to treat adolescent SUDs [9,[18][19][20][21][22][23]. Combinations of motivational enhancement therapy (MET; described below in more detail in section 2) and CBT are well-established interventions for treating adolescent SUD [9,21], and other studies have found that contingency management, an intervention in which an individual is rewarded for positive behavior, can be an effective supplement to MET, CBT, and family-based therapies [19,20].…”

“…A follow-up study compared the effectiveness of a drug counseling and 12-step program to a 10-session MET/CBT model and found the 12-step program to be associated with fewer substance-related consequences, to be at least as beneficial in reducing substance use frequency and prolonging abstinence over time compared to MET/CBT, and also found that 12-step meeting attendance was associated with longer abstinence during and following treatment [21].…”

“God Put Weed Here for Us to Smoke”: A Mixed-Methods Study of Religion and Spirituality among Adolescents with Cannabis use Disorders

“…Treatment for all participants consisted of two individual and eight group sessions. In the parent study, 45 abstinence from substance use increased equally in both conditions during and following treatment. Participants completed baseline and two post-treatment assessments (i.e., 3- and 6-month follow-ups 1 ).…”