Can Treating Internalizing Disorders Prevent Substance Abuse?

Successfully treatment internalizing disorders (IDs) in adolescents can lower the risk of substance or alcohol use disorders later in life, according to findings presented at the AACAP 57th Annual Meeting in New York, NY.

In a session entitled, “Psychosocial Treatments for Internalizing Adolescents with Substance Abuse Disorders,” John Curry, PhD, of Duke University, Durham, NC, reviewed data from two studies looking at the treatment of internalized disorders, which often precede substance abuse in adolescents. But while it has been shown that youths with ID are at a higher risk of developing substance use disorder (SUD) than those who don’t have the disorders, clinical evidence on the impact of treatment is lacking, he said.

Curry presented data from a 2004 study in which Philip C. Kendall, MD, and colleagues evaluated the maintenance of outcomes of children who received 16-week cognitive behavioral treatment for primary anxiety disorders about seven years earlier. In the study, which was published in the Journal of Consulting and Clinical Psychology, investigators found that successfully treating ID did not predict fewer subsequent diagnoses of depression or SUD. It did, however, impact behaviors and symptoms of SUD, such as drinking days per month, loss of activity because of drug use, and attempts to quit, all of which were positively affected.

Therefore, “there is some evidence that a good response to short-term treatment can reduce the odds of some substance abuse problems later in life,” said Curry.

He also evaluated data from the Substance Use Outcomes Following Treatment for Adolescent Depression (SOFTAD) study, an extended follow-up of a 12-site study comparing the efficacy of fluoxetine combined with cognitive behavioral therapy (CBT) with a CBT/placebo regimen in adolescents with major depressive disorder (MDD). In the SOFTAD trial, successful treatment of depression was not shown to impact whether adolescents would develop alcohol use disorder; however, it did positively impact whether they would develop substance use disorder.

He drew several conclusions from the results of both studies:

• Mixed evidence suggests that successful treatment of internalized disorders can prevent or lower the risk of later alcohol or substance use disorder
• For childhood anxiety disorders, successful treatment is associated with less subsequent drug use and fewer symptoms of dependence
• Adolescent with MDD appear to be at a higher risk for developing SUD during emerging adult years
• Use of alcohol or drugs prior to treatment of major depressive disorder raises risk of subsequent alcohol or substance use disorder
• Treatment of major depressive disorder mitigates the risk of alcohol or substance use disorder
• Recurring episodes of major depressive disorder most often follows the onset of first instance of alcohol or substance use disorder

Finally, Curry pointed out that psycho-education in the treatment of adolescents with major depressive disorder should include this follow-up information.