Family Therapy Reduces Adolescent Substance Abuse, PTSD Symptoms

Carla Kmett Danielson, PhD

Risk reduction through family therapy may be optimal for adolescents with PTSD and co-occurring substance use issues.

A team, led by Carla Kmett Danielson, PhD, Department of Psychiatry & Behavioral Sciences, National Crime Victims Research & Treatment Center at the Medical University of South Carolina, examined whether exposure-based risk reduction through family therapy is a safe and efficacious treatment compared to standard treatment for adolescents with co-occurring substance use problems and PTSD symptoms.

There is currently no empirical evidence supported treatments evaluated that address co-occurring substance use problems and PTSD symptoms among adolescents in an integrative fashion.

The randomized clinical trial involved 124 adolescents between 13-18 years old who were followed up for 18 months after baseline November 2012 to January 2017 at community-based child advocacy centers in the US. Adolescents engaging in at least 1 interpersonal traumatic event who engaged in non-tobacco substance use at least once during the previous 90 days and reported 5 or more PTSD symptoms were enrolled.

The team collected blinded assessments at baseline, as well as at 3, 6, 12, and 18 months following baseline.

The primary outcomes sought in the study were focused on the number of nontobacco substance-using days measured with the timeline follow-back method and PTSD symptom severity using the UCLA PTSD Reaction Index for DSM-IV completed by adolescents and caregivers.

The secondary outcomes were focused on marijuana, alcohol, and polysubstance use and PTSD criterion standard symptom severity.

Reduced risk family therapy produced significantly greater reductions in substance-using days from baseline to 12 months (event rate [ER], .28; 95% CI, .12-.65) and month 18 (ER, .10; 95% CI, .04-.24).

The investigators also observed substantial reductions in PTSD symptoms within groups for reduced risk family therapy from baseline to months 3 (β , −9.25; 95% CI, −12.95 to −5.55), 6 (β , −16.63; 95% CI , −20.40 to −12.87), 12 (β , −17.51; 95% CI, −21.62 to −13.40), and 18 (β , −19.02; 95% CI, −23.07 to −14.96).

This was also true for the treatment-as-usual control group from baseline to months 3 (β , −9.62; 95% CI, −13.16 to −6.08), 6 (β , −13.73; 95% CI, −17.43 to −10.03), 12 (β , −15.53; 95% CI, −19.52 to −11.55), and 18 (β , −13.88; 95% CI, −17.69 to −10.09).

However, the investigators did not observe between-group differences.

The investigators aimed to determine whether an exposure-based, integrative intervention for adolescents with substance use problems and PTSD symptoms results in improved outcomes compared to standard treatment that consists of trauma-focused cognitive behavioral therapy.

Overall, there was greater reductions in substance-using days, marijuana use, polysubstance use and PTSD avoidance and hyperarousal symptoms in patients in the risk reduction through family therapy condition over time.

“For adolescents who have substance use problems and posttraumatic stress disorder symptoms, an exposure-based treatment for posttraumatic stress disorder symptoms that incorporates substance abuse interventions may yield the best long-term outcomes for these problems,” the authors wrote.

The study, “Safety and Efficacy of Exposure-Based Risk Reduction Through Family Therapy for Co-occurring Substance Use Problems and Posttraumatic Stress Disorder Symptoms Among Adolescents,” was published online in JAMA Psychiatry.