Integrated Treatment of Adolescents with Substance Use Disorders and PTSD - PROJECT SUMMARY/ABSTRACT Substance use disorders (SUD) and post-traumatic stress disorder (PTSD) are debilitating mental health disorders that frequently co-occur and have onset during adolescence. Approximately 9% of adolescents aged 12-17 meet criteria for a current SUD, with more than 70% of those having experienced a traumatic event and 35% meeting criteria for PTSD. If left untreated, a cyclical relationship between substance use and PTSD serves to maintain or exacerbate the other, leading to a chronic course of illness. Adolescents with co-occurring SUD/PTSD are at increased risk of developing other serious mental health problems (e.g., depression, suicidal ideation), HIV-related risk behaviors, and academic and interpersonal problems. There is a critical need to intervene earlier in the developmental trajectory to prevent the long-term deleterious outcomes associated with SUD/PTSD in adulthood. However, there are no effective individual treatments for adolescents with SUD/PTSD. Clinicians agree that comorbid SUD/PTSD among adolescents is a significant problem, and that a feasible and effective intervention is clearly needed. Efficacious, evidence-based treatments for adults with SUD/PTSD have been developed over the past two decades and can be adapted to address the unique developmental needs of adolescents with SUD/PTSD and improve outcomes and functioning for this highly understudied population. Based on promising preliminary data, the proposed study will directly address this need by evaluating an integrated, trauma-focused intervention, Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE), specifically adapted for adolescents (COPE-A). A Stage Ia study of COPE-A demonstrated safety, feasibility, and significant pre- to post-treatment reductions in SUD and PTSD symptoms, while a Stage Ib pilot RCT comparing COPE-A to Person Centered Therapy (PCT) showed safety, feasibility, and preliminary efficacy in significantly reducing substance use and PTSD severity. Stage I studies also resulted in a treatment manual, clinician training protocol, and fidelity monitoring procedures, all of which will be used in the proposed study. The primary objective of this Stage II RCT is to evaluate the efficacy of COPE-A, compared to PCT, in reducing (a) substance use frequency and amount, and (b) PTSD severity among a larger sample of adolescents (N = 120) with co-occurring SUD/PTSD. Secondary objectives are to examine the effects of COPE- A on associated areas of functioning including depression, HIV risk behaviors, interpersonal functioning, and quality of life. In line with our prior work, we will recruit nationally and deliver the intervention via telehealth. Ecological momentary assessment (EMA) will monitor daily substance use and PTSD symptoms to examine their temporal and reciprocal relationship and identify underlying mechanisms of change to inform future research.
