Project Summary (Abstract)
This R34 will develop and test an adjunctive treatment protocol for addressing co-occurring
internalizing disorders among adolescents (age 13-21) enrolled in usual care for substance use
problems. Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent
among youth receiving community-based treatment for substance use disorders (SUDs), and
unresolved ID issues significantly interfere with SUD treatment and recovery processes. Yet, the
youth SUD clinical workforce is not systematically educated or trained in evidence-based
practices for ID; thus, line services for youth SUD do not systematically target IDs. The research
literature offers a few integrated behavioral models for simultaneously treating both SUDs and
IDs in youth; however, such models feature intensive manualized procedures that have proven
cumbersome to scale and deliver in frontline settings. As a result, the clinical workforce, though
desiring ID-focused training, currently has inadequate resources for treating IDs effectively. A
promising solution to reduce this quality gap is developing a modular, family-based protocol to
augment routine care for comorbid SUD/ID by directly targeting ID as a primary treatment goal:
Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). Fam-AID will contain
six modules designed to enhance existing SUD services and to be delivered in any sequence to
meet client needs: (1) Family Engagement of caregivers in treatment planning and services; (2)
Relational Reframing of family constraints, resiliencies, and social capital connected to the
youth's ID symptoms; (3) Functional Analysis of the youth's ID symptoms and related behaviors;
(4) Core cognitive-behavioral treatment techniques to address the youth's ID symptoms and
functional needs, featuring transdiagnostic interventions (emotion acceptance, emotional
exposure, behavioral activation) to address negative affect and emotional dysregulation
underlying both depression and anxiety; (5) Family Psychoeducation and Safety Planning
focused on education about comorbid SUD/ID and prevention of youth self-harm.
The study will follow the NIDA blueprint for Stage 1 development of behavioral protocols. In
the Pilot Stage we will use rapid cycle prototyping methods in collaboration with end-user
stakeholders at two Pilot sites to: (1) Draft protocol delivery and fidelity guidelines adapted from
existing study team resources; (2) Solicit clinic staff and client input on protocol content and
delivery via cognitive interviewing; (3) Pilot the prototype components on 2-3 cases at each site.
We will then conduct an Interrupted Time Series Study for N = 60 comorbid SUD/ID cases
across two sites serving diverse youth: 30 will receive TAU (historical control), and then
following line staff training in the protocol, 30 new cases will receive TAU enhanced by Fam-
AID. Aim 1 will examine Fam-AID cases for protocol acceptability via therapist and client
interviews and fidelity benchmarks via therapist- and observer-report protocol fidelity data. Aim
2 will compare Fam-AID versus TAU for immediate outcomes on family attendance in sessions
and ultimate outcomes on youth ID symptoms at Baseline, 3-, and 6-month follow-up.
