Comparing self-report and parental report of psychopathologies in adolescents with substance use disorders

Evaluation of the multimodal DELTA therapy for adolescents with substance use disorders: an exploratory pilot trial

Background

In order to address the lack of manualized treatment programs for adolescents with substance use disorders (SUDs), we developed a manualized group intervention (DELTA). DELTA focusses on substance use reduction and abstinence as well as alleviation of SUD symptoms via additional modules for co-occurring disorders. The goal of this exploratory trial was to assess if DELTA can be conducted in adolescent SUD patients and if participation is related to reductions in substance use, SUD-related problems, and further psychopathologies.

Method

We recruited adolescents at a psychiatric outpatient unit, which were then allocated to either DELTA intervention group (N = 85) or to a waiting-list control group (WL, N = 61) based on parental decision to start a therapy or not. Self-report measures were used as primary outcomes (substance use via interview, use-related problems via DUDIT-Drug Use Disorder Identification Test) and secondary outcomes (psychopathologies via YSR-Youth Self Report). T-tests and Pearson correlations were used to analyze between-group differences across time.

Results

On average, participants attended M = 7.7 (SD = 5.1) of the 16 sessions. Substance use and use-related problems regarding all substances but nicotine was decreased after the intervention, with small to medium not significant effects in favor of DELTA. Self-reported psychopathologies were also reduced at follow-up, with non-significant advantages for DELTA.

Conclusion

DELTA showed small effects on SUD-related and depression-related variables. However, the interpretation is limited by the small sample size. Nonetheless, the DELTA intervention is viable in SUD outpatient treatment and will be further evaluated.Clinical trial registration: The study was registered at clinicaltrials.gov under NCT03444974. Registered February, 26th 2018 (https://clinicaltrials.gov/ct2/show/NCT03444974).

Study protocol: the pragmatic, exploratory DELTA-JU trial of the group-based multimodal DELTA intervention for abstinent adolescents with substance use disorders living in youth welfare institutions

Background

The DELTA intervention contains 16 weekly group sessions plus additional individual sessions and educational session for parents. It aims to reduce substance use and related problems such as substance use disorders (SUD) in adolescents. Recent results indicated positive effects in psychiatric outpatients. Conducting DELTA in youth welfare settings seems feasible, however, organizational and content adjustments such as smoking cessation elements should be added in order to reduce relapse risks and to prevent negative health consequences.

Methods/design

The pre-registered DELTA-JU study (German Clinical Trials Register, DRKS00027913) is separated into three stages: In the adjustment stage during months 1-4, we will revise the DELTA manual based on semi-structured interviews (n = 10) with personnel from youth welfare institutions specialized in serving adolescents with SUD in the study region, analyzed with content analysis. In the sampling stage during months 5-22, participants qualifying for a SUD and willing to regularly participate in the 16 weekly DELTA-JU group sessions will be enrolled to either one of two arms (cluster randomization: immediate intervention, waitlist with subsequent intervention 16 weeks later). Adolescents will be assessed at baseline and follow-up (16 weeks after first group session) with an additional pre-assessment (16 weeks before intervention starts) for the waitlist group. Assessment procedures include questionnaires and clinical interviews among others. At the same time, institutional personnel will receive a 1-day workshop on SUD-relevant topics based on the DELTA parental education group and on feedback from the qualitative interviews. Personnel will also be assessed twice with questionnaires. In the dissemination stage during months 23-24, final study evaluation results will be prepared and submitted for publication.

Discussion

This study will create a setting-specific manual for vulnerable adolescents suffering from SUDs, and, in many cases, from co-occurring mental disorders. If shown to be effective, DELTA-JU can be disseminated within other institutions of youth welfare.