This past November (2011), The Journal of Consulting and Clinical Psychology published the results of a pioneer study conducted at Brown University assessing the efficacy of an integrated treatment for adolescents with co-occurring suicidality and alcohol and other drug use disorders (AOD).
The AOD/Suicide Connection
These researchers explain how AOD and suicidal behavior commonly co-occur among adolescent clinical populations; approximately 27% to 50% of adolescents who die by suicide battled with AOD. Further, rates of AOD among adolescents who attempt suicide ranged from 12% to 50%. Researchers stressed the fact that the relationship between AOD and suicidality appears to strengthen as each problem increases in severity. Regardless of the fact that these two problems have been known to interrelate, treatment commonly occurs separately. The researchers implemented a randomized trial to evaluate if different treatments would impact these comorbid conditions.
Treating Maladaptive Thinking and Behavior with CBT
In order to do so, they recruited 40 adolescents and their families from a psychiatric inpatient unit and randomly assigned them either to the integrated CBT (I-CBT) protocol or to the enhanced treatment as usual protocol (E-TAU) for 18 months. The I-CBT protocol was grounded in social cognitive learning theory, which proposes that in part, mental health problems may stem from prior learning histories, particularly when looking at the learning of social behaviors and core beliefs. The idea was to use CBT techniques to help adolescents relearn adaptive ways of relating to self and others, and develop self-efficacy. Consistent with social cognitive learning theory, the I-CBT protocol integrated CBT techniques to remediate maladaptive cognitions and behaviors found to underlie both adolescent suicidality and AOD. They worked with adolescents individually and with parents around appropriate modeling and parenting practices. The hypothesis was that improvement in adolescent and parent skill development should lead to reductions in youth AOD and suicidality.
The E-TAU protocol was determined independently by each community provider, but did not necessarily focus as much on CBT interventions and techniques.
Results for this randomized trial showed that CBT was associated with greater reductions in heavy drinking days, days of marijuana use, and marijuana-related problems over the course of treatment. Also, youths who received the I-CBT protocol reported less global impairment, as well as fewer suicide attempts, psychiatric hospitalizations, emergency departments visits and arrests. These findings may indicate that cognitive behavioral therapies (CBT) may provide more therapeutic benefit to treating alcohol and substance abuse disorders when suicidality is present.
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J. & Monti, P. (2011). Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial. Journal of Consulting and Clinical Psychology, 79, 728-739.