Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study (Preprint)

Abstract

BACKGROUND Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not address both SUD and ID problems holistically are less effective. A few integrated behavioral models for treating SUDs and IDs in adolescents exist; however, they feature intensive manualized procedures that are can be cumbersome to scale and deliver. As a result, the adolescent SUD clinical workforce is not systematically educated or trained in evidence-based practices for IDs. OBJECTIVE This pilot treatment development study will develop and test a modular treatment protocol for addressing co-occurring IDs among adolescents (age 13-18) enrolled in routine care for SU problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by three evidence-based foundations for treating co-occurring adolescent IDs: family engagement techniques, transdiagnostic individual CBT techniques, and family psychoeducation and safety planning. METHODS This quasi-experimental study will proceed in two stages. The Pilot Stage will use rapid cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources; solicit provider and client input on protocol content and delivery via cognitive interviewing; and pilot prototype components on 4-6 cases. The second stage will be an Interrupted Time Series Study for N = 60 comorbid SUD/ID cases across two sites serving diverse adolescent: 30 will receive treatment as usual (TAU), and then following clinician 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 along with fidelity benchmarks via therapist- and observer-report protocol fidelity data. Aim 2 will compare TAU Only versus TAU + Fam-AID for impacts on family treatment attendance and on adolescent ID and SU symptoms measured at baseline, 3-, and 6-month follow-up. RESULTS Study recruitment will begin in April 2025. CONCLUSIONS We anticipate that Fam-AID will contain five treatment modules that can be delivered in any sequence to meet client needs: Family Engagement of primary supports in treatment planning and services; Relational Reframing of family constraints, resiliencies, and social capital connected to the adolescent’s ID symptoms; Functional Analysis of the adolescent’s ID symptoms and related behaviors; Cognitive-Behavioral Therapy to address the adolescent’s ID symptoms and functional needs, featuring three core techniques (emotion acceptance, emotional exposure, behavioral activation) to address negative affect and emotional dysregulation; and Family Psychoeducation and Safety Planning focused on education about comorbid SUD/ID and prevention of adolescent self-harm. If shown feasible and effective, Fam-AID will offer SUD clinicians a set of pragmatic interventions for treating co-occurring IDs in adolescent clients. CLINICALTRIAL ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979.