The efficacy of two adolescent substance abuse treatments and the impact of comorbid depression: Results of a small randomized controlled trial.

Abstract

Objective The purpose of this randomized trial was to investigate the efficacy of two behavioral treatments focusing on different change mechanisms in ameliorating a borderline personality disorder constellation of behaviors and substance use in adolescents referred by juvenile diversion programs. Methods Forty adolescents 14 to 17 years of age and meeting DSM IV criteria for borderline personality disorder and substance use disorders were randomized to Integrative Borderline Personality Disorder-Oriented Adolescent Family Therapy (I-BAFT) or Individual Drug Counseling (IDC). This design allowed a comparison of two manualized interventions, one family-based and one individually-oriented. Profiles of clinical change were used to detect impact and to estimate treatment effect sizes. Results Primary analyses showed that both interventions had a clinically significant impact on borderline personality disorder behaviors 12 months after baseline but with no differential treatment effects. The impact on substance use was more complex. Subgroup analyses revealed that adolescents with depression had significantly more severe profiles of borderline personality disorder and substance use. These youth were the only group to show reductions in substance use, but only if they received the I-BAFT intervention. Study data also documented the high dosage of intensive residential treatment needed by this population. Conclusions and Implications for Practice Results highlight the intensive treatment needs of juvenile justice involved youth with co-occurring substance use and borderline personality disorder including depression, the hybrid outpatient and residential treatment often required by this population, and the promise of a family oriented approach particularly for youth with severe symptoms and co-occurring depression.

Systematic Review and Meta-Analyses of Psychotherapies for Adolescents With Subclinical and Borderline Personality Disorder: Methodological Issues

“…Lastly, the authors only searched seven electronic databases for relevant articles and used an English language restriction. This may have caused for some randomized controlled trials to be left out, for example, Santisteban et al, 2 Salzer et al, 3 and a pilot study by Gleeson et al 4 Valuable information have thus not been included.…”

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

“…SFT seeks to promote a healthy family structure (Weaver et al, 2013), and BSFT draws on a combination of structural and strategic theories (Horigian et al, 2013). Also drawing from SFT in combination with dialectical behaviour therapy, integrative borderline personality disorder-oriented adolescent family therapy (I-BAFT) is a manualised intervention for adolescent self-harming behaviour (Santisteban, Mena, Muir, McCabe, Abalo & Cummings, 2015). Meanwhile, multidimensional family therapy (MDFT) addresses the adolescent, parents, family interactions, and factors outside the family (Liddle et al, 2009, as cited in Danzer, 2014.…”

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review

“…There are also some programmes designed for patients and relatives that include different treatment components for each group. In these cases, the treatment is given jointly, but the main focus is on patients rather than on family members or carers (Santisteban, Muir, Mena, & Mitrani, 2003;Santisteban et al, 2015).…”

“…Thus far, small pilot studies have only provided feasibility and acceptability data for the intervention programme (Santisteban et al, 2003;Santisteban et al, 2015). In general, all these programmes recommend that family members be included in the treatment plan, but the fundamental focus is not on the family or carers.…”