Cited by 254Substance Abuse Treatment and OutcomesSuicide and Self-Harm StudiesPersonality Disorders and Psychopathology

Treatment of co-occurring substance abuse and suicidality among adolescents: A randomized trial.

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Esposito-Smythers, Christianne, Spirito, Anthony, Kahler, Christopher W., Hunt, Jeffrey, Monti, Peter·2011·Journal of Consulting and Clinical Psychology

Abstract

OBJECTIVE: This study tested a cognitive-behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial. METHOD: Forty adolescents (Mage = 15 years; 68% female, 89% White) and their families recruited from an inpatient psychiatric hospital were randomly assigned to an integrated outpatient cognitive-behavioral intervention for co-occurring AOD and suicidality (I-CBT) or enhanced treatment as usual (E-TAU). Primary measures include the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Suicide Ideation Questionnaire, Columbia Impairment Scale, Timeline Followback, Rutgers Alcohol Problem Index, and Rutgers Marijuana Problem Index. Assessments were completed at pretreatment as well as 3, 6, 12, and 18 months postenrollment. RESULTS: In intent-to-treat analyses, I-CBT was associated with significantly fewer heavy drinking days and days of marijuana use relative to E-TAU but not with fewer drinking days. Those randomized to I-CBT in comparison to E-TAU also reported significantly less global impairment as well as fewer suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests. Adolescents across groups showed equivalent reductions in suicidal ideation. CONCLUSIONS: I-CBT for adolescents with co-occurring AOD and suicidality is associated with significant improvement in both substance use and suicidal behavior, as well as markedly decreased use of additional health services including inpatient psychiatric hospitalizations and emergency department visits. Further testing of integrated protocols for adolescent AOD and suicidality with larger and more diverse samples is warranted.

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  • Only three randomized controlled trials have demonstrated efficacy in temporarily reducing risk for suicidal behavior among adolescents with a history of suicide attempts or self-harm.

    “Only three randomized controlled trials have demonstrated efficacy in temporarily reducing the risk for suicidal behavior among adolescents with a history of suicide attempts or self-harm (Asarnow et al. 2017, Esposito-Smythers et al. 2011, McCauley et al. 2018).”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Esposito-Smythers et al. 2011

    The Results (Suicide Attempts and Other Adverse Psychiatric/Legal Outcomes; page unavailable) report significantly fewer suicide attempts in the randomized I-CBT group than in enhanced treatment as usual over 18 months. But the Participants and Study Sample sections show that 25% of the adolescents had suicidal ideation only, without a reported prior attempt; the trial therefore does not establish the result solely among adolescents with a history of attempts or self-harm. This citation supports the efficacy finding for this trial, not the sentence’s count of three trials. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • In substance use disorders, CBT reduced attempt frequency compared with treatment as usual in adolescents but not in adults.

    “In substance use disorders, CBT reduced attempt frequency compared with TAU in adolescents(92) but not in adults.(93)”
  • Family intervention and Cognitive Behavior Therapy contribute to reductions in suicidality in adolescents.

    “consistent with findings of other studies demonstrating that family intervention and Cognitive Behavior Therapy (CBT) contribute to reductions in suicidality in adolescents (e.g.Asarnow, Hughes, Babeva, & Sugar, 2017;Esposito-Smythers, Spirito, Hahler, Hunt, & Monti, 2011).”
  • Esposito-Smythers et al demonstrated the effectiveness of a protocol that included cognitive behavioral therapy for SUD, individual cognitive behavioral therapy for depression and suicidality, and family skills training.

    “Esposito-Smythers et al [22] demonstrated the effectiveness of a protocol that included cognitive behavioral therapy (CBT) for SUD, individual CBT for depression and suicidality, and family skills training.”

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Authors
Esposito-Smythers, C., Spirito, A., Kahler, C. W., Hunt, J., & Monti, P.
Affiliations
  • George Mason University (US)
  • Brown University (US)
Venue
Journal of Consulting and Clinical Psychology
Published
2011-12
Volume
79
Issue
6
Pages
728-739
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
OpenAlex
W2169253176
Cited by
254
References
40
Citations by year
2026: 4 · 2025: 15 · 2024: 11 · 2023: 21 · 2022: 21 · 2021: 33 · 2020: 22 · 2019: 23 · 2018: 17 · 2017: 11 · 2016: 20 · 2015: 13 · 2014: 26 · 2013: 12 · 2012: 3
FWCI
10.32
Type
journal article
Language
en
Open access
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (R01 AA014191)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
adolescent substance use disorders, suicidality, co-occurring disorders, cognitive behavioral therapy, alcohol consumption, cannabis use, suicide attempts, psychiatric hospitalization, emergency department visits, functional disability, suicidal ideation
MeSH terms
Adolescent, Major Depressive Disorder, Female, Humans, Male, Suicide, Attempted, Cognitive Behavioral Therapy, Treatment Outcome, Substance-Related Disorders, Suicidal Ideation

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