Cited by 49Personality Disorders and PsychopathologySubstance Abuse Treatment and OutcomesPsychotherapy Techniques and Applications

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

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Santisteban, Daniel A., Mena, Maite P., Muir, Joan, McCabe, Brian E., Abalo, Clara, Cummings, Amanda M.·2015·Psychiatric Rehabilitation Journal

Abstract

OBJECTIVE: The purpose of this randomized trial was to investigate the efficacy of 2 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 14-17 years of age and meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) 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. This design allowed a comparison of 2 manualized interventions, 1 family based and 1 individually oriented. Profiles of clinical change were used to detect impact and 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 youths were the only group to show reductions in substance use, but they only did so 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 youths 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 youths with severe symptoms and co-occurring depression. (PsycINFO Database Record

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  • For adolescents with substance use disorders, interventions that do not holistically address both substance use disorders and internalizing disorders are less effective.

    “For such clients, interventions that do not holistically address both SUDs and IDs are less effective.”

    From Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study (2024) · cites this paper as [13]

    The Discussion reports that, among adolescents with borderline personality disorder, substance use disorder, and depression, only those receiving the holistic I-BAFT intervention showed substantial improvement in substance use; the substance-use-focused IDC intervention did not improve substance use in adolescents with depression. The paper describes a holistic approach as potentially well suited to this subgroup, but does not establish that interventions addressing only substance use are less effective for adolescents with substance use and internalizing disorders generally. (LLM, conf=0.86)

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  • Adolescents with cooccurring SUD+ID are more difficult to treat effectively than those who do not have IDs.

    “Longitudinal outcome data suggest that adolescents with cooccurring SUD+ID are more difficult to treat effectively than those who do not have IDs.”

    From Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study (2024) · cites this paper as [13]

    The Discussion (page not provided) says adolescents with depression can have difficulty reducing substance use during treatment, supporting the claim for that subgroup. But the trial studied adolescents who all had substance abuse and borderline personality disorder, compared those with and without depression, and found outcomes depended on treatment; it does not establish that adolescents with SUD and internalizing disorders generally are harder to treat than those without them. (LLM, conf=0.86)

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  • Studies have shown that maintenance of SUD treatment gains and posttreatment recovery to adaptive levels of functioning are harder to achieve for adolescents with IDs and related negative affect.

    “Studies have also shown that maintenance of SUD treatment gains [11,12] and posttreatment recovery to adaptive levels of functioning [13] are harder to achieve for adolescents with IDs and related negative affect.”

    From Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study (2024) · cites this paper as [13]

    The Results (Profiles of Clinical Change; page unavailable) examine recovery at 12 months and report that substance-use outcomes differed between adolescents with and without comorbid depression. They do not establish that adolescents with depression or related negative affect had greater difficulty returning to adaptive levels of functioning; the reported recovery measures concern substance use and borderline-personality-disorder behavior. (LLM, conf=0.79)

    Experimental — accuracy not yet measured
  • The evidence base for these adaptations is rather scarce; a recent review identified only ten randomized clinical trials.

    “The evidence base for these adaptations is rather scarce. A recent review identified only ten randomized clinical trials [22–31].”
  • The majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.

    “The results indicate that the majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.”

    From The (cost-)effectiveness of early intervention (MBT-early) versus standard protocolized treatment (CBT) for emerging borderline personality disorder in adolescents (the EARLY study): a study protocol for a randomized controlled trial (2024) · cites this paper as [29]

    The Method (Procedures; page unavailable) describes one trial comparing I-BAFT with Individual Drug Counseling, not a set of trials comparing specialized treatments with treatment as usual. The Results (Profiles of Clinical Change; page unavailable) report outcomes for those two conditions. Searches for the claimed majority of trials and treatment-as-usual comparison found no passage addressing that point. (LLM, conf=0.77)

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Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Bernstein DP 1997 Adolescent personality disorders: Just a passing phase? The Journal of the California Alliance for the Mentally Ill 8 56 57
  2. Enders CK 2010 Applied Missing Data Analysis New York Guilford Press
  3. Linehan M 1993 Cognitive behavioral treatment of borderline personality disorder New York Guilford Press
  4. Maquire ER 2009 Police organizational structure and child sexual abuse case attrition Policing: An International Journal of Police Strategies & Management 32 157 179
  5. Miller AL Rathus JH DuBose AP Dexter-Mazza ET Goldklang AR 2007 Dialectical behavior therapy for Adolescents Dimeff LA Koerner K Dialectical behavior therapy in clinical practice: Applications across disorders and settings New York, NY Guilford Press
  6. Rubin DB 1987 Multiple imputation for nonresponse in surveys New York Wiley
  7. Schwarz G 1978 Estimating the dimension of a model Annals of Statistics 6 461 464

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Authors
Santisteban, D. A., Mena, M. P., Muir, J., McCabe, B. E., Abalo, C., & Cummings, A. M.
Affiliations
University of Miami (US)
Venue
Psychiatric Rehabilitation Journal
Published
2015-03
Volume
38
Issue
1
Pages
55-64
ISSN
  • 1095-158X (ISSN-L)
  • 1559-3126
OpenAlex
W2313493864
Cited by
49
References
28
Citations by year
2026: 5 · 2025: 6 · 2024: 5 · 2023: 1 · 2022: 5 · 2021: 6 · 2020: 8 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 2 · 2015: 1
FWCI
3.73
Type
journal article
Language
en
Open access
Locations
  • Psychiatric Rehabilitation Journal (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (R01 DA019057, RO1 DA027920)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
borderline personality disorder, adolescent substance use, comorbid depression, family-based treatment, residential treatment, treatment efficacy, co-occurring disorders
MeSH terms
Adolescent, Behavior Therapy, Borderline Personality Disorder, Depressive Disorder, Family Therapy, Female, Humans, Juvenile Delinquency, Male, Treatment Outcome, Substance-Related Disorders

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