A Promising Intervention for Suicidal, Substance-Abusing Adolescents

Suicidal, substance-abusing adolescents challenge the best treatment programs. Most interventions have addressed suicide and substance abuse in parallel care or sequentially, with only a few focusing on these frequently co-occurring conditions in an integrated fashion. This first-of-its-kind, randomized, controlled, 1-year study compared integrated cognitive-behavioral therapy (I-CBT) with enhanced treatment as usual in 36 nonpsychotic, nonbipolar, nonhomicidal, non–developmentally delayed adolescent participants with suicidality and substance abuse (mean age, 15.7; mean duration of prior treatments, 3 years; 78% taking medications at baseline).

Medication management was provided as needed. Patients abused alcohol, cannabis, or both, but no other substances; all lived at home with a parent or guardian willing to participate in treatment. CBT included motivational interviewing, individual and family CBT, and parent training. For 6 months, I-CBT involved weekly sessions for adolescents and biweekly sessions for parents; frequency of visits decreased in the continuation and maintenance phases (each 3 months). Community-based treatment as usual was enhanced with a diagnostic assessment, medication management, advice on community resources, and availability of psychiatric emergency and non-emergency appointments.

At 18 months, compared with the control group, the I-CBT group showed fewer heavy drinking days, days of marijuana use, suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests; and less self-reported anxiety and global impairment. Suicidal ideation and depressed mood improved similarly in the two groups.