Borderline Adolescent Family Therapy Trial

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DESCRIPTION (provided by applicant): The proposed Stage I-B study focuses on adolescents who meet criteria for both Borderline Personality Disorder (BPD) and Substance Abuse Disorder. These adolescents display a pattern of self-destructive behaviors (suicide attempts, self-mutilization, violent reactions) that intensify and exacerbate their drug abuse, and severely disrupt treatment and family relations. This constellation of symptoms and their severity require specialized interventions. A previous NIDA funded Stage I study led to the development of the Integrative Borderline Adolescent Family Therapy (I-BAFT) model that integrated 1) Linehan's work on skills training specifically for Borderline adults with 2) family treatment based on Structural Family Therapy shown efficacious with substance abusing adolescents and 3) individual level interventions adapted for this specific subtype of drug abuser. This application proposes to conduct a "Stage I-B study of behavioral and psychosocial therapies for substance abuse disorder" testing the newly developed I-BAFT in a small randomized trial and providing a more substantial test of its efficacy, to obtain the necessary indicators needed for a Stage II trial. In addition to focusing on drug and BPD outcomes, the study will also obtain preliminary indicators of impact on hypothesized mediators (e .g. family functioning and emotion regulation). We will recruit 40 drug-abusing adolescents (20 male and 20 female, 14-17 years of age) who meet DSM-IV criteria for BPD, and their families. Participants will be recruited from the Juvenile Addictions Receiving Facility (JARF) at the University of Miami/Jackson Memorial Hospital and the Juvenile Assessment Center (JAC). The adolescents and their families will be randomly assigned to either the (1) I-BAFT condition, or (2) the Individual Drug Counseling (IDC) condition. Both treatment conditions are manualized and have adherence checklists available. Both I-BAFT and IDC will be implemented as seven-month interventions with two sessions per week. Assessments will be conducted at baseline, mid-treatment (4 months), post-treatment (8 months), and follow-up (12 months). Longitudinal data analysis (growth curve modeling) and Clinical Significance v/ill be used to test study hypotheses.