Relapse Prevention for Suicidal Dually Diagnosed Youths

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DESCRIPTION (provided by applicant): Development and testing of interventions for suicidal adolescents are public health priorities. Alcohol and substance use disorders and depressive disorders are both associated with increased risk of suicidal behavior in adolescents and commonly co-occur. However, interventions have not been specifically developed for suicidal dually diagnosed youths. The purpose of this study is to develop, refine, and pilot test a cognitive behavioral relapse prevention intervention (CBT-RP) for this population. CBT-RP is based on the relapse prevention model of Mariatt and Gordon (1985). CBT-RP melds cognitive behavioral relapse prevention, motivational enhancement approaches, and mindfulness meditation, and extends the original focus of the relapse prevention model on alcohol and substance use to suicidal outcomes and depression. Treatment development will follow recommendations of Rounsaville et al. (2001) and will culminate in a pilot randomized controlled trial (RCT) to determine the effects associated with CBT-RP (n=36). The first aim of this project is to develop and refine treatment manuals and procedures for CBT-RP and for "enhanced supportive care" (the comparison intervention in the pilot RCT). The second aim is to develop and pilot test procedures for training CBT-RP therapy and enhanced supportive care. The third aim is to assess the feasibility of CBT-RP and enhanced supportive care via monitoring of recruitment and retention of subjects, monitoring of therapist adherence to the protocol, and monitoring of adverse events. The fourth aim is to assess the feasibility of assessment methods as reflected in the burden of completing assessments. The fifth aim is to estimate the degree of change and variability of response to CBT-RP + fluoxetine relative to enhanced supportive care + fluoxetine on the primary outcomes (suicidal ideation, depressive symptoms, and substance abuse problem severity). Fluoxetine is prescribed for all adolescents in the study (a) to improve the generalizability of findings (given that the majority of depressed, treatment -seeking youths receive antidepressant medication), and (b) because of ethical concerns about withholding an efficacious treatment for depression with a vulnerable group. The final aim is to assess the acceptability of CBT-RP via exit interviews and ratings of patient satisfaction. These results will be used to design an adequately powered, multi-site RCT examining the efficacy of CBT-RP for suicidal dually diagnosed adolescents.