A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder

Abstract

Objective: Substance use is common among adolescents with post-traumatic stress disorder (PTSD). We aimed to develop and study an integrated treatment for adolescents with co-occurring disorders.

Design: This is a therapy development and open pilot trial study of a manualized therapy for adolescents with post-traumatic stress, depression, and substance use that uses a combination of cognitive therapy (CT) and mindfulness.

Methods: Descriptive statistics and paired sample t-tests were calculated to assess for changes in PTSD symptoms, depression, and substance use frequency from baseline to end of treatment using standardized measures and validated by urine drug screens. We also examined for safety, predictors of clinical outcomes, and treatment retention.

Results: Thirty-seven adolescents participated in the study; 62% were study completers as defined by retention for at least 6 weeks of treatment. There were significant improvements in PTSD and depression symptoms from baseline to end of treatment, reflecting medium effect sizes, and which was associated with changes in trauma-associated cognitions. There was a reduction in cannabis use, which was the most commonly used substance.

Conclusions: Preliminary results suggest feasibility, safety, and potential clinical effectiveness of an integrated therapy for adolescents with PTSD, depression, and substance use. Retention was comparable to other therapy clinical trial studies of adolescents despite the high risk for poor treatment retention and poor clinical outcomes among adolescents with PTSD and co-occurring disorders. We discuss the rationale for continued research of this mindfulness-based CT for adolescents with co-occurring disorders.

Practitioner points: Adolescents with co-occurring PTSD and substance use achieved meaningful improvement in PTSD and depression symptom severity after receiving a CT and mindfulness dual diagnosis approach. An integrated manualized therapy for dual diagnosis shows promise for reducing cannabis use in adolescents with PTSD. Changes in trauma-related cognitions have the potential to improve PTSD and depression symptoms in adolescents with substance use problems.

Keywords: adolescent; cannabis; co-occurring disorders; cognitive therapy; mindfulness; post-traumatic stress; substance use.