- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05384223
Evaluation of RRFT for Co-occurring SUD and PTSD Among Teens
July 29, 2023 updated by: Carla Kmett Danielson, Medical University of South Carolina
Evaluation of Clinical Effectiveness, Cost, and Implementation Factors to Optimize Scalability of Treatment for Co-occurring SUD and PTSD Among Teens
Psychosocial traumatic events during childhood, serve as strong and consistent predictors of substance use problems (SUP) during adolescence and adulthood.PTSD that extends from such trauma often co-occurs with SUP.
Despite this well-established link, standard care for adolescents with co-occurring SUP and PTSD for the last several decades has been to treat these problems separately.
This compartmentalized approach to treatment creates a burden on teens and families, raises unique challenges to clinicians in both mental health and addiction domains, and may contribute to high rates of SUP relapse among adolescents with co-occurring PTSD.
To address this problem, our team recently completed a rigorous National Institute on Drug Abuse (NIDA)-funded randomized controlled trial (RCT) supporting the efficacy of an integrative, exposure-based treatment we developed, Risk Reduction through Family Therapy (RRFT), in greater long term reductions in SUP, as well as PTSD avoidance and hyperarousal symptoms, in comparison to standard treatment in a large teen sample.
The proposed RCT, with an effectiveness-implementation Hybrid Type I design, substantially builds on that prior research by proposing to 1) evaluate whether RRFT's clinical effectiveness for reducing SUP and PTSD can be extended to youth in outpatient substance use treatment settings-where youth are presenting for SUP treatment and where clinicians often have less experience treating PTSD (Aim 1); 2)evaluate the cost-effectiveness of RRFT and to explore inner context variables (e.g., perceived treatment acceptability, attitudes, and satisfaction among the participating adolescents, caregivers, agency leaders, and therapists and barriers to and facilitators of implementation) that might affect RRFT implementation in diverse practice settings(Aim 2).
The proposed effectiveness-implementation trial will recruit adolescents (13-18 years) with a history of psychosocial trauma presenting with SUP and PTSD symptoms for outpatient substance use disorder treatment at sites in Denver, Colorado.
Participants will be randomized to RRFT or Treatment as Usual.
A multi-method, multi-respondent approach will track clinical outcomes(SUP, PTSD, and putative targets of treatment, such as emotional suppression)at 3, 6, and 12 months post-baseline.
Study Overview
Status
Recruiting
Conditions
Study Type
Interventional
Enrollment (Estimated)
212
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Paula Riggs, PhD
- Email: paula.riggs@cuanschutz.edu
Study Contact Backup
- Name: Rachel Baechtold, MS
- Phone Number: 812.345.7912
- Email: mailto:rachel.baechtold@cuanschutz.edu
Study Locations
-
-
Colorado
-
Aurora, Colorado, United States, 80045
- Recruiting
- CU Medicine Psychiatry - Outpatient Clinic
-
Contact:
- Rachel Baechtold, MS
- Phone Number: 812-345-7912
- Email: rachel.baechtold@cuanschutz.edu
-
Denver, Colorado, United States, 80236
- Recruiting
- ARTS - Synergy Outpatient Services
-
Contact:
- Rachel Baechtold, MS
- Phone Number: 812-345-7912
- Email: rachel.baechtold@cuanschutz.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
13 years to 18 years (Child, Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Aged 13-18 years;
- Experienced lifetime DSM-V PTSD Criteria A-defined potentially traumatic event, such as interpersonal violence, with memory of incident(s), such as child sexual abuse (forced or unwanted vaginal or anal penetration by an object, finger, or penis; oral sex; touching of the respondent's breasts or genitalia; or respondents' touching of another person's genitalia); child physical abuse (nonaccidental physical injury to the child or any action that results in a physical impairment of the child), witnessed domestic violence (exposure to conduct by a household member against another household member that involves attempted or completed assault or murder); witnessed community violence; dating violence; as well as disasters, accidents, etc.;
- Five or more current DSM-V PTSD symptoms as assessed on the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS)/UCLA PTSD Index;
- Substance use, defined as alcohol or non-tobacco drug use, in the past 28 days prior to study screening per self-report. If in a restrictive setting for the 28 days prior to study screening, substance use will be anchored to use prior to entering restrictive setting;
- A current (past year) non-nicotine substance use disorder (SUD) as assessed on the K-SADS;
- Willingness to include caregiver as a participant;
- English-speaking.
Exclusion Criteria:
- Presence of Pervasive Developmental Disability or Moderate/Severe Mental Retardation or other cognitive limitation that would preclude meaningful engagement in RRFT or cognitive-behavioral therapy
- Actively suicidal/homicidal;
- Active psychosis.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: RRFT (Risk Reduction through Family Therapy)
|
RRFT is an adaptation and integration of existing empirically-supported interventions with similar theoretical rationales targeting similar populations, particularly Multisystemic Therapy principles (MST)for adolescent SUP and Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) components for PTSD in youth.
RRFT consists of seven primary components: Psychoeducation and Engagement, Coping, Family Communication, Substance Use, PTSD, Healthy Dating and Sexual Decision-Making, and Revictimization Risk Reduction.
|
Active Comparator: Treatment as Usual (TAU): Encompass
|
Encompass is currently a research to practice treatment for adolescents with co-occurring substance use disorders and mental health problems and is used as the standard treatment in the target study settings.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Timeline Follow Back (TFLB) - Change from baseline in # days non-tobacco substance used in past 28 days @ 3,6, and 12 months.
Time Frame: Collected at baseline, 3, 6, & 12 months
|
The Timeline Follow Back (TLFB) is a validated, subjective measure that uses a calendar for people to provide estimates of substance use (drugs/alcohol) on a daily basis, retrospectively.
Key dates and calendars are used to aid in memory recall.
The measure is beneficial in both clinical and research environments.
Over time, the TLFB looks for a decrease in substance use.
Higher numbers of substance use are indicative of greater substance use.
|
Collected at baseline, 3, 6, & 12 months
|
UCLA PTSD Index DSM V - Change from baseline in UCLA PTSD total score @ 3,6, and 12 months
Time Frame: Collected at baseline, 3, 6, & 12 months
|
The University of California, Los Angeles (UCLA) Post Traumatic Stress Disorder Index Diagnostic and Statistical Manuals 4th ed (DSM-IV; UCLA PTSD Index DSM-IV) is a validated, subjective measure that consists of 23 yes or no questions regarding the occurrence of different traumas or losses that may happen during a child's life.
Each question is followed up with details of the trauma that occurred and more extensive questioning for the trauma experienced that is still most bothersome in the present day.
These follow-up questions gauge symptoms of PTSD on a five-point Likert scale that ranges from "none" (score of 0, no days has this symptom occurred in the last month) to "most" (score of 4, symptom occurred almost every day in the past month).
The most traumatic experience is also followed by several yes/no questions that gauge distress and functional impairment.
Higher scores are indicative of higher rates of PTSD symptoms.
|
Collected at baseline, 3, 6, & 12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Timeline Follow Back (TFLB) - total # of days/28 day of cannabis use, alcohol use, and other non-nicotine substance use (excluding cannabis, alcohol).
Time Frame: Collected at baseline, 3, 6, & 12 months
|
The Timeline Follow Back (TLFB) is a validated, subjective measure that uses a calendar for people to provide estimates of substance use (drugs/alcohol) on a daily basis, retrospectively.
Key dates and calendars are used to aid in memory recall.
The measure is beneficial in both clinical and research environments.
Over time, the TLFB looks for a decrease in substance use.
Higher numbers of substance use are indicative of greater substance use.
|
Collected at baseline, 3, 6, & 12 months
|
Alabama Parenting Questionnaire (APQ) - positive parenting subscale, inconsistent discipline subscale, and supervision/monitoring subscale.
Time Frame: Collected at baseline, 3, 6, & 12 months
|
The Alabama Parenting Questionnaire (APQ) is a validated measure consisting of questions that look into family interactions and, more specifically, interactions between youth and caregiver.
The scale is scored on a five-point Likert scale that ranges from "never" (score of 1) to "always" (score of 5) when looking at how often certain behaviors occur within the home.
High scores on the positive parenting subscale and low scores on the poor monitoring/supervision, inconsistent discipline, and corporal punishment subscales are indicative of positive parenting.
|
Collected at baseline, 3, 6, & 12 months
|
Difficulties in Emotion Regulation Scale (DERS) - Change from baseline in total score @ 3, 6, & 12 mo f/u
Time Frame: Change from baseline in total score @ 3, 6, & 12 month follow-up
|
The Difficulties in Emotion Regulation Scale (DERS) is an instrument measuring emotion regulation problems.
is a 36-item self-report measure of six facets of emotion regulation.
Items are rated on a scale of 1 ("almost never") to 5 ("almost always").
Higher scores indicate more difficulty in emotion regulation.
|
Change from baseline in total score @ 3, 6, & 12 month follow-up
|
Timeline Follow Back (TLFB) - Average quantity of specific substance used on days of use/28 days
Time Frame: Collected at baseline, 3, 6, & 12 months
|
The Timeline Follow Back (TLFB) is a validated, subjective measure that uses a calendar for people to provide estimates of substance use (drugs/alcohol) on a daily basis, retrospectively.
Key dates and calendars are used to aid in memory recall.
The measure is beneficial in both clinical and research environments.
Over time, the TLFB looks for a decrease in substance use.
Higher numbers of substance use are indicative of greater substance use.
|
Collected at baseline, 3, 6, & 12 months
|
Urine Drug Screen (UDS) - Between group comparison -total # negative UDS /total # collected at baseline, 3, 6, & 12 months
Time Frame: Collected at baseline, 3, 6, & 12 months
|
Participants will complete urine drug screens that will be at least 6 panel including cocaine, THC (tetrahydrocannabinol-marijuana), opiates, amphetamines, methamphetamines, and benzodiazepines
|
Collected at baseline, 3, 6, & 12 months
|
Response to Stress Questionnaire (RSQ) - Change from baseline in Adolescent/Child's Self-Report Responses to Family Stressors (subscale score items a-l)
Time Frame: Change from baseline @ 3,6, and 12 months
|
The RSQ measures coping and involuntary stress responses.
Higher scores indicate higher stress.
|
Change from baseline @ 3,6, and 12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Collaborators
Investigators
- Principal Investigator: Carla Kmett Danielson, PhD, Medical University of South Carolina
- Principal Investigator: Paula Riggs, PhD, University of Colorado, Denver
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
October 26, 2022
Primary Completion (Estimated)
June 1, 2026
Study Completion (Estimated)
June 1, 2026
Study Registration Dates
First Submitted
May 17, 2022
First Submitted That Met QC Criteria
May 17, 2022
First Posted (Actual)
May 20, 2022
Study Record Updates
Last Update Posted (Actual)
August 1, 2023
Last Update Submitted That Met QC Criteria
July 29, 2023
Last Verified
July 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- Pro00113543
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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