Intervention with substance-abusing runaway adolescents and their families: results of a randomized clinical trial

To examine the efficacy of 3 theoretically distinct interventions among substance-abusing runaway adolescents and to explore individual differences in trajectories of change.

Adolescents (N = 179) between the ages of 12 and 17 were recruited from a runaway shelter in a midwestern city. The sample included 94 females (52.5%) and 85 males (47.5%); the majority of the adolescents were African American (n = 118, 65.9%). Adolescents were randomly assigned to the Community Reinforcement Approach (CRA, n = 57), Motivational Interviewing (MI, n = 61), or Ecologically-Based Family Therapy (EBFT, n = 61). Substance use was assessed at baseline, 3, 6, 9, 12, 18, and 24 months via Form 90 and urine screens.

Hierarchical linear modeling revealed statistically significant improvement in frequency of substance use among runaways in all 3 treatment groups, with a slight increase at posttreatment. Latent trajectory profile analysis explored individual differences in change trajectories and yielded a 3-class model. The majority of adolescents (n = 136, 76%) showed reductions in substance use over time, with a slight increase at follow-up (Class 1: Decreasing). Twenty-four (13.4%) adolescents had shown high levels of substance use over time with patterns of increase and decrease (Class 2: Fluctuating high users), and 19 (10.6%) decreased but returned to baseline levels by 2 years postbaseline (Class 3: U shaped). Few differences among treatment conditions were noted; within the "decreasing" group, adolescents in MI treatment showed a quicker decline in their substance use but a faster relapse compared with those receiving EBFT.

These findings suggest that CRA, EBFT, and MI are viable treatments for runaway substance-abusing adolescents.