Impact of Evidence-Based Psychosocial Treatment on Service Utilization Among Adolescents with Co-Occurring Posttraumatic Stress Disorder Symptoms and Substance Use Problems - Abstract
Objective: To examine the impact of evidence-based, trauma-focused treatment on mental health service utilization and juvenile justice involvement among adolescents with co-occurring posttraumctic stress disorder (PTSD) symptoms and substance use problems. Method: This study is a secondary analysis of a randomized controlled trial examining the efficacy of Risk Reduction Through Family Therapy (RRFT), an integrated treatment for youth with co-occurring PTSD and substance use problems. Participants were 127 adolescents (aged 13-18 years) with at least one
memorable experience of interpersonal trauma, at least one day of nontobacco substance use in the previous 90 days, and five or more PTSD symptoms. Adolescents (87% female; mean [SD] age 15.4 [1.3]; 63% white) were randomized to RRFT (n = 61) or treatment as usual (TAU; primarily Trauma Focused Cognitive Behavioral Therapy [TF-CBT]; n = 63) groups. Data on health service utilization was collected at baseline (pre-treatment) and at 18 months posttreatment using the Services Assessment for Child and Adolescent (SACA). Results: Youth in both treatment conditions had fewer inpatient mental health hospitalizations and lower rates of juvenile justice involvement at 18-month follow up. Participants who received RRFT showed a relatively greater reduction in hospitalizations post-treatment compared with those who received TAU. Conclusions: Evidence-based trauma-focused treatment, irrespective of the incorporation of specific substance use modalities, can be effective in reducing utilization of costly and intensive health services among youth with PTSD. These findings suggest that evidence-based trauma-focused psychosocial treatment has the potential to offset the public health costs associated with the comprehensive treatment needs of this population.