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A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder.

Kelly JF, Kaminer Y, Kahler CW, Hoeppner B, Yeterian J, Cristello JV, Timko C. A pilot randomized clinical trial testing integrated 12-Step facilitation (iTSF) treatment for adolescent substance use disorder. Addiction (Abingdon, England). 2017 Dec 1; 112(12):2155-2166.

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BACKGROUND AND AIMS: The integration of 12-Step philosophy and practices is common in adolescent substance use disorder (SUD) treatment programs, particularly in North America. However, although numerous experimental studies have tested 12-Step facilitation (TSF) treatments among adults, no studies have tested TSF-specific treatments for adolescents. We tested the efficacy of a novel integrated TSF. DESIGN: Explanatory, parallel-group, randomized clinical trial comparing 10 sessions of either motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT; n  =  30) or a novel integrated TSF (iTSF; n  =  29), with follow-up assessments at 3, 6 and 9 months following treatment entry. SETTING: Out-patient addiction clinic in the United States. PARTICIPANTS: Adolescents [n  =  59; mean age  =  16.8 (1.7) years; range  =  14-21; 27% female; 78% white]. INTERVENTION AND COMPARATOR: The iTSF integrated 12-Step with motivational and cognitive-behavioral strategies, and was compared with state-of-the-art MET/CBT for SUD. MEASUREMENTS: Primary outcome: percentage days abstinent (PDA); secondary outcomes: 12-Step attendance, substance-related consequences, longest period of abstinence, proportion abstinent/mostly abstinent, psychiatric symptoms. FINDINGS: Primary outcome: PDA was not significantly different across treatments [b  =  0.08, 95% confidence interval (CI)  =  -0.08 to 0.24, P  =  0.33; Bayes'' factor  =  0.28). SECONDARY OUTCOMES: during treatment, iTSF patients had substantially greater 12-Step attendance, but this advantage declined thereafter (b  =  -0.87; 95% CI  =  -1.67 to 0.07, P  =  0.03). iTSF did show a significant advantage at all follow-up points for substance-related consequences (b  =  -0.42; 95% CI  =  -0.80 to -0.04, P  <  0.05; effect size range d  =  0.26-0.71). Other secondary outcomes did not differ significantly between treatments, but effect sizes tended to favor iTSF. Throughout the entire sample, greater 12-Step meeting attendance was associated significantly with longer abstinence during (r  =  0.39, P  =  0.008), and early following (r  =  0.30, P  =  0.049), treatment. CONCLUSION: Compared with motivational enhancement therapy/cognitive-behavioral therapy (MET/CBT), in terms of abstinence, a novel integrated 12-Step facilitation treatment for adolescent substance use disorder (iTSF) showed no greater benefits, but showed benefits in terms of 12-Step attendance and consequences. Given widespread use of combinations of 12-Step, MET and CBT in adolescent community out-patient settings in North America, iTSF may provide an integrated evidence-based option that is compatible with existing practices.

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