Multisystemic Therapy-Emerging Adults (MST-EA) for Substance Abuse

NCT ID: NCT03035877

Last Updated: 2024-05-10

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 183 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2017-08-28
• Study Completion Date: 2023-04-13

Brief Summary

This study's purpose is to examine the effectiveness of a promising intervention for emerging adults (EAs) with alcohol and other drug (AOD) abuse and justice involvement in achieving the ultimate outcome of reduced criminal activity. The study will also examine that effect on intermediate outcomes as follows: 1) reduced AOD use; 2) greater gainful activity (increased educational success, employment and housing stability; decreased antisocial peer involvement and relationship conflict); 3) and greater improvement in self-regulation (self-efficacy, goal directedness and responsibility taking). The intervention to be tested is Multisystemic Therapy-Emerging Adults (MST-EA). MST-EA is an adaptation of MST, a well-established, effective intervention for antisocial behavior in adolescents.

Detailed Description

Prevalence of alcohol and other drug (AOD) abuse and criminal activity is highest during emerging adulthood compared to any other developmental period, and causes extraordinary costs to society. Emerging Adults (EAs; ages 17-26) with AOD abuse have greater incarceration rates than EAs without AOD abuse, and AOD-abusing offenders have significantly more recidivism, severe offending, and incarceration than other offenders. Such serious behavior interferes with successful transition into adulthood in areas such as school completion, employment and housing. Thus, there is a strong public health need for effective treatment to reduce AOD abuse and justice involvement in EAs. Surprisingly, there are no interventions with established efficacy to reduce criminal activity among EAs, with or without AOD abuse. Among younger adolescents, the comprehensive causes of antisocial behavior are addressed by effective interventions (e.g., Multisystemic Therapy [MST]; Treatment Foster Care Oregon [TFCO]), and the present investigative team has developed and evaluated a well-defined age-tailored intervention for EAs with criminal behavior. The developed intervention is an adaptation of MST and integrates a skills coaching component from TFCO, both well-established effective juvenile justice interventions. Initial MST-EA research focused on justice-involved young adults who had mental health problems, a high-risk subpopulation of offenders, but AOD abuse quickly became a primary problem the MST-EA team treated. As a single-source intervention, MST-EA targets the EA correlates of criminal activity and AOD abuse, including gainful EA activities (positive relationships, school, work, and housing) and reduced AOD abuse-in part by targeting the proximal mechanism of poor self-regulation. In a successfully completed community-based open trial, the safety, feasibility, and preliminary efficacy of the intervention were established.

The proposed study will evaluate the effectiveness of MST-EA for reducing justice involvement and AOD abuse. EAs (n = 240) with AOD abuse and justice involvement (recent arrests or release from justice facilities) will be randomized to receive MST-EA or Enhanced Treatment as Usual (E-TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with confirmation of outcome data using official records. Aims will be to evaluate the effect over time of MST-EA for reducing AOD abuse and criminal activity, as well as to evaluate the effect of MST-EA on the key proximal target of treatment (self-regulation) and intermediate outcomes of treatment (gainful activities). A final aim of the study will be to investigate if the direct effect of treatment on criminal activity is mediated by its effect on self-regulation, AOD abuse, and gainful activities. In this specific age group, there is a complete absence of AOD abuse and recidivism reduction treatments with demonstrated effectiveness. The ultimate effect of the proposed research would be decreased AOD abuse and justice involvement in a high-risk population, as well as improved outcomes that have significant societal impact (e.g., reduced homelessness and unemployment).

Conditions

Antisocial Behavior

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Multisystemic Therapy-Emerging Adults

This group will receive Multisystemic Therapy-Emerging Adults.

Group Type: EXPERIMENTAL

Multisystemic Therapy-Emerging Adults

Intervention Type: BEHAVIORAL

MST-EA is a home- and community-based treatment for emerging adults (ages 17-21) that aims to address antisocial behavior and problems caused by substance use disorders. The model also addresses co-occurring mental health problems when present. Therapists work directly with the young adult and his/her social network. This treatment also involves the use of coaches who help young people develop skills for young adulthood.

Enhanced Treatment as Usual

This group will have access to an enhanced version of services typically delivered to young adults who have a substance use disorder and have been in trouble with the law.

Group Type: ACTIVE_COMPARATOR

Enhanced Treatment as Usual

Intervention Type: BEHAVIORAL

With Enhanced Treatment as Usual (E-TAU), emerging adults will get the treatments that they usually receive when they have a substance use disorder and have been in trouble with the law. In addition, they will receive travel vouchers for attending services, a card with an individualized list of contacts when in crisis, and facilitation with identifying need of services and accessing those services.

Interventions

Multisystemic Therapy-Emerging Adults

MST-EA is a home- and community-based treatment for emerging adults (ages 17-21) that aims to address antisocial behavior and problems caused by substance use disorders. The model also addresses co-occurring mental health problems when present. Therapists work directly with the young adult and his/her social network. This treatment also involves the use of coaches who help young people develop skills for young adulthood.

Intervention Type: BEHAVIORAL

Enhanced Treatment as Usual

With Enhanced Treatment as Usual (E-TAU), emerging adults will get the treatments that they usually receive when they have a substance use disorder and have been in trouble with the law. In addition, they will receive travel vouchers for attending services, a card with an individualized list of contacts when in crisis, and facilitation with identifying need of services and accessing those services.

Intervention Type: BEHAVIORAL

Other Intervention Names

MST-EA; E-TAU

Eligibility Criteria

Inclusion Criteria

• Age 16 to 26 years
• Recent arrest or release from jail/prison/detention (within the past 18 months but excluding arrest for parole/probation violations)
• Presence of alcohol or drug (AOD) abuse disorder and recent AOD use (within the past 90 days)
• Able to reside in a stable community setting (not currently homeless, not currently in-patient; can include individuals ready for discharge to the community)

Exclusion Criteria

• Actively psychotic, suicidal, or homicidal
• Pervasive Development Disorders (PDD) or mental retardation
• Sex offending as the primary offense type

• Minimum Eligible Age: 16 Years
• Maximum Eligible Age: 26 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Massachusetts, Worcester

OTHER

Sponsor Role: collaborator

Connecticut Department of Children and Families

UNKNOWN

Sponsor Role: collaborator

North American Family Institute

UNKNOWN

Sponsor Role: collaborator

Court Support Services Division

UNKNOWN

Sponsor Role: collaborator

Youth Villages

OTHER

Sponsor Role: collaborator

Chestnut Health Systems

OTHER

Sponsor Role: collaborator

Oregon Social Learning Center

OTHER

Sponsor Role: lead

Responsible Party

Ashli Sheidow

Senior Research Scientist

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Ashli J Sheidow, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Chestnut Health Systems

Maryann Davis, Ph.D.

Role: PRINCIPAL_INVESTIGATOR

University of Massachusetts, Worcestor

Locations

North American Family Institute

Hamden, Connecticut, United States

North American Family Institute

Hartford, Connecticut, United States

North American Family Institute

New Haven, Connecticut, United States

Youth Villages

Johnson City, Tennessee, United States

Countries

United States

Other Identifiers

1R01DA041425-01

Identifier Type: NIH

Identifier Source: org_study_id

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