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

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

Method: 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.

Results: 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.

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