Family Intervention for Teen Drinking in the ER

Aim 1: To investigate in a randomized controlled trial the engagement potential and
effectiveness of family-centered intervention (MDFT) and family-involved MI (FMII) for teens
with alcohol problems

- Hypothesis 1a: Treatment engagement will be higher in MDFT and FMII than in standard
care as evidenced by higher numbers of MDFT and FMII youth enrolled in substance abuse
treatment.

- Hypothesis 1b: Treatment completion will be higher for MDFT than FMII/group and
standard care as evidenced by more teens/families in MDFT completing a full course of
treatment.

- Hypothesis 1c: Youth assigned to MDFT and FMII/group will show greater decreases in
alcohol use and binge drinking than youth in standard care at the 3 month follow-up
(end of treatment). MDFT participants will show greater decreases in alcohol use and
binge drinking than FMII/group and standard care during the post-treatment period and
up to 18 month follow-up, and they will be less likely to meet diagnostic criteria for
an AUD at 18 months.

- Hypothesis 1d: Youth assigned to MDFT and FMII/group will show greater reductions than
youth in standard care in problems related to alcohol use, including drug use, drinking
and driving, alcohol-related injury, health and mental health problems, school
problems, delinquency, and association with substance abusing peers at the 3 month
follow-up (end of treatment). Youth in MDFT will show greater reductions in these
problems than FMII/group and standard care in the post-treatment period and up to 18
month follow-up.

Aim 2: To explore differential treatment effects with comorbid adolescents

- Hypothesis 2: For youth with low baseline levels of alcohol, drug, and psychiatric
problems, MDFT and FMII/group will both be more effective than standard care. MDFT will
reduce alcohol use more significantly than FMII/group for teens with more severe
baseline alcohol, drug, and psychiatric problems.

Aim 3: To examine the contribution of motivation and family factors as mediators of
treatment effects

- Hypothesis 3a: In both MDFT and FMII/group, motivation to change at the end of the
initial engagement sessions in both teen and parent will predict treatment
participation and 3 month outcomes (end of treatment) to a greater extent than
motivation in the teen or parent alone.

- Hypothesis 3b: In both MDFT and FMII/group, effective parenting practices and strong
family relationships will predict better alcohol and related outcomes at 3 month
follow-up.

Aim 4: To examine long-term abstinence, patterns and predictors of relapse up to 18 months
follow-up

- Hypothesis 4a: Four distinct patterns of relapse will emerge between 3 month and 18
month follow-up: high abstinence, low abstinence, decreasing abstinence, and increasing
abstinence.

- Hypothesis 4b: MDFT youth will be more likely to be in the high abstinence and
increasing abstinence groups; youth in FMII/group will be more likely to be in the
decreasing abstinence group; and youth in standard care will be more likely to be in
the low abstinence group.

- Hypothesis 4c: Youth in MDFT will show more significant reductions in risk factors for
alcohol relapse (family dysfunction, lack of abstinence motivation, positive alcohol
expectancies, poor abstinence coping, lack of support for abstinence) than youth in
FMII/group or standard care.

Aim 5: To compare the total/net monetary benefits to society of MDFT, FMII/group, and
standard care

- Hypothesis 5: MDFT and FMII/group will generate significantly higher total and net
monetary benefits to society than youth in standard care at 18 months post-ER visit.

- Research Question 5: Will MDFT or FMII/group generate higher total/net benefits to
society?

Inclusion Criteria:

1. Between ages 12 to 18 years old

2. Present in ER/trauma unit

3. Meet minimum cut-off of 4 on the AUDIT; OR BAC of 0.01% or more on QED; OR report
alcohol use within 6 hours of ER visit

4. Not receiving any other behavioral treatment

5. At least one parent/guardian is willing to participate in assessments and
intervention

6. Parent consent/youth assent

Exclusion Criteria:

1. Meet DSM-IV dependence criteria for any substance other than alcohol, marijuana, or
tobacco

2. Mental retardation or pervasive developmental disorders

3. Psychotic symptoms

4. Current suicidality