Integrated Suicide and Substance Use Intervention for Adolescents in Substance Use Treatment

Suicide and substance use are often interrelated, with each exacerbating the other. Adolescents with problematic substance use typically receive outpatient substance use treatment, where suicidal thoughts and behaviors (STBs) are rarely addressed in a comprehensive manner. Given the role that substance use can play in STBs, and vice versa, greater attention to the development and implementation of integrated suicide and substance use interventions is essential. The integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST) is an alcohol-focused intervention that has demonstrated feasibility and acceptability with suicidal adolescents in inpatient psychiatric treatment. iASIST is the only brief intervention for adolescents specifically tailored to address the interrelated problems of alcohol use and STBs in an integrated way, but it is designed specifically for an inpatient psychiatric population where suicide is the primary concern. There are currently no interventions designed for the reverse problem: suicide risk among adolescent substance users. 

The aims of this project are: 1) Use feedback from 5 clinicians and 5 adolescents via qualitative in-depth interviews to develop the integrated Suicide Intervention for Teens who use Substances (iSITS) for adolescents in outpatient substance use treatment who endorse STBs. We will incorporate elements of iASIST and hypothesize that iSITS alterations will be related to frequency and duration, targeting multiple substances, primary emphasis on STBs, mHealth booster content, integration of medication assisted treatment, and safety planning procedures, 2) Conduct an open trial of iSITS with 10 patients to make revisions before testing the final version of iSITS, and 3) Test the feasibility and acceptability of iSITS in a pilot trial with 20 adolescents in outpatient substance use treatment who endorse STBs. We hypothesize that all the clinicians will report conducting the protocol is acceptable and they will complete the protocol with acceptable adherence and competency in 80% of their participants. We anticipate improved attitudes towards evidence-based treatments among clinicians. Finally, an exploratory aim will test the effects of iSITS on mechanisms of behavior change and on preliminary effects on suicide- and substance-related outcomes. 

PI Sellers will first conduct qualitative in-depth interviews with 5 clinicians from an adolescent outpatient substance use program to develop iSITS. Next, an open trial will be conducted. PI Sellers will enroll 5 adolescents and deliver the iSITS followed by qualitative in-depth interviews to gather feedback on the feasibility and acceptability and inform any intermediary changes to the intervention.PI Sellers will then provide training on the intervention to the substance use clinicians. Subsequently, each of the 5 clinicians will deliver the intervention to 1 patient. PI Sellers will meet with the clinicians for supervision and revise the intervention based on clinician feedback. If there are substantial modifications to the protocol, PI Sellers will retrain the clinicians in preparation for the pilot trial, where each clinician will recruit 4 additional patients to participate. The data from this formative study will provide the foundation upon which to apply for external funding to test iSITS in a fully powered randomized controlled trial.