1. 1 Trauma Systems Therapy for Adolescent Substance Abuse (TST-SA) Liza Suárez, Ph.D. Glenn Saxe, MD Center for Anxiety and Related Disorders Center for Medical and Refugee Trauma Boston University Boston Medical Center Jill Ehrenreich, Ph.D. David Barlow, Ph.D. Center for Anxiety and Related Disorders Boston University

2. 2 Need for Integrated Treatment Approaches Increased risk among adolescents Increased risk among adolescents Late identification and poor response to current treatment approaches Late identification and poor response to current treatment approaches Clinicians need training in more areas Clinicians need training in more areas Multiple problems associated with SUD- PTSD comorbidity Multiple problems associated with SUD- PTSD comorbidity Involved with multiple service systems Involved with multiple service systems No current integrated approaches available for adolescents No current integrated approaches available for adolescents

3. 3 Goals of TST 1. Treatment must be developmentally informed. 2. Treatment must directly address the social ecology. 3. Treatment must be compatible with systems of care. 4. Treatment must be disseminate-able.

4. 4 TST in a Nutshell Interventions in TST are designed to work in two dimensions: Interventions in TST are designed to work in two dimensions: –Strategies that operate through and in the social environment to promote change –Strategies that enhance the individual's capacity to self-regulate. Specific TST interventions include home and community-based care, emotional regulation skills training, services advocacy, trauma processing, and psychopharmacology. Specific TST interventions include home and community-based care, emotional regulation skills training, services advocacy, trauma processing, and psychopharmacology.

5. 5 Empirical support from TST Open Trial (Saxe, Ellis, Fogler, Hansen, & Sorkin, 2005) TST open trial (Saxe, Ellis, Fogler, Hansen, & Sorkin, 2005)  trauma symptoms,  emotional and behavioral regulation  trauma symptoms,  emotional and behavioral regulation More stable social environment More stable social environment Transitioning from more intensive to less intensive phases of treatment. Transitioning from more intensive to less intensive phases of treatment. TST controlled trial (preliminary findings) Reduced drop out rates (100% vs 10 % retention after 3 months) Reduced drop out rates (100% vs 10 % retention after 3 months) Dissemination: Ulster County Program Evaluation  trauma symptoms,  family stability  trauma symptoms,  family stability  hospitalization rates and length of hospital stay  hospitalization rates and length of hospital stay  length for need of services  length for need of services

6. 6 Why Trauma Systems Therapy for Adolescent Substance Abuse? Comprehensive and flexible treatment approach Comprehensive and flexible treatment approach Dual focus on social environmental and emotional regulation interventions Dual focus on social environmental and emotional regulation interventions Engagement and the treatment alliance Engagement and the treatment alliance Help families navigate multiple systems of care Help families navigate multiple systems of care

7. 7 TST-SA Components Added for the Adaptation of TST for Adolescent Substance Abuse Motivational enhancement strategies Motivational enhancement strategies Psychoeducation about substance abuse and its interaction with symptoms of traumatic stress. Psychoeducation about substance abuse and its interaction with symptoms of traumatic stress. Behavior management strategies for parents Behavior management strategies for parents Additional empirically supported substance abuse treatment components Additional empirically supported substance abuse treatment components Teen and parent workbook Teen and parent workbook Weekly assessment tools. Weekly assessment tools.

8. 8 Training opportunities A learning collaborative for TST-SA will take place in late October of 2006. For more information about this training, or TST-SA, contact Liza Suarez at lsuarez@bu.edu or 617-353-9610 A learning collaborative for TST-SA will take place in late October of 2006. For more information about this training, or TST-SA, contact Liza Suarez at lsuarez@bu.edu or 617-353-9610lsuarez@bu.edu For more information about Trauma Systems Therapy contact Glenn Saxe at Glenn.Saxe@bmc.org or 617-414-7531 For more information about Trauma Systems Therapy contact Glenn Saxe at Glenn.Saxe@bmc.org or 617-414-7531 Glenn.Saxe@bmc.org