367 Group and Family Cognitive Behavior Therapy for Adolescent Depression and Substance Abuse: A Case Study John E Curry and Karen C. Wells, Duke University Medical Center John E. Lochrnan, University of Alabama W. Edward Craighead, University of Colorado Paul D. Nagy, Duke University Medical Center Cognitive behavior therapy ( CBT) has been demonstrated to be an effective acute intervention for adolescent depression. However, studies to date of CBT with depressed adolescents have excluded those with comorbid substance abuse. Treatment of comorbid sub- stance abuse requires that the targets of CBT be expanded to include social cognitive and family factors associated with the substance use disorder We developed an integrated group and family therapy model of intervention for adolescents with both depression and substance abuse. The case of R.P. illustrates the application of this treatment model. Treatment includes skills training in the context of a closed, mixed-gend~ twice-weekly adolescent group and weekly family therapy sessions to apply new .skills in the family context. Central clinical issues and core cognitive and behavioral correlates of t~P. "sdepression and substance abuse are delineated as they oc- curred during the course of treatment. Treatment was associated with improvements in mood and reductions in substance use. U 'NIPOLAR DEPRESSION and substance use disorders are two of the three most common forms of psy- chopathology among adolescents (Lewinsohn et al., 1993). Comorbidity of unipolar depression and substance use dis- orders is also high, with approximately 20% to 25 % of com- munity adolescents with one of the disorders having had the other type during his or her lifetime (Lewinsohn et al.). Comorbidity appears to be higher among adolescents in treatment (Bukstein, Glancy, & Kaminer, 1992; Hovens, Cantwell, & Kiriakos, 1994). Adolescents with these two types of disorders are at elevated risk for several negative outcomes, including escalation into more severe substance abuse, suicidal ideation, attempts and completed suicides (Brent, 1995; Henry et al., 1993; Levy & Deykin, 1989). In light of the frequency and impact of comorbid depression and substance use disorders, it is essential to develop and to test treatments for adolescents with both disorders. There is now considerable evidence in support of cogni- tive behavior therapy (CBT) as efficacious acute treatment for adolescent unipolar depression (Kaslow & Thomp- son, 1998; Reinecke, Ryan, & DuBois, 1998). Both Lewin- sohn's more behavioral model and Beck's cognitive therapy have been successfully applied with depressed adolescents (Brent et al., 1997; Clarke, Rohde, Lewinsohn, Hops, & Seeley, 1999; Lewinsohn, Clarke, Hops, & Andrews, 1990). These studies have shown that CBT compares fa- vorably to a wait-list condition or to alternative acute treatments and leads to remission from the depressive ep- Cognitive and Behavioral Practice 8, 367-376, 2001 1077-7229/01/367-37651.00/0 Copyright © 2001 by Association for Advancement of Behavior Therapy. All rights of reproduction in any form reserved. isode in approximately 50% to 65% of adolescents by the end of acute treatment. However, all adolescent depres- sion treatment studies to date have excluded substance- abusing teens. Therefore, it is not clear that CBT would be effective with dually diagnosed adolescents. Evidence in support of CBT for adolescent substance abuse is less direct than that supporting CBT for adoles- cent depression. Adult intervention studies include suc- cessful models of CBT for substance use disorders (Car- roll et al., 1994). Cognitive behavioral prevention programs have reduced future rates of adolescent substance abuse (Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995; Loch- man, White, Curry, & Rumer, 1992). Behavioral family therapy appears effective in reducing teen substance use (Azrin et al., 1994). Taken together, these literatures sug- gest that an expanded and modified CBT might be effec- tive with adolescents who are both depressed and abusing substances. Therefore, our group of investigators began to develop a CBT specifically for these young people. The treatment development process and results of pilot test- ing will be described more fully elsewhere (Curry, Wells, Lochman, Craighead, & Nagy, 2001). In this paper, we will first describe the'modifications in treatment that were introduced to address both depression and sub- stance abuse, and then describe the acute (12 weeks) treatment of an adolescent carried out in the context of this therapy development program. Modifying Treatment Content of CBT for Dually Diagnosed Adolescents CBT for adolescent depression addresses social, cogni- tive, and family processes that are associated with depres-