Our group has worked to apply Trauma Systems Therapy (TST) to the problem of Adolescent Traumatic Stress and Substance Abuse (ATSSA). The resulting intervention combines the work from the Adolescent Traumatic Stress and Substance Abuse Treatment Center at Boston University and the Center for Medical and Refugee Trauma at Boston Medical Center and utilizes existing promising practices for treating adolescent substance abuse, traumatic stress, and emotional regulation problems.

Trauma Systems Therapy, developed by Glenn Saxe at Boston Medical Center, is a community based program designed to enhance and facilitate a child’s ability to regulate emotional and behavioral responses to social environmental stressors. The program is designed to address barriers toward families’ engagement in treatment and is designed to be used in community settings with populations facing significant stressors.

Trauma Systems Therapy can be seen as a framework for organizing a series of empirically validated interventions to address the real-world needs of children facing considerable adversity. It is designed to help children and families where there is ongoing stress in the social environment.

Treatment components include home-based services, legal advocacy, emotional regulation skills training, cognitive processing, and psychopharmacology.

Adaptations for utilizing TST with substance abusing adolescents include:

• Inclusion of additional motivational interviewing strategies to engage youth and establish a commitment to change.
• Psychoeducation about substance abuse and its interaction with trauma symptoms.
• Stronger emphasis on behavioral management strategies for parents to increase monitoring and limit setting, particularly around drug use and high risk behaviors.
• Information about interfacing with systems of care that TSSA youth are typically involved with, such as the juvenile correctional system, alternative school settings, and substance abuse treatment facilities.

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