Family-Based Treatment Programs Can Reduce Adolescent Drug Abuse

By Patrick Zickler, NIDA NOTES Staff Writer

Many factors influence adolescent drug abuse. Peer relationships; family, school, and neighborhood environments; and social or cultural norms can each act as protective factors or can put adolescents at increased risk. NIDA-supported researchers are developing and evaluating a variety of treatments designed to address the range of influences that play a role in adolescent drug abuse. In a study that compared three treatment approaches, researchers have found that Multidimensional Family Therapy (MDFT), which involves individual therapy and family therapy, produced better treatment outcomes than did Adolescent Group Therapy (AGT) or Multifamily Educational Intervention (MEI), a treatment delivered in sessions involving more than one family.

Dr. Howard Liddle at the University of Miami School of Medicine and colleagues at the University of Pennsylvania in Philadelphia, the University of Washington in Seattle, and Families First, a treatment center in Stockton, California, evaluated the treatment programs in a study involving 152 adolescents who had been referred to treatment through the juvenile justice system. The participants (average age 15.9 years, 80 percent male) came from single-parent families (48 percent), two-parent families (31 percent), and step families (21 percent) and had been using drugs for an average of 2.5 years; 51 percent were polydrug users, 49 percent marijuana and alcohol users.

Participants were randomly assigned to one of the treatment programs, which were administered in community clinics in weekly sessions over a period of 5 to 6 months. Before treatment began, the researchers evaluated each participant's drug use, school performance, problem behavior (acting-out behavior measured by a widely used assessment scale), and family functioning (measured by the Global Health Pathology Scale). The same characteristics were measured at the end of treatment and at follow up evaluations 6 months and 12 months after treatment ended.

Overall, the adolescents showed reductions in drug use after all three treatment programs, but the improvements were greatest for participants who received MDFT. At the end of treatment, 42 percent of MDFT, 25 percent of AGT, and 22 percent of MEI participants had decreased their drug use. Drug use declined further in the 12 months following treatment, with MDFT associated with the greatest reduction. Participants in MDFT also showed greater improvement in family functioning and academic performance than did adolescents who received AGT or MEI treatment.

"There was an overall pattern of improvement for each of the treatments, but family-based therapy stands out in its success in this study," Dr. Liddle says. "Those receiving MDFT showed the most improvement in drug use and academic performance, followed by participants who received AGT, then those receiving MEI."
Improvement in family function was most notable in MDFT participants, Dr. Liddle says. "The MDFT families moved from assessments of 'behaviorally incompetent' to the 'competent' range, while AGT families showed no change, and MEI families deteriorated on the family functioning scales."

Participants in MDFT were less likely than those in other programs to drop out of treatment -- 70 percent of those assigned to MDFT completed treatment, compared with 66 percent of participants in MEI and 52 percent in AGT.

Each program provided improvement in one or more outcomes measured in the study, but involvement of family members was associated with the best overall progress. "Given the pattern of results, it seems reasonable to conclude that a simultaneous focus on the family and the individual adolescent is an important ingredient for successful treatment of adolescent drug abuse," Dr. Liddle says.

Multidimensional Family Therapy Reduces Youth Drug Use, Improves School Performance and Family Interaction
	Start of Treatment	End of Treatment	12-Month Follow up
Drug Use, Past 30 days a
1 (no use) to 15 (marijuana use daily and other drugs used more than twice per week) MDFT b AGT MEI	9.89 8.83 10.03	4.79 7.33 7.26	4.25 5.08 7.26
Academic Perfomance a
Grade point average from 1 (D) to 4 (A) MDFT AGT MEI	1.77 1.85 1.98	2.56 2.44 2.05	2.62 2.26 1.92
Family Function a
1 (optimal) to 10 (severely dysfunctional) MDFT AGT MEI	6.15 6.00 4.31	5.18 5.67 4.77	4.70 5.83 5.35
a Average of all patients. b MDFT = Multidimensional Family Therapy; AGT = Adolescent Group Therapy; MEI = Multifamily Educational Intervention.
Multidimensional Family Therapy, which involves individual therapy and family therapy, produced better treatment outcomes for teenagers than did Adolescent Group Therapy or Multifamily Educational Intervention, a treatment delivered in sessions involving more than one family.

Source
Liddle, H.A., et al. Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug and Alcohol Abuse 27(4):651-687, 2001. [Abstract]

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