Cynthia L. Rowe

Impact of psychiatric comorbidity on treatment of adolescent drug abusers

Comorbidity of substance abuse disorders (SUD) and psychiatric disorders is one of the most important areas of investigation in contemporary drug abuse treatment research. This study examined the impact of psychiatric comorbidity on the treatment of 182 adolescent drug abusers in a randomized clinical trial comparing family and individual cognitive-behavioral therapy. Three distinct groups of adolescent substance abusers were compared: (1) Exclusive Substance Abusers (SUD only); (2) Externalizers (SUD + externalizing disorder); and (3) Mixed Substance Abusers (SUD + externalizing and internalizing disorder). The purpose of this study was to determine whether adolescents in these comorbid groups differed in clinical presentation and treatment response. More severe comorbidity was associated with greater family dysfunction and being female and younger at intake. An examination of substance use trajectories over time indicated that the Mixed group initially responded to treatment but returned to intake levels of substance use by 1 year post-discharge.

Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment

Abstract This randomized clinical trial evaluated a family-based therapy (Multidimensional Family Therapy, MDFT; Liddle 2002a) and a peer group therapy with 80 urban, low-income. and ethnically diverse young adolescents (11 to 15 years) referred for substance abuse and behavioral problems. Both treatments were outpatient, relatively brief, manual-guided, equal in intervention dose, and delivered by community drug treatment therapists. Adolescents and their parents were assessed at intake to treatment, randomly assigned to either MDFT or group therapy, and reassessed at six weeks after intake and at discharge. Results indicated that the family-based treatment (MDFT. an intervention that targets teen and parent functioning within and across multiple systems on a variety of risk and protective factors) was significantly more effective than peer group therapy in reducing risk and promoting protective processes in the individual, family, peer, and school domains. as well as in reducing substance use over the course of treatment. These results. which add to the body of previous findings about the clinical and cost effectiveness of MDFT, suppon the clinical effectiveness and dissemination potential of this family-based, multisystem and developmentally-oriented intervention.

Multidimensional Family Therapy for Young Adolescent Substance Abuse: Twelve-Month Outcomes of a Randomized Controlled Trial

Research has established the dangers of early onset substance use for young adolescents and its links to a host of developmental problems. Because critical developmental detours can begin or be exacerbated during early adolescence, specialized interventions that target known risk and protective factors in this period are needed. This controlled trial (n = 83) provided an experimental test comparing multidimensional family therapy (MDFT) and a peer group intervention with young teens. Participants were clinically referred, were of low income, and were mostly ethnic minority adolescents (average age = 13.73 years). Treatments were manual guided, lasted 4 months, and were delivered by community agency therapists. Adolescents and parents were assessed at intake, at 6-weeks post-intake, at discharge, and at 6 and 12 months following treatment intake. Latent growth curve modeling analyses demonstrated the superior effectiveness of MDFT over the 12-month follow-up in reducing substance use (effect size: substance use frequency, d = 0.77; substance use problems, d = 0.74), delinquency (d = 0.31), and internalized distress (d = 0.54), and in reducing risk in family, peer, and school domains (d = 0.27, 0.67, and 0.35, respectively) among young adolescents.

Transporting a research-based adolescent drug treatment into practice

This article describes the key ingredients and processes in transporting an empirically supported, research-developed family therapy for adolescent drug abusers, Multidimensional Family Therapy (MDFT), into an intensive day treatment program. Using the same systems change principles that guide this treatment approach, the technology transfer process has been, from its inception, a collaborative, multidimensional, systemic intervention aimed at changing organizational structures, and attitudinal and behavioral patterns with multiple staff members at several levels of the program. This article describes: (1) the conceptual and empirical basis for these technology transfer efforts; (2) the technology being adapted and transferred; and (3) the critical events and processes that have shaped the transfer of MDFT into this program. We discuss this process and the outcomes thus far through the lens of Simpsons organizational change model and specify the implications of this experience for the expansion of current conceptualization of technology transfer.

Treatment adherence process research in family therapy: A rationale and some practical guidelines.

Treatment adherence research has recently established a permanent niche in psychotherapy outcome research as a means for testing whether interventions have been implemented as intended. Advanced-level adherence methods allow investigators to move beyond treatment integrity questions regarding model fidelity and toward treatment process questions regarding therapeutic technique and intervention dosage. Though still in the developmental stage, treatment adherence process procedures appear to be congruent with the methods, goals, and theoretical framework that characterize contemporary psychotherapy process research. Because adherence process research is

Treatment Adherence and Differentiation in Individual Versus Family Therapy for Adolescent Substance Abuse.

Treatment adherence and differentiation in dynamic cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse were evaluated with a treatment adherence process measure. Full-length videotapes of 90 treatment sessions (36 clients) were reviewed by nonparticipant raters. Adherence scales for each treatment generated through factor analysis of observational ratings demonstrated sound interrater reliability and internal consistency. Therapists in each condition used techniques unique to their own model and avoided those unique to the competing model. Individual therapists emphasized behavioral and substance-use interventions, whereas family therapists focused on interactional and affective interventions. Challenges in conducting adherence research that compares individual and family treatments are addressed. as are implications of these results for advancing treatment development for adolescent drug users.

Changing Provider Practices, Program Environment, and Improving Outcomes by Transporting Multidimensional Family Therapy to an Adolescent Drug Treatment Setting

Effective interventions for drug abusing adolescents are underutilized. Using an interrupted time series design, this study tested a multicomponent, multi-level technology transfer intervention developed to train clinical staff within an existing day treatment program to implement multidimensional family therapy (MDFT), an evidence-based adolescent substance abuse treatment. The sample included 10 program staff and 104 clients. MDFT was incorporated into the program and changes were noted in the program environment, therapist behavior, and in most (e.g., drug abstinence, and out of home placements) but not all (e.g., drug use frequency) client outcomes. These changes remained after MDFT supervision was withdrawn.

Translating Parenting Research into Clinical Interventions for Families of Adolescents

The contributions of parenting to the adolescents psychosocial development have become the focus of increased attention by researchers and clinicians alike. Although parents face the difficult challenge of providing increasing levels of autonomy to the maturing adolescent while peers become more central to the adolescents life, parents continue to exert significant influence throughout this developmental stage. Significant progress in this research specialty has been highlighted by researchers, assisting in the specification of developmentally sensitive interventions for problem adolescents. We review selective, clinically relevant research on parenting during the adolescent transition in order to demonstrate how interventions can be informed by basic developmental research. The clinical implications of parenting within the adolescent developmental research are emphasized throughout the review. A particular intervention module, a parental reconnection intervention, which has been used in the context of a family-based intervention, Multidimensional Family Therapy is described as a prototype of an empirically based treatment component.

Implementation Outcomes of Multidimensional Family Therapy-Detention to Community: A Reintegration Program for Drug-Using Juvenile Detainees:

Responding to urgent calls for effective interventions to address young offenders’ multiple and interconnected problems, a new variant of an existing empirically-validated intervention for drug-using adolescents, Multidimensional Family Therapy (MDFT)—Detention to Community (DTC) was tested in a two-site controlled trial. This article (a) outlines the rationale and protocol basics of the MDFT-DTC intervention, a program for substance-using juvenile offenders that links justice and substance abuse treatment systems to facilitate adolescents’ postdetention community reintegration; (b) presents implementation outcomes, including fidelity, treatment engagement and retention rates, amount of services received, treatment satisfaction, and substance abuse—juvenile justice system collaboration outcomes; and (c) details the implementation and sustainability challenges in a cross-system (substance abuse treatment and juvenile justice) adolescent intervention. Findings support the effectiveness of the MDFT-DTC intervention, and the need to develop a full implementation model in which transfer and dissemination issues could be explored more fully, and tested experimentally.

When the levee breaks: treating adolescents and families in the aftermath of hurricane katrina.

Hurricane Katrina brought to the surface serious questions about the capacity of the public health system to respond to community-wide disaster. The storm and its aftermath severed developmentally protective family and community ties; thus its consequences are expected to be particularly acute for vulnerable adolescents. Research confirms that teens are at risk for a range of negative outcomes under conditions of life stress and family disorganization. Specifically, the multiple interacting risk factors for substance abuse in adolescence may be compounded when families and communities have experienced a major trauma. Further, existing service structures and treatments for working with young disaster victims may not address their risk for co-occurring substance abuse and traumatic stress reactions because they tend to be individually or peer group focused, and fail to consider the multi-systemic aspects of disaster recovery. This article proposes an innovative family-based intervention for young disaster victims, based on an empirically supported model for adolescent substance abuse, Multidimensional Family Therapy (MDFT; Liddle, 2002). Outcomes and mechanisms of the models effects are being investigated in a randomized clinical trial with clinically referred substance-abusing teens in a New Orleans area community impacted by Hurricane Katrina.