Gayle A. Dakof

MULTIDIMENSIONAL FAMILY THERAPY FOR ADOLESCENT DRUG ABUSE: RESULTS OF A RANDOMIZED CLINICAL TRIAL

Random assignment was made of 182 clinically referred marijuana- and alcohol-abusing adolescents to one of three treatments: multidimensional family therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). Each treatment represented a different theory base and treatment format. All treatments were based on a manual and were delivered on a once-a-week outpatient basis. The therapists were experienced community clinicians trained to model-specific competence prior to the study and then supervised throughout the clinical trial. A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake, termination, and 6 and 12 months following termination. Results indicate improvement among youths in all three treatments, with MDFT showing superior improvement overall. MDFT participants also demonstrated change at the 1-year follow-up period in the important prosocial factors of school/academic performance and family functioning as measured by behavioral ratings. Results support the efficacy of MDFT, a relatively short-term, multicomponent, multitarget, family-based intervention in significantly reducing adolescent drug abuse and facilitating adaptive and protective developmental processes.

Treating adolescent drug abuse: a randomized trial comparing multidimensional family therapy and cognitive behavior therapy.

AIM To examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT). DESIGN A 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling. SETTING Community-based drug abuse clinic in the northeastern United States. PARTICIPANTS A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse. MEASUREMENTS Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day frequency of alcohol use; (iv) 30-day frequency of other drug use; and (v) 30-day abstinence. FINDINGS Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. CONCLUSION Both interventions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.

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.

Adolescent and Parent Therapeutic Alliances as Predictors of Dropout in Multidimensional Family Therapy

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response.

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.

Changes in Parenting Practices and Adolescent Drug Abuse During Multidimensional Family Therapy

The nature and extent of changes in parenting and the link between parental subsystem changes and reduction in adolescent substance abuse and problem behaviors were examined in a sample of 29 parents and their drug-abusing adolescents. Participants completed 16 sessions of multidimensional family therapy. Over two thirds of the parents showed moderate to excellent improvement in parenting. Chi-square goodnessof-fit analyses revealed a statistically significant association between improvement in parenting and reduction in adolescent drug use and behavior problems. Results of this exploratory study provide qualified support for a fundamental tenet of family therapy—that change in the parental subsystem is related to improvement in the problem behavior of 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.

Understanding Gender Differences in Adolescent Drug Abuse: Issues of Comorbidity and Family Functioning

Abstract Female adolescent drug use has increased dramatically in the last 30 years, and there is a growing consensus that the syndrome of female adolescent substance abuse is different from the well-recognized male pattern. Gender differences in patterns of comorbidity and family functioning were investigated in a sample of 95 youths (42 girls and 53 boys) referred for substance abuse treatment. The findings indicate that male and female adolescent substance users differ in several clinically meaningful ways. The results from a discriminant function analysis indicate that substance-using adolescents referred to treatment are distinguished especially by the greater degree to which girls have internalizing symptoms and family dysfunction. The clinical implications of these gender differences are articulated.

Predictors of engagement in adolescent drug abuse treatment

OBJECTIVES To identify key demographic, parent, and adolescent characteristics that influence engagement in outpatient drug abuse treatment. METHOD Youths aged 12 to 17 years (N = 224; 81% male and 72% African American) referred for drug treatment and their parents participated in this study. Marijuana was the primary substance of abuse. Data were gathered prior to treatment on demographic variables as well as on both parent and youth perspectives on youth, parent, and family functioning. RESULTS A discriminant function analysis revealed that engagement in treatment was related to, in order of weighting, more positive parental expectations for their adolescents educational achievement (standardized discriminant function coefficient [SDF] = 0.68), higher parental reports of youth externalizing symptoms (SDF = 0.59), and higher levels of family conflict perceived by the youth (SDF = 0.36). Family income, gender, juvenile justice status, minority group status, family structure, parental age and psychopathology, and treatment characteristics did not distinguish treatment-engaged from unengaged adolescents. CONCLUSIONS The results suggest that both parent and youth perceptions are pivotal to whether or not adolescents are engaged in psychotherapy. These findings lead the authors to recommend adolescent engagement interventions focusing on both the youth and his or her parents and suggest a content focus for adolescent engagement interventions.

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.