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.
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Multidimensional Family Therapy Reduces Youth Drug Use, Improves School Performance and Family Interaction |
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Start of |
End of |
12-Month |
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Drug Use, Past 30 days a |
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1 (no use) to 15 (marijuana use daily and other drugs used
more than twice per week) |
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Academic Perfomance a |
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Grade point average from 1 (D) to 4 (A) |
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Family Function a |
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1 (optimal) to 10 (severely dysfunctional) |
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a Average of all patients. |
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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. |
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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]
Volume 17, Number 4 (November 2002)