FamilyBased Substance Abuse Treatment for Young Adolescents: TwelveMonth Treatment Outcomes

1
Family-Based Substance Abuse Treatment for Young
Adolescents Twelve-Month Treatment
Outcomes Craig Hendersona, Ph.D., Cynthia Rowea,
PhD., Paul Greenbaumb, Ph.D., Gayle A. Dakofa,
Ph.D., Shi Huanga, M.S., Howard A. Liddlea,
Ed.D. aCenter for Treatment Research on
Adolescent Drug Abuse University of Miami School
of Medicine bUniversity of South
Florida Presented at the 2005 Joint Meeting on
Adolescent Effectiveness Society for Substance
Abuse Treatment Effectiveness (SASATE) Washington,
DC, March 20-23, 2005
2
Substance Abuse among Young Adolescents

• Substance abuse among young teens has been a
  growing public health problem in U.S. and abroad
  in the past decade
• The younger youth start using, the more chronic
  and severe their substance abuse and related
  consequences
• Without effective intervention, substance abuse
  in early adolescence seriously derails
  development across life domains

3
Early Intervention for Young Adolescent Substance
Abusers

• Enormous clinical and scientific potential of
  early intervention remains largely untapped
• Extensive research in developmental
  psychopathology informs intervention design
• Objective is to alter emerging substance use
  trajectories by targeting risk factors within
  teens, families, and their social ecologies
• Targeted outcomes substance use, emotional
  problems, delinquency, school problems, and
  association with deviant peers

4
Multidimensional Family Therapy

• Empirically developed, tested, and refined in
  clinical trials over the past 20 years
• Best practice for ADA in U.S. (NIDA, 1999
  USDHHS, 2002 Drug Strategies, 2003 CSAT, 1998
  CSAP/OJJDP, 1999) and recognized internationally
  (HTA, 2003 Rigter, 2005)
• Strong empirical support in comparison to other
  state-of-the-art, active treatments
• Engages/ retains teens and parents in treatment
• Impacts drug use as well as other problems

5
Multidimensional Family Therapy

• Lower cost than standard community care
• Success in treating a range of adolescent drug
  abusing samples (different ethnicities, clinical
  severity, geographical regions, genders, etc.)
• Flexible treatment system that has been adapted
  for the needs of different populations and
  settings
• Community-based therapists trained to adequate
  adherence/competence to manual
• Solid foundation for exploring the potential of
  MDFT for early intervention

6
Multidimensional Family Therapy vs. Peer Group
Treatment for Young Substance Abusing Teens

• Randomized controlled trial of MDFT vs.
  manualized peer group treatment
• Both treatments delivered by community-based
  therapists in a drug treatment clinic
• Both treatments lasted between 12 16 weeks
• Ethnically diverse, clinically referred sample
• Comprehensive assessment of youth and their
  parents at intake, 6 weeks, discharge, 6 months,
  and 12 months following intake
• Intent to treat design (over 90 follow up rates)

7
Treatment Conditions

• Multidimensional Family Therapy (Liddle, 2002)
• Multiple systems, developmentally and
  ecologically oriented approach
• Targets multiple risk factors across domains
• Intervenes directly in the adolescent, parent,
  family, extrafamilial subsystems
• For the current study, had to be adapted to
  younger adolescents developmental level
• Peer Group Treatment
• Behaviorally oriented approach
• Seeks to bolster social and other life skills
• 6 modules drug education, self esteem,
  values/identity, decision making, personal
  control, and interpersonal relationships

8
Sample Characteristics

• 83 early adolescents randomized to MDFT or
  adolescent peer group treatment
• Sample Characteristics
• Between 11 and 15 years (M13.7)
• Primarily Male (73) and Ethnic Minority (42
  Hispanic 38 African American)
• Median annual family income 19,000 53 resided
  in single parent homes
• 47 diagnosed with substance dependence, 16 with
  substance abuse
• 61 reported weekly or more use of any drug
• First treatment episode for 98 of adolescents
• 39 conduct disorder 29 ADHD 9 depression
• Referrals from juvenile justice (45), schools
  (41), and parents (12)
• 58 had been previously arrested 91 reported
  past history of any illegal activity

9
Percent Retained in MDFT vs. Group Treatment

10
Results

11
MDFT participants decrease substance use problems
more rapidly
More MDFT participants report no substance use
problems
12
Trend for more MDFT participants to abstain from
drug use
Of those using drugs, MDFT participants decrease
more rapidly.
13
MDFT participants decrease delinquent behavior,
but group increases
14
Results
Finding
Outcome Domain

15
Summary of Findings

• Youth in MDFT were more likely to complete
  treatment than youth in peer group therapy
• MDFT more rapidly reduced substance use and
  substance related problems and maintained gains
  over time
• MDFT 93 reported NO drug use at 12 months
• Group 55 reported NO drug use at 12 months
• Youth receiving MDFT improved more rapidly and
  maintained gains in targeted risk domains
• IndividualEmotional distress, behavior problems,
  and delinquency
• PeerSelf-reported peer delinquency
• SchoolAcademic and conduct grades absences
• FamilyPositive family interactions

16
Implications

• Findings support the durability of effects (up to
  1 year) of MDFT as an early intervention approach
• Both treatments more effectively retained youth
  in therapy than standard care
• Intervention with teens, parents, their families,
  and extrafamilial systems had greater impact in
  multiple domains than peer group therapy
• MDFT more significantly decreased involvement
  with antisocial, drug using peers than a peer
  group approach that intervened directly with
  peers
• Results add to an accumulating evidence base for
  MDFT with a range of substance abusing adolescents

17
Acknowledgements Completion of this research was
supported by a grant from the Substance Abuse and
Mental Health Services Administration/Center for
Substance Abuse Treatment (Grant No. KD1 TI11871,
H. Liddle, PI). We also thank our colleagues
at The Village, Inc. for their significant
contributions to this study. Please see our
website for more information on the Centers
program of research www.miami.edu/ctrada