Reducing adolescent cannabis abuse and cooccurring problems through familybased intervention

1
Reducing adolescent cannabis abuse and
co-occurring problems through family-based
intervention

• Howard Liddle, Ed.D., Cynthia Rowe, Ph.D.,
• Gayle Dakof, Ph.D., Craig Henderson, Ph.D.
• Center for Treatment Research on Adolescent Drug
  Abuse
• University of Miami Miller School of Medicine

Presented at the College on Problems of Drug
Dependence Annual Convention Orlando, FL June
22, 2005
2
(No Transcript)
3
Adolescent Cannabis Abuse

• Serious public health issue
• Linked to a range of other problems

• Increasing need for drug treatment

• Treatment need far surpasses available
  services for youth

• Research-supported models exist but are not
  practiced in community settings where theyre
  needed

4
Risk and Protective Factors

• Multiple interacting risk factors for
  adolescent cannabis abuse
• Family conflict/ poor communication
• Parenting skills deficits
• Negative peer relationships
• School failure and disconnection
• Behavior problems
• Emotional reactivity

5
Development of Cannabis Abuse

• Cannabis experimentation is developmentally
  normative for teens
• Cannabis abuse/dependence is predicted by early
  childhood risk
• Cannabis abuse compromises emotional/social/cogn
  itive development
• Early cannabis abuse linked to long- term
  deficits across domains

6
Families and Drug Abuse

• Family factors are strong predictors of
  adolescent cannabis abuse
• Parenting skills deficits
• Poor communication
• Parental substance abuse/psychopathology
• Conflict/disconnection in family

• Families are a primary context for development
  in adolescence, but there are others (schools,
  peers)
• Effective interventions go beyond a
  uni- dimensional theory of change

7
Multidimensional Family Therapy

• Integrative family-based drug treatment
• Addresses multiple risk factors
• Multisystemic assessment intervention
• Flexibility in different service settings
• Well specified, adaptable protocols
• Now recognized as a Best Practice (NIDA,
  USDHHS, Drug Strategies, CSAT)

8
MDFT Core Processes

• Facilitation of development
• Working the four corners adolescent, parent,
  family, and extrafamilial interventions
• Building adolescents connection to school, work,
  family, and prosocial outlets/friends
• Improving parents functioning decreasing
  stress addressing parenting practices
• Changing family environment
• Targeting multiple domains of functioning in
  addition to reducing drug use

9
Study 1 MDFT vs. Group and Multifamily Education

• 182 adolescents randomized to MDFT, adolescent
  group therapy, or multifamily educational
  intervention
• Sample Characteristics
• 13 - 18 years old (M16) mostly male (80)
• 51 White/non-Hispanic, 18 African American, 15
  Hispanic, 6 Asian
• Average annual family income 25,000
• 48 from single parent homes
• 61 involved with juvenile justice at intake

10
MDFT vs. Peer Group and Multifamily Education
Substance Use Outcomes
Liddle , Dakof et al. Am J Drug Alcohol Abuse
(2001)
Drug Use
Pre-Tx Post-Tx 6 month 12 month
MDFT
Group
MFET
11
Study 2 MDFT with Young Adolescent Cannabis
Abusers

• 83 young adolescents randomized to MDFT or
  adolescent peer group treatment
• Sample Characteristics
• 11 - 15 years old (M13.7)
• Primarily male (73) and minority youth (42
  Hispanic 38 African American)
• Average annual family income 19,000
• 53 from single parent homes
• 47 substance dependent 16 substance abusing
• Referred from juvenile justice (45)/ schools
  (41)
• First treatment episode for 98 of adolescents

12
Change in Cannabis Use
Of those using drugs, MDFT participants decrease
more rapidly.
Trend for more MDFT participants to abstain from
drug use
Continuous data log transformedMore MDFT
participants report abstaining from drug use at
intake
CH
13
Percentage Arrested During 12 Month Follow-Up
Percentage Placed on Probation During 12 Month
Follow-Up



MDFT
Group
p
14
Change in Self-Reported Mental Health Symptoms
MDFT participants decrease GMDI more rapidly.
GMDI only assessed at Intake and 6 and 12 month
follow-ups consequently, data were analyzed
using conventional latent growth curve modeling
15
Study 3 MDFT vs. Individual Cognitive Behavioral
Therapy (CBT)

• 224 adolescents randomized to MDFT or individual
  Cognitive Behavioral Therapy (CBT)
• Sample Characteristics
• Between 13 and 17 years (M15.4)
• Primarily male (81) and African American (72)
• Family income 13,000 58 with single parents
• 88 substance dependent 15 substance abusing
• 60 had an externalizing disorder/ 28 int.
  disorder
• Referred from juvenile justice (48)/ social
  services (36)
• 73 involved in the juvenile justice system at
  intake

16
Change in Cannabis Use Frequency
(4-6 Months Post Baseline)
(Post Discharge)
17
Proportion of Adolescents Abstaining from
Cannabis Use
18
Study 4 Cannabis Youth Treatment Study

• MDFT one of 5 CYT treatments tested at two sites
  (one urban and one rural)
• 12 18 year olds with marijuana use disorders
• Primarily male (83) and White/non-Hispanic
  (61) 30 African American
• 50 from single parent homes
• 46 cannabis dependent 40 cannabis abusing
• 71 reported weekly or more use of any drug
• 61 had an externalizing disorder/ 33 int.
  disorder
• 62 involved with juvenile justice at intake

19
CYT Study Change in Cannabis Use
43 reduction from Intake to 6-Month Follow-Up
41 reduction from Intake to 12-Month Follow-Up
Reductions at 12 Month Follow-Up maintained
through 30 months
20
CYT Study Average Episode Cost of Drug Treatment
Dennis et al., in press, Journal of Substance
Abuse Treatment
21
Study 5 Intensive MDFT as an Alternative to
Residential Treatment

• 113 adolescents randomized to residential
  treatment or intensive in-home MDFT
• 13 - 17 year olds referred for residential
  treatment
• Primarily male (75) and Hispanic (69)
• Family income 18,800
• 43 from single parent homes
• 90 substance dependent 25 substance abusing
• Average of 3.6 DSM-IV diagnoses (78 CD)
• Heavily juvenile justice involved (81)
• Extensive family problems 54 familial substance
  abuse 58 familial CJ involvement

22
Change in Drug Use Frequency
23
Change in School Absences
During follow-up, residential youth increase
school absences, whereas MDFT participants
decrease absences
24
Change in School Suspensions
Proportion of youth suspended decreases in MDFT,
but increases among residential treatment youth
25
Relative Costs of MDFT and Residential Treatment
Zavala, French, et al. (in press), Journal of
Substance Abuse Treatment
26
Impact of MDFT on Alcohol and Polysubstance Use

• Many youth in MDFT trials have had a substance
  use disorder other than alcohol or cannabis at
  intake
• 50 (Liddle et al., 2001)
• 32 (Liddle, 2002b)
• 38 (Liddle Dakof, 2002)
• MDFT is more effective than comparison treatments
  in reducing more severe forms of other drug use
  (most frequently amphetamine, barbiturates, and
  cocaine) and alcohol use

27
MDFT and CBT Average Change in Hard Drug Use
Intake to 12 Month Follow-Up
MDFT youth decrease hard drug use, whereas CBT
youth increase
(4-6 Months Post Baseline)
(Post Discharge)
28
Summary and Conclusions

• Adolescent cannabis abuse is a serious clinical
  problem for many teens
• Those at greatest vulnerability for chronic
  cannabis abuse are those with multiple problems
  early in life, particularly family dysfunction
• Comprehensive interventions are needed to target
  the multiple systems that maintain symptoms
• MDFT is effective with a range of adolescent
  cannabis abusers
• MDFT impacts cannabis use as well as delinquency,
  school problems, and mental health symptoms
• The models flexibility and relative economic
  costs and benefits increase its implementation
  potential