Brief Strategic Family Therapy Versus Treatment as Usual: Results of a Multisite Randomized Trial for Substance Using Adolescents

Miller School of Medicine, University of Miami, FL, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 10/2011; 79(6):713-27. DOI: 10.1037/a0025477
Source: PubMed


To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs.
A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to TAU with a multiethnic sample of adolescents (213 Hispanic, 148 White, and 110 Black) referred for drug abuse treatment at 8 community treatment agencies nationwide. Randomization encompassed both adolescents' families (n = 480) and the agency therapists (n = 49) who provided either TAU or BSFT services. The primary outcome was adolescent drug use, assessed monthly via adolescent self-report and urinalysis for up to 1 year post randomization. Secondary outcomes included treatment engagement (≥2 sessions), retention (≥8 sessions), and participants' reports of family functioning 4, 8, and 12 months following randomization.
No overall differences between conditions were observed in the trajectories of self-reports of adolescent drug use. However, the median number of days of self-reported drug use was significantly higher, χ2(1) = 5.40, p < .02, in TAU (Mdn = 3.5, interquartile range [IQR] = 11) than BSFT (Mdn = 2, IQR = 9) at the final observation point. BSFT was significantly more effective than TAU in engaging, χ2(1) = 11.33, p < .001, and retaining, χ2(1) = 5.66, p < .02, family members in treatment and in improving parent reports of family functioning, χ2(2) = 9.10, p < .011.
We discuss challenges in treatment implementation in community settings and provide recommendations for further research.

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    • "À la différence de la MDFT, la BSFT reste essentiellement centrée sur la famille de l'adolescent. Des études récentes ont comparé son utilisation à celle de la thérapie usuelle [21] et ont mesuré l'adhésion du thérapeute à la méthode [22]. Les résultats sont encourageants , allant dans le sens d'une meilleure efficacité de la BSFT. "
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    ABSTRACT: Le cannabis est la substance illicite la plus consommée en France chez les jeunes. L’augmentation de l’usage et sa précocité sont un problème majeur de santé publique. L’efficacité de la thérapie familiale multidimensionnelle a été démontrée aux États-Unis puis récemment en France. La thérapie familiale multidimensionnelle (MDFT) est une approche pluridisciplinaire qui se situe au carrefour de la psychologie développementale, des théories écologiques et de la thérapie familiale. En tant que technique psychothérapeutique, elle puise ses sources principalement dans la thérapie familiale systémique. L’objectif de cet article est de montrer quelles sont les influences qui ont conduit à la création d’un nouveau modèle en thérapie familiale : la MDFT. Il s’agira également de mettre en lumière la spécificité de la MDFT, ses différences et ses similitudes avec les courants de thérapie familiale systémique dont elle est principalement issue.
    Full-text · Article · Oct 2014 · L Encéphale
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    • "À la différence de la MDFT, la BSFT reste essentiellement centrée sur la famille de l'adolescent. Des études récentes ont comparé son utilisation à celle de la thérapie usuelle [21] et ont mesuré l'adhésion du thérapeute à la méthode [22]. Les résultats sont encourageants , allant dans le sens d'une meilleure efficacité de la BSFT. "
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    ABSTRACT: Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy. The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method. The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision). Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.
    Full-text · Article · Aug 2013 · L Encéphale
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    • "The aim of INCANT was to test the usefulness of MDFT in a study with high external validity, and as such, we sought to compare MDFT to treatment as currently delivered in a site. INCANT shared this emphasis on external validity with for instance trials implemented by the National Institute on Drug Abuse Clinical Trials Network (e.g., Robbins et al., 2011). The therapists offering MDFT and IP were similar in age, gender and clinical experience. "
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    ABSTRACT: Background: Noticing a lack of evidence-based programmes for treating adolescents heavily using cannabis in Europe, government representatives from Belgium, France, Germany, The Netherlands, and Switzerland decided to have U.S.-developed multidimensional family therapy (MDFT) tested in their countries in a trans-national trial, called the International Need for Cannabis Treatment (INCANT) study. Methods: INCANT was a 2 (treatment condition)×5 (time) repeated measures intent-to-treat randomised effectiveness trial comparing MDFT to Individual Psychotherapy (IP). Data were gathered at baseline and 3, 6, 9 and 12 months thereafter. Study participants were recruited at outpatient secondary level addiction, youth, and forensic care clinics in Brussels, Berlin, Paris, The Hague, and Geneva. Participants were adolescents from 13 through 18 years of age with a recent cannabis use disorder. 85% were boys; 40% were of foreign descent. One-third had been arrested for a criminal offence in the past 3 months. Three primary outcomes were assessed: (1) treatment retention, (2) prevalence of cannabis use disorder and (3) 90-day frequency of cannabis consumption. Results: Positive outcomes were found in both the MDFT and IP conditions. MDFT outperformed IP on the measures of treatment retention (p<0.001) and prevalence of cannabis dependence (p=0.015). MDFT reduced the number of cannabis consumption days more than IP in a subgroup of adolescents reporting more frequent cannabis use (p=0.002). Conclusions: Cannabis use disorder was responsive to treatment. MDFT exceeded IP in decreasing the prevalence of cannabis dependence. MDFT is applicable in Western European outpatient settings, and may show moderately greater benefits than IP in youth with more severe substance use.
    Full-text · Article · Nov 2012 · Drug and alcohol dependence
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