Nathan H. Azrin’s research while affiliated with Nova Southeastern University and other places

This presentation focuses on testing an intervention strategy intended to reduce family risk factors in a high-risk, selected population, namely families where there is parental substance abuse. Objective: Approximately 50% of Child Protective Service (CPS) referrals abuse drugs; yet, existing intervention studies in this population have been limited to case examinations. A family-based behavioral therapy was evaluated in mothers referred from CPS. Method: 72 mothers evidencing drug abuse or dependence and child neglect were randomly assigned to a family behavior therapy (FBT) or treatment as usual (TAU). Participants were assessed at baseline, 6- month-, and 10-month post-randomization. Results: As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not specific to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6-month and 10-month post-randomization when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use, but not marijuana use, from baseline to 6-month post-randomization. The effect size for hard drug use in TAU mothers referred due to child drug exposure was relatively high at 10-month post-randomization. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6-month and 10-month post-randomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6-month post-randomization, although these results were not maintained at 10-month post-randomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases in incarceration from baseline to 6-month post-randomization relative to TAU mothers. Conclusions: Family-based behavioral intervention programs offer promise for reducing family risk factors in mothers who have been reported to CPS for concurrent child neglect of their children and substance abuse. Recommendations are offered in light of the study results.

Objective: Approximately 50% of child protective service (CPS) referrals abuse drugs; yet, existing treatment studies in this population have been limited to case examinations. Therefore, a family-based behavioral therapy was evaluated in mothers referred from CPS for child neglect and drug abuse utilizing a controlled experimental design. Method: Seventy-two mothers evidencing drug abuse or dependence and child neglect were randomly assigned to family behavior therapy (FBT) or treatment as usual (TAU). Participants were assessed at baseline, 6 months, and 10 months postrandomization. Results: As hypothesized, intent-to-treat repeated measures analyses revealed mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month postrandomization assessments when assigned to FBT, as compared with TAU mothers and FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6 and 10 months postrandomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug-exposed children and FBT mothers of drug-exposed children at 6 and 10 months postrandomization. Although effect sizes for mothers assigned to FBT were slightly larger for marijuana use than TAU (medium vs. large), these differences were not statistically significant. Specific to secondary outcomes, mothers in FBT, relative to TAU, increased time employed from baseline to 6 and 10 months postrandomization. Mothers in FBT, compared to TAU, also decreased HIV risk from baseline to 6 months postrandomization. There were no differences in outcome between FBT and TAU for number of days children were in CPS custody and alcohol intoxication, although FBT mothers demonstrated marginal decreases (p = .058) in incarceration from baseline to 6 months postrandomization relative to TAU mothers. Conclusion: Family-based behavioral treatment programs offer promise in mothers who have been reported to CPS for concurrent substance abuse and child neglect of their children. However, continued intervention development in this population is very much needed.

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed therapy sessions. In this study, the authors empirically developed a standardized intervention to assist mental health providers in emergency prevention and management (EPM) with their clients. EPM includes assessment of emergent conditions and a self-control procedure that may be utilized by consumers to prevent or resolve emergencies. EPM responses of 26 mothers referred by Child Protective Services for 6 months of evidence-supported treatment were examined. Relevant to clinical utility, the results indicated that providers implemented EPM in a little more than half (56.9%) of their treatment sessions, and all emergencies assessed in EPM were endorsed by at least 8% of the sample throughout their treatment. EPM was implemented with fidelity according to service providers, and corroborated by blind raters. Participants were found to be compliant and satisfied with EPM. The average number of emergencies endorsed over the course of EPM administrations was negatively correlated with the frequency of EPM administrations, suggesting that EPM may have helped reduce emergencies. Pretreatment factors (e.g., household income, child abuse potential, family functioning, parental stress, child behavior problems, number of days child removed from home) and hard drug use (but not marijuana or alcohol) during treatment were associated with the number of emergencies reported by participants.

The results of a multiple-baseline case study of family behavior therapy (FBT) is described in a woman formally diagnosed with alcohol dependence, bipolar disorder, generalized anxiety disorder, specific phobia, and panic disorder. She was referred to treatment from the local Department of Family Services for child neglect and domestic violence. After baseline measures were administered, the first phase of treatment involved home safety tours aimed at reducing home hazards and cleanliness. A second phase of treatment additionally targeted family relationships through communication skills training exercises, and a third phase involved administration of the remaining FBT components to assist in comprehensively addressing other problem areas. Results indicated most problem areas were substantially improved, but only after they were comprehensively targeted in therapy.

High rates of co-occurrence between substance abuse and child neglect have been well documented and especially difficult to treat. As a first step in developing a comprehensive evidence-based treatment for use in this population, the present case examination underscores Family Behavior Therapy (FBT) in the treatment of a mother who evidenced Substance Dependence, child neglect, Post-Traumatic Stress Disorder, Bipolar I Disorder, and domestic violence. Utilizing psychometrically validated self-report inventories and objective urinalysis, treatment was found to result in the cessation of substance use, lower risk of child maltreatment, improved parenting attitudes and practices, and reduced instances of violence in the home. The importance of utilizing validity scales in the assessment of referrals from child welfare settings is discussed, and future directions are reported in light of the results.

A comprehensive evidence-based treatment for substance abuse and other associated problems (Family Behavior Therapy) is described, including its application to both adolescents and adults across a wide range of clinical contexts (i.e., criminal justice, child welfare). Relevant to practitioners and applied clinical researchers, topic areas include its theoretical and empirical background, intervention protocols, methods of enhancing motivation for treatment, and future directions.

Behavioral psychologists have developed effective methods of treatment for overeating and weight control, including mealtime regulation, avoidance of taboo foods, and removal of identified precursors to the bingeing behavior. The current study sought to examine the relationship between speed of eating and levels of satiation in weight conscious individuals. Ten participants were instructed to eat at a fast and a slow rate in a within-subjects reversal design. Consuming food at a slow rate helped participants achieve satiation quicker with comparable amounts of food intake. Slow eaters were also less likely to overeat. These results suggest that slow eating may prevent excessive food consumption in weight conscious individuals, constituting an effective means of weight management.

A single-case controlled study found that a bulimic's desire to vomit was virtually eliminated by slowed eating, but not by rapid eating. The present study attempted to determine whether this same relation was exhibited by a larger number (N = 6) of bulimics who were instructed to eat at a fast or a slow rate in a between-subjects reversal design. For all 6 participants, the urge to vomit was found to be greater during fast versus slow eating after comparable amounts of food intake. Clinically, these results suggest that eating slowly might be incorporated into treatment for bulimic vomiting.

Little is known about the reliability and validity of self-and collateral reports of adolescent drug use frequency within adolescent treatment samples. Therefore, in the present study drug counselors systematically obtained contemporaneous reports of adolescent marijuana use frequency from 31 conduct-disordered and drug abusing youth, and separately, their parents, during each outpatient treatment session for 6 months. A urine drug screen was also scheduled to occur during each treatment session. At the conclusion of treatment, a blind assessor obtained retrospective reports of the youths' frequency of marijuana use during each of the six months of treatment from both the adolescents and their parents using the Timeline Follow-Back (TLFB) procedure. With only one exception (i.e., parents reported that their children had used marijuana more often in the first month of treatment according to the retrospective TLFB method, as compared with the contemporaneous method), contemporaneous and retrospective reporting methods yielded similar information throughout each of the 6 months of treatment for both youth and their parents. A significant positive relationship between urinalysis testing and youth reports of their drug use was found for each of the 6 months of treatment. Similar relationships with urinalysis testing were generally found to exist in both parent report methods (i.e., contemporaneous, retrospective) across the 6 months of treatment. The results suggest adolescents and their parents provide consistent reports of marijuana use frequency throughout treatment, and that these reports are corroborated utilizing standardized retrospective reporting methods and urinalysis testing. Future directions are discussed in light of these findings.