The study of family-based treatment for substance abusing adolescents

Howard A. Liddle, Ed.D., a pioneer and leader in adolescent substance abuse research, has earned the 2003 Dan Anderson Research Award from the Hazelden Foundation. Liddle, professor of Epidemiology and Public Health and director of the Center for Treatment Research on Adolescent Drug Abuse at the University of Miami School of Medicine, achieved the honor for his rigorous study that documents the effectiveness of a strong family-based approach to treating young people with substance abuse problems over approaches with less family involvement.

The award, sponsored by the Butler Center for Research at Hazelden, specifically recognizes Liddle for "Multidimensional Family Therapy for Adolescent Drug Abuse: Results of a Randomized Clinical Trial," a study published in the American Journal of Drug and Alcohol Abuse (2001, Vol. 27, No. 4, pages 651-688).

Liddle and associates compared the effectiveness of three types of outpatient treatment for marijuana- and alcohol-abusing adolescents: multidimensional family therapy (MDFT), adolescent group therapy (AGT), and multifamily educational intervention (MEI). All three treatments indicated improvements among the young patients, but MDFT demonstrated superior improvement overall. The family-based treatment (MDFT) not only stood out in terms of reducing drug abuse and related serious functional impairments, but also in improving prosocial behaviors such as school performance and family functioning.

"This study emphasizes the importance of including the entire family when treating addicted young people," said Val Slaymaker, Ph.D., director of the Butler Center for Research at Hazelden. "Our scientific panel (which selected the award winner) felt this study was scientifically rigorous, with multiple controls, and has high potential to impact the treatment field."

Indeed, Liddle feels that this study and previous research strongly support the efficacy of family-based treatment for young people. Said Liddle: "Our study demonstrates that comprehensive family-based treatment-an approach that assesses and intervenes simultaneously into several important domains of the teen's life in a systematic and coordinated way-is not only feasible to conduct in regular outpatient settings and be used by line clinicians, but also that it can yield significant and superior improvement in symptom reduction and promotion of prosocial factors compared to other manualized treatments. And these positive outcomes were still present at the one-year post-treatment assessment."

Liddle's study was a randomized clinical trial that looked at three commonly used treatment interventions, with treatment dosage and duration equalized. MDFT and MEI are both family-based interventions that aim to change, among other things, parenting behaviors and family interactions. However, MDFT works with one family at a time, and MEI works with several families at once. MDFT derives from more of a family therapy or psychotherapy tradition than does MEI, which is more structured and psychoeducationally focused than MDFT. AGT focuses on peer group support with minimal family involvement. MDFT works on different systems that impact the teen's development. It keys on the individual characteristics of the adolescent, the parents, and other relevant family members, as well as transactional patterns that link the development and continuation of drug use and related problem behaviors. In addition to recognizing parenting styles and beliefs as prime intervention targets, MDFT also attends to the legal and juvenile-justice problems of the adolescent, school behavior and performance, and job-related issues when applicable. It was the most comprehensive of the three treatments.

Conclusions of the study: MDFT showed a rapid and dramatic decrease in drug use. At the end of treatment, 42 percent of youths who received MDFT reported clinically significant reduction in drug use (vs. 32 percent for MEI and 25 percent for AGT). At one-year follow-up, 45 percent in MDFT, 32 percent in AGT, and 26 percent in MEI showed significant change in drug use. Also, one year after treatment, 76 percent of youths in MDFT had a C average or better in school, while 60 percent of AGT and 40 percent of MEI youths had a C average or better. The family-intensive therapy of MDFT also demonstrated improved family functioning.

"I'm humbled and honored to receive this award," said Liddle. "I'm grateful to my colleagues and team members from this study who share in my commitment to showing that empirically supported clinical models such as MDFT can make a big difference in our care of adolescents and their families, as well as in the systems of care that offer these treatments. Our next step, and an urgent one, involves getting these science-based practices into regular community settings."

Liddle's research was selected as the best from among several outstanding candidates by the five-member Scientific Panel of the Butler Center for Research. The panel includes Slaymaker; Dennis Donovan, Ph.D., University of Washington; A. Thomas McLellan, Ph.D., University of Pennsylvania; Frances Levin, M.D., Columbia University; and Ken Winters, Ph.D., University of Minnesota. Liddle will receive the award and a $2,000 honorarium early this spring at Hazelden's Substance Abuse Research Forum in Minneapolis (date TBA).