Multidimensional Family Therapy for Adolescent Drug Abuse: Research Update and Illustration of Core Clinical Methods

Presented at the 2005 Joint Meeting on Adolescent Treatment Effectiveness

Washington, D.C.March 22, 2005

Howard A. Liddle, Ed.D., ABPPProfessor, Epidemiology & Public Health, and

Psychology;and Director, Center for Treatment Research on

Adolescent Drug AbuseUniversity of Miami School of Medicine

www.miami.edu/ctrada

MDFT Research Program and MDFT Research Program and Clinical ApproachClinical Approach

Clinical Approach Via Case

Sample Findings: Outcome

Sample Findings: Transportation

Intro: Background, Main Features Research

Program

ASUD specialtyASUD specialty

Research programResearch program

Treatment developmentTreatment development

Integration of research and clinical Integration of research and clinical

workwork

Key Terms

Renaissance of adolescent treatment

New treatments and methods exist

Feasibility and efficacy has been established

Mechanisms are being investigated

Treatment manuals are available

Training models and materials exist

Generalizability has been addressed

Full generalizability has not been established

Practice has influenced science

Science is influencing practice and policy

Developmental Status of a Changedand Changing Specialty

http://www.drugstrategies.org/teens/programs.html

Integrative Connected to basic research on development and dysfunction Diverse approaches

Expanded in scope: Multiple systems of assessment & intervention

Brief interventions as well Context of service delivery Well specified protocols

New Generation of Interventions

Reviews

Alexander et al (1996) Garfield & Bergin (4th) Friedlander (1998) Family therapy (Nichols / Schwartz) Brown et al (1990) Drug and alcohol abuse prevention Deas & Thomas (2001) Am. J Addictions Dennis et al (2001) Lebow & Gurman (1995) Ann. Rev. Psychol Liddle & Dakof (1995, 1996) (NIDA Monograph 156,

October JMFT 1996) National Institute on Drug Abuse (1999) Nissen et al. (2004) Nissen et al. (2004) J Psychoactive DrugsJ Psychoactive Drugs Ozechowski & Liddle (2000) Child & Family Psychology

Review

Reviews

Stanton & Shadish (Sept-1997) Psychol. Bull. Stevens & Morral (2003) Haworth Press Substance Abuse and Mental Health Services Administration (1999) Treatment Improvement

Protocol Vaughn & Howard (2004) Res. on Social Work

Practice Wagner & Waldron (2001) Waldron (1997) Advances in Clinical Child

Psychology Weinberg et al. (1998) J Amer. Acad. Child & Adol.

Psych. Williams et al J. Clinical Child Psychology Winters et al (1999) Sourcebook of adolescent

alcohol anddrug abuse

Reviews of Family-Based TreatmentsBEHAVIORAL PROBLEMS/DELINQUENCY Alexander et al (1996) Garfield & Bergin (4th) Friedlander (1998) Family therapy (Nichols / Schwartz) Lebow & Gurman (1995) Ann. Rev. Psychol

SUBSTANCE ABUSE Austin, Macgowan & Wagner (2005) Research on Social Work

Practice Dusenbury (2000) Dusenbury (2000) J of Primary PreventionJ of Primary Prevention Liddle & Dakof (1995, 1996) (NIDA Monograph 156, October JMFT

1996) Ozechowski & Liddle (2000) Child & Family Psychology Review Stanton & Shadish (Sept-1997) Psychol. Bull. Waldron (1997) Advances in Clinical Child Psychology Rowe & Liddle (2003) JMFT Liddle (2004) Addiction

Completed Treatment Outcome Studies

MDFT, Group, Multi-Family Clinical Trial

MDFT - Individual CBT Clinical Trial

MDFP Prevention Trial

MDFT-I Treatment Development

CYT Multisite Clinical Trial

MDFT - Group Early Adolescent Clinical Trial

Current Treatment Development and Outcome Studies

Alternative to Residential Treatment (NIDA) Transporting MDFT to Day Treatment (NIDA) Brief Version of MDFT (NIDA) Training Outcomes (NIDA) Long Term Follow Up (NIDA) Cost Outcomes (NIDA) Juvenile Drug Court (NIDA) Dependency Drug Court (NIDA) CJ-DATS Research Center (NIDA) International Studies

Clinical effectiveness in different Clinical effectiveness in different domainsdomains

Cost effectivenessCost effectiveness Symptom reductionSymptom reduction Grow protection and adaptationGrow protection and adaptation Well defined, user friendlyWell defined, user friendly

Mission Statement:Develop an effective and adoptable

treatment for adolescent drug abuse

Principles of MDFT Treatment DevelopmentPrinciples of MDFT Treatment Development

1.1. Treatment development is the Treatment development is the North StarNorth Star2.2. Heterogeneity of studiesHeterogeneity of studies3.3. ThematicThematic4.4. Basic research guides intervention design and Basic research guides intervention design and

developmentdevelopment5.5. Systems theory informs intervention developmentSystems theory informs intervention development6.6. Therapist development, training and supervision Therapist development, training and supervision

are criticalare critical7.7. MDFT treatment is both structured and flexibleMDFT treatment is both structured and flexible8.8. Advances in the field inform the research programAdvances in the field inform the research program9.9. Maximize synergyMaximize synergy

Mission Statement: Develop an effective and Mission Statement: Develop an effective and adoptable treatment for adolescent drug abuse adoptable treatment for adolescent drug abuse

Framework

Set of prescribed activities

Process

Research classification device

Destination

Yardstick

Crystal ball

The Many Faces of Treatment Development

Features and Themes of the MDFT Research Program

Research-based knowledge about development and dysfunction

Therapeutic ingredients and processes

Therapist competence and development

Efficacy: Rigorous treatment evaluation under controlled conditions

Effectiveness: Rigorous treatment evaluation in regular clinical settings

Research Program (2)

Transporting and disseminating Training studies Refining and adapting Defining and testing different

versions Continued exploration of key

components and processes

MDFT

Conceptual Frameworks Contributing to the MDFT Approach

Development Developmental Psychopathology

Ecology Risk and Protection

Family MDFT Adolescent

Components and Logic of MDFT Approach

Parent(s)

Extrafamilial

Problems are multidimensional

Multidimensional problems require multidimensional conceptualizations

Multidimensional conceptualizations yield multi-systems interventions

MDFT assesses and intervenes into multiple systems of development and influence

Center for Treatment Researchon Adolescent Drug Abuse

University of Miami School of Medicine

www.miami.edu\ctrada

hliddle@med.miami.edu