Preventing substance misuse offers only small steps forward

Preventing substance misuse offers only small steps forward
20 February 2012

Getting young people off drugs is known to be difficult. Therapies that work well with violence and offending seem less effective when applied to substance misuse. The most promising results in terms of the initial engagement and retention of young people in interventions, the actual usage of drugs and better family functioning come from programs offering some kind of family therapy.

Innovations in this area are constantly evolving and one initiative is brief strategic family therapy (BSFT). A team of US researchers have explored whether this produces better outcomes than more commonly employed community-based outpatient methods.

BSFT seeks to reduce behavior problems by improving family relationships, working with community institutions, such as schools, and engaging young people who are hard to reach and keep in programs.

The therapy is based on the assumption that each family has its own unique characteristics and it is only when members interact that these properties emerge. As this “system” influences all members, the family must be viewed as a whole rather than as the composite sum of the individuals or groups that comprise it. In BSFT, this view of the family system is evident in assumptions that the family is a system with interdependent and interrelated parts; the behavior of one family member can only be understood in context; and interventions must be implemented at the family level and acknowledge the complex relationships therein.

A BSFT project with young Hispanic substance abusers in Florida showed good results but it is unclear whether these benefits would apply to other ethnic groups. To examine this, adolescent drug users from 480 ethnically diverse families and 49 agency therapists involved with eight treatment facilities across the US were randomly allocated to two groups: one receiving BSFT and the other treatment as usual. Of the 480 young people, 377 were male and 267 were from backgrounds other than Hispanic/Latino. Three quarters were referred from the juvenile justice system and only a quarter lived with both birth parents. The young people were followed-up for one year using self-report questionnaires and urine tests.

No overall differences emerged between the two groups in terms of actual drug use although the BSFT youngsters abused substances less frequently. They were also more engaged with therapy and more likely to stay the course. The proportion receiving BSFT who engaged with the therapy was 88 per cent, compared with 74 per cent who were receiving treatment as usual. Drop-out figures showed similar differences – 40 per cent of the BSFT did not stay the course compared with 56 per cent in the other group. Boys were less likely to engage with treatment, but girls more likely to drop out. In terms of drug use, the two groups showed similar patterns, although the median number of self-reported drug use days was lower for the BSFT group.

This study offers prevention services a method that improves engagement and family functioning and reduces drop-out for an ethnically diverse group and so has implications for wider implementation. However, the amount of substance misuse is less affected. These may seem small contributions compared with the size of the core problem, but it is only by such small steps that progress will be made in difficult areas.

Reference:
Robbins, M., Feaster, D., Horigian, V. et al. (2011). Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance abusing adolescents. Journal of Consulting and Clinical Psychology, 79 (6), 713-727.

Other reference:
Szapocznik, J. and Kurtines, W. (2003). Brief Strategic Family Therapy for Adolescent Drug Abuse, NIH Publication No. 03-4751. Bethesda MD: National Institute on Drug Abuse

Explainers

Brief Strategic Family Therapy (BSFT)

Is designed for children ages 6 to 17 at risk of developing behavior problems and their families. It aims to improve youth behavior by improving family relationships.

Delivered in 12 to 16 family sessions, BSFT proceeds in phases, from the therapist “joining” the family, to “restructuring” family interactions. BSFT, developed by José Szapocznik of the University of Miami, claims to prevent or reduce substance abuse, conduct problems, and delinquency among young people.

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