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., ABPP Professor, Epidemiology & Public Health, and Psychology; and Director, Center for Treatment Research on Adolescent Drug Abuse University of Miami School of Medicine

MDFT Research Program and Clinical Approach Clinical Approach Via Case Sample Findings: Outcome Sample Findings: Transportation Intro: Background, Main Features Research Program

 ASUD specialty  Research program  Treatment development  Integration of research and clinical work 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 Changed and Changing Specialty

  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) J 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 and drug abuse

Reviews of Family-Based Treatments BEHAVIORAL 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) J 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 domains  Cost effectiveness  Symptom reduction  Grow protection and adaptation  Well defined, user friendly Mission Statement: Develop an effective and adoptable treatment for adolescent drug abuse

Principles of MDFT Treatment Development 1.Treatment development is the North Star 2.Heterogeneity of studies 3.Thematic 4.Basic research guides intervention design and development 5.Systems theory informs intervention development 6.Therapist development, training and supervision are critical 7.MDFT treatment is both structured and flexible 8.Advances in the field inform the research program 9.Maximize synergy Mission Statement: Develop an effective and 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 EcologyRisk 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 Research on Adolescent Drug Abuse University of Miami School of Medicine