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

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Multidimensional Family Therapy for Adolescent
Drug Abuse Research Update and Illustration of
Core Clinical Methods Presented at the 2005
Joint Meeting on Adolescent Treatment
EffectivenessWashington, 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
• www.miami.edu/ctrada

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MDFT Research Program and Clinical Approach
Intro Background, Main Features Research Program
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Key Terms

• ASUD specialty
• Research program
• Treatment development
• Integration of research and clinical work

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Developmental Status of a Changed and Changing
Specialty

• 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

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http//www.drugstrategies.org/teens/programs.html
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New Generation of Interventions

• 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

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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

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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

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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

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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

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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

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

• Clinical effectiveness in different domains
• Cost effectiveness
• Symptom reduction
• Grow protection and adaptation
• Well defined, user friendly

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Principles of MDFT Treatment Development
Mission Statement Develop an effective and
adoptable treatment for adolescent drug abuse

• Treatment development is the North Star
• Heterogeneity of studies
• Thematic
• Basic research guides intervention design and
  development
• Systems theory informs intervention development
• Therapist development, training and supervision
  are critical
• MDFT treatment is both structured and flexible
• Advances in the field inform the research program
• Maximize synergy

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The Many Faces of Treatment Development
Crystal ball
Yardstick
Set of prescribed activities
Framework
Destination
Process
Research classification device
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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

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Research Program (2)

• Transporting and disseminating
• Training studies
• Refining and adapting
• Defining and testing different versions
• Continued exploration of key components and
  processes

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Conceptual Frameworks Contributing to the MDFT
Approach
Developmental Psychopathology
Development
MDFT
Ecology
Risk and Protection
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Components and Logic of MDFT Approach

• Problems
• are multidimensional

• Multidimensional problems
• require multidimensional
• conceptualizations

Parent(s)
MDFT
Adolescent
Family
Extrafamilial

• Multidimensional
• conceptualizations yield
• multi-systems interventions

• MDFT assesses and intervenes
• into multiple systems of
• development and influence

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Center for Treatment Research on Adolescent Drug
Abuse University of Miami School of
Medicine www.miami.edu\ctrada hliddle_at_med.miami
.edu