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Family Based Therapy for Adolescents with Problematic Substance Use

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Family Based Therapy for Adolescents with Problematic Substance Use

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Substance use disorder is a medical condition where substance use leads to clinically significant impairment or distress[1]. Problematic substance use

among adolescents presents a unique situation that must be addressed as soon as possible. See substance use disorder.

Family-based approaches to treating substance use developed out of a link between family variables and adolescent behavior problems[2]. Family based therapy (FBT) is one such way of addressing adolescent substance use, as families and communities are an important part of treatment[3]. These are system-oriented approaches aimed at changing family patterns that may contribute to adolescent substance use.

FBT is considered an efficacious model for adolescent substance abuse[4]. Treatment focuses on communication and conflict management between parents and adolescents and parenting skills as well as helping adolescents better integrate into their communities[5]. FBT has some limitations, as it was developed in the United States, with most studies done in the United States[6]. FBT also has high costs associated with it, limiting access for people to treatment[7].

Prevalence

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In 2018, around 3.7% of adolescents (ages 12-17) in the U.S. had a past year substance use disorder (SUD). This means that 1 in 27 adolescents had a SUD in the past year. This prevalence is similar to that in 2017, but lower than the percentages in 2015 and 2016. See the figure to visualize SUD rates over time for different age groups[8].

 
This figure shows substance use disorder rates over time by age group.

Versions

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Multidimensional family therapy (MDFT)

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Multidimensional family therapy (MDFT) is a version of family therapy that targets the surrounding social systems of at-risk youths[9]. The intervention involves outpatient therapy with the adolescent and their family with the focus being on changing individual behavior as well as within-family interactions and interactions among relevant social systems[10]. In general, studies on MDFT have demonstrated improvement through significant declines in drug use and acting-out behaviors among adolescents[11]. In a randomized study, MFDT was found to have a positive impact on problem behaviors, including drug use, as well as the capacity to promote positive gains[12].

Multiple studies have found positive results from MDFT. Some specific outcomes include significant reductions in substance abuse with some relapse within a year[13]. MDFT was associated with the most improvement compared to adolescent group therapy (AGT) and multifamily educational intervention (MEI), as well as greater improvement compared to individual cognitive behavioral therapy (CBT-I)[14][15]. Based on these outcomes, MDFT has been widely regarded as a well-established treatment[16]. In a randomized control trial comparing MDFT and peer group therapy, MDFT was significantly more effective in reducing risk and promoting protective processes in the individual, family, peer, and school domains. MDFT also resulted in a reduction of substance abuse over the course of the treatment[17].

Brief strategic family therapy (BSFT)

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This diagram shows the three stages of Brief Strategic Family Therapy.

Brief strategic family therapy (BSFT) is a manualized, empirically validated family-based intervention meant to address components of family functioning connected to adolescent substance use[18]. It is very structured, with a prescribed process format that is directive problem-focused, and practical. Steps include Joining, Diagnosis, and Restructuring. Therapists aim to change family patterns of interactions[19]. One of the main change strategies is using cognitive restructuring via reframing, transforming negative affect due to frustrating family interactions to positive affect. BSFT is 12-16 sessions over 4 months involving multiple family members, with 8 optional booster sessions and flexibility depending on the needs of the family[20].

BSFT was evaluated by two systematic reviews. Austin, Macgowan, and Wagner (2005) found that BSFT, along with Multidimensional Family Therapy, are the most effective among family-based interventions, rated probably efficacious[21]. Waldron and Turner (2008) found it to be probably efficacious, but needing independent replication[22]. BSFT has been found to provide more engagement in therapy and increased family functioning as well as to reduce socialized aggression, conduct problems, and substance use[23].

Multisystemic therapy (MST)

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Multisystemic Therapy (MST) is a family-based, ecological treatment model for adolescents, which focuses on an individual’s social systems and its relations with clinical problems like substance use and delinquency[24]. This approach is marked by rigorous home-based services, therapist availability, less burden caseload (for the therapist), skill provision, and assurance of proper treatment standard. Its allows for meetings between the adolescent and therapist; however, family involvement is preferred. MST focuses more on antisocial behaviors and its connections with the functioning of the adolescent's family[25]. This approach provides high promise for treatment of substance use disorders, efficacy in keeping families in treatment, and room for variability in how therapists practice[26]. That said, other studies have noted the need for independent replication[27].

Ecological family-based treatment (FBT-E)/Ecologically Based Family Therapy (EBFT)

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Ecologically-Based Family Treatment (EBFT) is a home-based family therapy that targets runaway adolescents with substance abuse problems. EBFT is modeled after the Homebuilders family preservation model in which services are initiated by a family crisis. More specifically, EBFT is initiated when an adolescent runs away from home. The goal of EBFT is to reconnect families and target family distress so runaway adolescents can go back home[28]. This therapy was developed with the following assumptions in mind: services must address the needs and priorities of each family, with respect to their limited amounts of time and that most children are better off with their own families than elsewhere.

In a systematic review by Hogue et al. (2014), EBFT was found to reduce substance use more than treatment as usual[29]. The home-based EBFT model also resulted in better rates of treatment participation than office-based treatments. When compared to motivational interviewing and cognitive behavioral treatment on an individual basis, EBFT was associated with slower changes but also slower relapse, indicating a greater reward overall. All three treatments were equally effective in reduced alcohol substance use, but EBFT appeared to have the greatest latency. Hogue et al. (2014) deemed EBFT to be well-established and later in 2018, probability efficacious[30].

A limitation of ecologically-based family therapies (FBT-E) is that they consist of intensive and comprehensive therapeutic services that must fit into familial needs and time constraints. Especially since adolescents are best taken care of by their own family, therapy must fit into a limited amount of sessions so runaway adolescents can be reconnected with their families sooner rather than later[31].

Functional family therapy (FFT)

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Multisystemic Therapy (MST) and Functional Family Therapy (FFT) are similar interventions with overlapping treatment goals and target populations[32]. By intervening in the family and environmental system of 12–18 year old adolescents, both therapies have proven to effectively reduce externalizing behavioral problems, with a specific focus on antisocial behavior and delinquency[33]. Nonetheless, the two differ on the grounds that MST is typically used to treat more severe cases of behavior disorders. In comparison, FFT is more cost-effective and has been embraced nationwide as a valid treatment for substance abuse and juvenile outcomes[34].

FFT offers weekly sessions for up to 6 months, and involves two distinct phases, primarily designed to improve supportiveness and family communication, while also reducing the dysfunctional behavior patterns and negativity that cause or maintain adolescent recidivism or substance abuse[35]. The first phase introduces families to the process, committing them to the treatment process, and promoting their motivation to change. The second phase seeks to reshape the family dynamic to produce new patterns of interaction which emphasize better communication, behavioral modification, and advocacy outside the context of home[36].

Table Summarizing Versions

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Type of Treatment (Version) Description Outcomes Effectiveness Pros Cons
Multidimensional family therapy (MDFT) Delivery: Structured and flexible[37]


Duration: 3-6 months, generally outpatient[38]


Primary Objective: Improve functioning in adolescent, parents, family interactions, and extra-familial relationships; targets the surrounding social systems of at-risk youths[39]


Structure: 3 stages; Stage 1: Building a Foundation for Change; Stage 2: Facilitating Individual and Family Change; and Stage 3: Solidifying Changes[40]

Reduced substance use[41][42] High effectiveness[43]


Well-established[44]


Feasible[45]

Adaptations for multiple settings


Adopted in many locations around the world[46]

Need for long-term follow up and sample size calculations[47]
Brief strategic family therapy (BSFT) Delivery: Flexible to work with any family members[48]; very structured, with a prescribed process format that is directive problem-focused, and practical[49]


Duration: 12-16 sessions over 4 months involving multiple family members, with 8 optional booster sessions and flexibility depending on the needs of the family[50]


Primary Objective: Treat substance use in adolescents[51] by focusing on 4 things: 1) joining with the family, 2) assessing problematic interactions, 3) creating a context for change, and 4) restructuring family interactions[52][53]


Structure: 3 steps: Joining, Diagnosis, and Restructuring[54]

Engages family, reduces drug abuse, improves family relationships[55] Effective[56]


More effective than treatment as usual[57]

Developed for minorities[58] Needs independent replication[59]
Multisystemic therapy (MST) Delivery: Rigorous, room for therapist variability[60]


Primary Objective: Targets externalizing behavior problems[61]; focuses on antisocial behavior[62]


Structure: Involves skills training with schools and other agencies, rigid structure[63]

Significant improvement in individual and family adjustments[64]


Positive effects maintained for up to 4 years post-treatment[65]

Well-established[66]


Most effective with juveniles under 15[67]


Keeps families in treatment[68]


Room for variability in how therapist practices[69]

Extensively evaluated[70]


Has been adapted beyond adolescent drug use to behaviors in children with autism[71]

Need for replication[72]


Discrepancy in effectiveness over treatment as usual depending on location in the world[73]

Ecological family-based treatment /Ecologically Based Family Therapy (FBT-E/EBFT) Primary Objective: The Goal of EBFT is to reconnect families and target family distress so runaway adolescents can go back home[74] Reduces alcohol use[75] Reduces substance use more than treatment as usual[76]


Well established and probably efficacious[77][78]

Longer time to reuse[79] Slower changes[80]


Hard to fit into schedule of the family due to intensity[81]


Limited amount of sessions[82]

Functional family therapy (FFT) Duration: Weekly session for up to 6 months[83]


Primary Objective: Change dysfunctional family patterns that contribute to substance use[84]


Structure: Two phases- 1) engage families, increase motivation, introduce themes; 2) creating new patterns and behavioral change[85]

Assists with youth externalizing behavior, drug abuse, schizophrenia, bipolar in many settings[86] Supported by seven randomized control trials[87] Has been applied successfully in multiple contexts/ geographic locations[88] Narrow focus of research[89]


Limited information on what the mechanism of change is in successful interventions[90]

Resources

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How to find a therapist

How to recognize substance abuse has become a problem


References
  1. ↑ "Drug addiction (substance use disorder) - Symptoms and causes". Mayo Clinic. Retrieved 2019-12-01.
  2. ↑ Baldwin, Scott A.; Christian, Sarah; Berkeljon, Arjan; Shadish, William R. (2012). "The Effects of Family Therapies for Adolescent Delinquency and Substance Abuse: A Meta-analysis". Journal of Marital and Family Therapy 38 (1): 281–304. doi:10.1111/j.1752-0606.2011.00248.x. ISSN 1752-0606. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1752-0606.2011.00248.x. 
  3. ↑ Abuse, National Institute on Drug. "Principles of Adolescent Substance Use Disorder Treatment". www.drugabuse.gov. Retrieved 2019-12-01.
  4. ↑ Hogue, Aaron; Liddle, Howard A. (2009-05). "Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research". Journal of Family Therapy 31 (2): 126–154. doi:10.1111/j.1467-6427.2009.00459.x. ISSN 0163-4445. http://dx.doi.org/10.1111/j.1467-6427.2009.00459.x. 
  5. ↑ Baldwin, Scott A.; Christian, Sarah; Berkeljon, Arjan; Shadish, William R. (2012). "The Effects of Family Therapies for Adolescent Delinquency and Substance Abuse: A Meta-analysis". Journal of Marital and Family Therapy 38 (1): 281–304. doi:10.1111/j.1752-0606.2011.00248.x. ISSN 1752-0606. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1752-0606.2011.00248.x. 
  6. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-07-13). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1). doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. http://dx.doi.org/10.1186/s12888-016-0949-8. 
  7. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-07-13). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1). doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. http://dx.doi.org/10.1186/s12888-016-0949-8. 
  8. ↑ "Home Page | CBHSQ Data". www.samhsa.gov. Retrieved 2020-04-23.
  9. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-07-13). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1). doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. http://dx.doi.org/10.1186/s12888-016-0949-8. 
  10. ↑ Liddle, Howard A.; Hogue, Aaron (2001). Innovations in Adolescent Substance Abuse Interventions. Elsevier. pp. 229–261. ISBN 978-0-08-043577-0. http://dx.doi.org/10.1016/b978-008043577-0/50031-6. 
  11. ↑ Liddle, Howard A.; Hogue, Aaron (2001). Innovations in Adolescent Substance Abuse Interventions. Elsevier. pp. 229–261. ISBN 978-0-08-043577-0. http://dx.doi.org/10.1016/b978-008043577-0/50031-6. 
  12. ↑ Liddle, Howard A.; Hogue, Aaron (2001). Innovations in Adolescent Substance Abuse Interventions. Elsevier. pp. 229–261. ISBN 978-0-08-043577-0. http://dx.doi.org/10.1016/b978-008043577-0/50031-6. 
  13. ↑ Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004).The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. J Subst Abuse.2004;27:197-213.2004-20575-00410.1016/j.jsat.2003.09.00515501373. http://dx.doi.org/10.1016/j.jsat.2003.09.005 .
  14. ↑ Liddle, Howard A.; Hogue, Aaron (2001). Innovations in Adolescent Substance Abuse Interventions. Elsevier. pp. 229–261. ISBN 978-0-08-043577-0. http://dx.doi.org/10.1016/b978-008043577-0/50031-6. 
  15. ↑ Segal, Bernard (2014-03-18). Adolescent Substance Abuse Treatment in the United States. doi:10.4324/9781315821344. http://dx.doi.org/10.4324/9781315821344. 
  16. ↑ Waldron, Holly Barrett; Turner, Charles W. (2008-03-03). "Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse". Journal of Clinical Child & Adolescent Psychology 37 (1): 238–261. doi:10.1080/15374410701820133. ISSN 1537-4416. http://dx.doi.org/10.1080/15374410701820133. 
  17. ↑ Liddle, Howard A.; Rowe, Cynthia L.; Dakof, Gayle A.; Ungaro, Rocio A.; Henderson, Craig E. (2004-03). "Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment". Journal of Psychoactive Drugs 36 (1): 49–63. doi:10.1080/02791072.2004.10399723. ISSN 0279-1072. http://dx.doi.org/10.1080/02791072.2004.10399723. 
  18. ↑ Szapocznik, Jose; Hervis, Olga; Schwartz, Seth (2003). "Brief Strategic Family Therapy for Adolescent Drug Abuse". PsycEXTRA Dataset. Retrieved 2019-12-01.
  19. ↑ Szapocznik, José; Zarate, Monica; Duff, Johnathan; Muir, Joan (2013-05). "Brief Strategic Family Therapy: Engaging Drug Using/Problem Behavior Adolescents and Their Families in Treatment". Social Work in Public Health 28 (3-4): 206–223. doi:10.1080/19371918.2013.774666. ISSN 1937-1918. PMID 23731415. PMC PMC3995135. http://www.tandfonline.com/doi/abs/10.1080/19371918.2013.774666. 
  20. ↑ Robbins, Michael S.; Szapocznik, José; Horigian, Viviana E.; Feaster, Daniel J.; Puccinelli, Marc; Jacobs, Petra; Burlew, Kathy; Werstlein, Robert et al. (2009-05). "Brief strategic family therapy™ for adolescent drug abusers: A multi-site effectiveness study". Contemporary Clinical Trials 30 (3): 269–278. doi:10.1016/j.cct.2009.01.004. PMID 19470315. PMC PMC3163853. https://linkinghub.elsevier.com/retrieve/pii/S155171440900007X. 
  21. ↑ Austin, Ashley M.; Macgowan, Mark J.; Wagner, Eric F. (2005-03). "Effective Family-Based Interventions for Adolescents With Substance Use Problems: A Systematic Review". Research on Social Work Practice 15 (2): 67–83. doi:10.1177/1049731504271606. ISSN 1049-7315. https://doi.org/10.1177/1049731504271606. 
  22. ↑ Waldron, Holly Barrett; Turner, Charles W. (2008-03-03). "Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse". Journal of Clinical Child & Adolescent Psychology 37 (1): 238–261. doi:10.1080/15374410701820133. ISSN 1537-4416. http://dx.doi.org/10.1080/15374410701820133. 
  23. ↑ "BSFT® Program Effectiveness | Evidence for the BSFT® Program | Brief Strategic Family Therapy® at Miller School of Medicine". www.bsft.org. Retrieved 2019-12-02.
  24. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-07-13). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1). doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. http://dx.doi.org/10.1186/s12888-016-0949-8. 
  25. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-07-13). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1). doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. http://dx.doi.org/10.1186/s12888-016-0949-8. 
  26. ↑ Henggeler, Scott; Schoenwald, Sonja; Borduin, Charles; Rowland, Melisa; Cunningham, Phillippe (2001-05). "Multisystemic Treatment of Antisocial Behavior in Children and Adolescents". Behavioral Disorders 26 (3): 259–260. doi:10.1177/019874290102600306. ISSN 0198-7429. http://dx.doi.org/10.1177/019874290102600306. 
  27. ↑ Austin, Ashley M.; Macgowan, Mark J.; Wagner, Eric F. (2005-03). "Effective Family-Based Interventions for Adolescents With Substance Use Problems: A Systematic Review". Research on Social Work Practice 15 (2): 67–83. doi:10.1177/1049731504271606. ISSN 1049-7315. http://dx.doi.org/10.1177/1049731504271606. 
  28. ↑ Slesnick, Natasha; Prestopnik, Jillian L (2009-07). "Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents". Journal of Marital and Family Therapy 35 (3): 255–277. doi:10.1111/j.1752-0606.2009.00121.x. PMID 19522781. PMC PMC2697451. http://doi.wiley.com/10.1111/j.1752-0606.2009.00121.x. 
  29. ↑ Hogue, Aaron; Henderson, Craig E.; Ozechowski, Timothy J.; Robbins, Michael S. (2014-06-13). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013". Journal of Clinical Child & Adolescent Psychology 43 (5): 695–720. doi:10.1080/15374416.2014.915550. ISSN 1537-4416. http://dx.doi.org/10.1080/15374416.2014.915550. 
  30. ↑ Hogue, Aaron; Henderson, Craig E.; Becker, Sara J.; Knight, Danica K. (2018-06-12). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons". Journal of Clinical Child & Adolescent Psychology 47 (4): 499–526. doi:10.1080/15374416.2018.1466307. ISSN 1537-4416. http://dx.doi.org/10.1080/15374416.2018.1466307. 
  31. ↑ Slesnick, Natasha; Prestopnik, Jillian L (2009-07). "Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents". Journal of Marital and Family Therapy 35 (3): 255–277. doi:10.1111/j.1752-0606.2009.00121.x. PMID 19522781. PMC PMC2697451. http://doi.wiley.com/10.1111/j.1752-0606.2009.00121.x. 
  32. ↑ Eeren, Hester V.; Goossens, Lucas M. A.; Scholte, Ron H. J.; Busschbach, Jan J. V.; van der Rijken, Rachel E. A. (2018-07-01). "Multisystemic Therapy and Functional Family Therapy Compared on their Effectiveness Using the Propensity Score Method". Journal of Abnormal Child Psychology 46 (5): 1037–1050. doi:10.1007/s10802-017-0392-4. ISSN 1573-2835. PMID 29313186. PMC PMC6010495. https://doi.org/10.1007/s10802-017-0392-4. 
  33. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-12). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1): 237. doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. PMID 27412612. PMC PMC4944475. http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0949-8. 
  34. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-12). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1): 237. doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. PMID 27412612. PMC PMC4944475. http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0949-8. 
  35. ↑ Stratton: Stratton, P. (2016). The Evidence Base of Family Therapy and Systemic Practice.
  36. ↑ Robbins, Mike; Sexton, Tom; Weeks, Gerald (2004-03-01). Sexton, Thomas L.. ed. Handbook of Family Therapy: The Science and Practice of Working with Families and Couples (in en) (0 ed.). Routledge. doi:10.4324/9780203490419. ISBN 978-0-203-49041-9. https://www.taylorfrancis.com/books/9781135451318. 
  37. ↑ Stratton, P. (2016). The Evidence Base of Family Therapy and Systemic Practice.
  38. ↑ Wagner, Eric F.; Waldron, Holly B. (2001). Innovations in adolescent substance abuse interventions. New York: Pergamon. ISBN 978-0-08-043577-0. OCLC 162566183. https://www.worldcat.org/oclc/162566183. 
  39. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-12). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1): 237. doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. PMID 27412612. PMC PMC4944475. http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0949-8. 
  40. ↑ Liddle, H. A. (2015). Multidimensional family therapy. In T. L. Sexton & J. Lebow (Eds.), Handbook of family therapy. New York: Routledge.
  41. ↑ Dennis, M., Godley, S. H., Diamond, G., Tims, F. M., Babor, T., Donaldson, J., Liddle, H., Titus, J. C., Kaminer, Y., Webb, C., Hamilton, N., & Funk, R. (2004).The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials. J Subst
  42. ↑ Liddle, Howard A.; Rowe, Cynthia L.; Dakof, Gayle A.; Ungaro, Rocio A.; Henderson, Craig E. (2004-03). "Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment". Journal of Psychoactive Drugs 36 (1): 49–63. doi:10.1080/02791072.2004.10399723. ISSN 0279-1072.
  43. ↑ Liddle, Howard A.; Rowe, Cynthia L.; Dakof, Gayle A.; Ungaro, Rocio A.; Henderson, Craig E. (2004-03). "Early Intervention for Adolescent Substance Abuse: Pretreatment to Posttreatment Outcomes of a Randomized Clinical Trial Comparing Multidimensional Family Therapy and Peer Group Treatment". Journal of Psychoactive Drugs 36 (1): 49–63. doi:10.1080/02791072.2004.10399723. ISSN 0279-1072.
  44. ↑ Waldron, Holly Barrett; Turner, Charles W. (2008-03-03). "Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse". Journal of Clinical Child & Adolescent Psychology 37 (1): 238–261. doi:10.1080/15374410701820133. ISSN 1537-4416. http://www.tandfonline.com/doi/abs/10.1080/15374410701820133. 
  45. ↑ Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59–81.
  46. ↑ Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59–81.
  47. ↑ Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59–81.
  48. ↑ Szapocznik, José; Schwartz, Seth J.; Muir, Joan A.; Brown, C. Hendricks (2012-06). "Brief strategic family therapy: An intervention to reduce adolescent risk behavior.". Couple and Family Psychology: Research and Practice 1 (2): 134–145. doi:10.1037/a0029002. ISSN 2160-410X. PMID 23936750. PMC PMC3737065. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029002. 
  49. ↑ Szapocznik, José; Schwartz, Seth J.; Muir, Joan A.; Brown, C. Hendricks (2012-06). "Brief strategic family therapy: An intervention to reduce adolescent risk behavior.". Couple and Family Psychology: Research and Practice 1 (2): 134–145. doi:10.1037/a0029002. ISSN 2160-410X. PMID 23936750. PMC PMC3737065. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029002. 
  50. ↑ Robbins, Michael S.; Szapocznik, José; Horigian, Viviana E.; Feaster, Daniel J.; Puccinelli, Marc; Jacobs, Petra; Burlew, Kathy; Werstlein, Robert et al. (2009-05). "Brief strategic family therapy™ for adolescent drug abusers: A multi-site effectiveness study". Contemporary Clinical Trials 30 (3): 269–278. doi:10.1016/j.cct.2009.01.004. PMID 19470315. PMC PMC3163853. https://linkinghub.elsevier.com/retrieve/pii/S155171440900007X. 
  51. ↑ Szapocznik, José; Schwartz, Seth J.; Muir, Joan A.; Brown, C. Hendricks (2012-06). "Brief strategic family therapy: An intervention to reduce adolescent risk behavior.". Couple and Family Psychology: Research and Practice 1 (2): 134–145. doi:10.1037/a0029002. ISSN 2160-410X. PMID 23936750. PMC PMC3737065. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029002. 
  52. ↑ Robbins, M. S., Horigian, V. E., & Szapocznik, J. (2008). Brief strategic family therapy: An empirically-validated intervention for reducing adolescent behavior problems. Praxis der Kinderpsychologie und Kinderpsychiatrie, 57(5), 381–400.
  53. ↑ Szapocznik, José; Schwartz, Seth J.; Muir, Joan A.; Brown, C. Hendricks (2012-06). "Brief strategic family therapy: An intervention to reduce adolescent risk behavior.". Couple and Family Psychology: Research and Practice 1 (2): 134–145. doi:10.1037/a0029002. ISSN 2160-410X. PMID 23936750. PMC PMC3737065. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029002. 
  54. ↑ Szapocznik, José; Zarate, Monica; Duff, Johnathan; Muir, Joan (2013-05). "Brief Strategic Family Therapy: Engaging Drug Using/Problem Behavior Adolescents and Their Families in Treatment". Social Work in Public Health 28 (3-4): 206–223. doi:10.1080/19371918.2013.774666. ISSN 1937-1918. PMID 23731415. PMC PMC3995135. http://www.tandfonline.com/doi/abs/10.1080/19371918.2013.774666. 
  55. ↑ Santiseban, S., Suarez-Morales, L., Robbins, M., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45, 259–271.
  56. ↑ Santiseban, S., Suarez-Morales, L., Robbins, M., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45, 259–271.
  57. ↑ Robbins, Michael S.; Feaster, Daniel J.; Horigian, Viviana E.; Rohrbaugh, Michael; Shoham, Varda; Bachrach, Ken; Miller, Michael; Burlew, Kathleen A. et al. (2011). "Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents.". Journal of Consulting and Clinical Psychology 79 (6): 713–727. doi:10.1037/a0025477. ISSN 1939-2117. PMID 21967492. PMC PMC3440775. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0025477. 
  58. ↑ Szapocznik, José; Schwartz, Seth J.; Muir, Joan A.; Brown, C. Hendricks (2012-06). "Brief strategic family therapy: An intervention to reduce adolescent risk behavior.". Couple and Family Psychology: Research and Practice 1 (2): 134–145. doi:10.1037/a0029002. ISSN 2160-410X. PMID 23936750. PMC PMC3737065. http://doi.apa.org/getdoi.cfm?doi=10.1037/a0029002. 
  59. ↑ Waldron, Holly Barrett; Turner, Charles W. (2008-03-03). "Evidence-Based Psychosocial Treatments for Adolescent Substance Abuse". Journal of Clinical Child & Adolescent Psychology 37 (1): 238–261. doi:10.1080/15374410701820133. ISSN 1537-4416. http://www.tandfonline.com/doi/abs/10.1080/15374410701820133. 
  60. ↑ Henggeler, Scott; Schoenwald, Sonja; Borduin, Charles; Rowland, Melisa; Cunningham, Phillippe (2001-05). "Multisystemic Treatment of Antisocial Behavior in Children and Adolescents". Behavioral Disorders 26 (3): 259–260. doi:10.1177/019874290102600306. ISSN 0198-7429. http://journals.sagepub.com/doi/10.1177/019874290102600306. 
  61. ↑ Stouwe, Van der T., Asscher, J. J., Stams, G. J. J. M., Dekovic, M., & van der Laan, P. H. (2014). The effectiveness of multisystemic therapy (MST): A meta-analysis. Clinical Psychology Review, 34, 468–481.
  62. ↑ Goorden, Maartje; Schawo, Saskia J.; Bouwmans-Frijters, Clazien A.M.; van der Schee, Evelien; Hendriks, Vincent M.; Hakkaart-van Roijen, Leona (2016-12). "The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review". BMC Psychiatry 16 (1): 237. doi:10.1186/s12888-016-0949-8. ISSN 1471-244X. PMID 27412612. PMC PMC4944475. http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-016-0949-8. 
  63. ↑ Stratton, P. (2016). The Evidence Base of Family Therapy and Systemic Practice.
  64. ↑ Henggeler, S., & Lee, S. (2003). Multisystemic treatment of serious clinical problems. In A. Kazdin & J. Weisz (Eds.), Evidence based psychotherapies for children and adolescents (pp. 301–324). New York: Guilford.
  65. ↑ Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411–419.
  66. ↑ Stouwe, Van der T., Asscher, J. J., Stams, G. J. J. M., Dekovic, M., & van der Laan, P. H. (2014). The effectiveness of multisystemic therapy (MST): A meta-analysis. Clinical Psychology Review, 34, 468–481.
  67. ↑ Stouwe, Van der T., Asscher, J. J., Stams, G. J. J. M., Dekovic, M., & van der Laan, P. H. (2014). The effectiveness of multisystemic therapy (MST): A meta-analysis. Clinical Psychology Review, 34, 468–481.
  68. ↑ Henggeler, Scott; Schoenwald, Sonja; Borduin, Charles; Rowland, Melisa; Cunningham, Phillippe (2001-05). "Multisystemic Treatment of Antisocial Behavior in Children and Adolescents". Behavioral Disorders 26 (3): 259–260. doi:10.1177/019874290102600306. ISSN 0198-7429. http://journals.sagepub.com/doi/10.1177/019874290102600306. 
  69. ↑ Henggeler, Scott; Schoenwald, Sonja; Borduin, Charles; Rowland, Melisa; Cunningham, Phillippe (2001-05). "Multisystemic Treatment of Antisocial Behavior in Children and Adolescents". Behavioral Disorders 26 (3): 259–260. doi:10.1177/019874290102600306. ISSN 0198-7429. http://journals.sagepub.com/doi/10.1177/019874290102600306. 
  70. ↑ Henggeler, Scott W.; Schaeffer, Cindy M. (2016-09). "Multisystemic Therapy ® : Clinical Overview, Outcomes, and Implementation Research". Family Process 55 (3): 514–528. doi:10.1111/famp.12232. http://doi.wiley.com/10.1111/famp.12232. 
  71. ↑ Wagner, David V.; Borduin, Charles M.; Kanne, Stephen M.; Mazurek, Micah O.; Farmer, Janet E.; Brown, Rachel M. A. (2014-07). "Multisystemic Therapy for Disruptive Behavior Problems in Youths With Autism Spectrum Disorders: A Progress Report". Journal of Marital and Family Therapy 40 (3): 319–331. doi:10.1111/jmft.12012. http://doi.wiley.com/10.1111/jmft.12012. 
  72. ↑ Austin, Ashley M.; Macgowan, Mark J.; Wagner, Eric F. (2005-03). "Effective Family-Based Interventions for Adolescents With Substance Use Problems: A Systematic Review". Research on Social Work Practice 15 (2): 67–83. doi:10.1177/1049731504271606. ISSN 1049-7315. http://journals.sagepub.com/doi/10.1177/1049731504271606. 
  73. ↑ Sundell, K., Hansson, K., Andrée Löfholm, C., Olsson, T., Gustle, L.-H. and Kadesjö, K. (2008) ‘The transportability of multisystemic therapy to Sweden: short-term results from a randomized trial of conduct-disordered youths’, Journal of Family Psychology, vol 22, no 4, pp 550–60.
  74. ↑ Slesnick, Natasha; Prestopnik, Jillian L (2009-07). "Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents". Journal of Marital and Family Therapy 35 (3): 255–277. doi:10.1111/j.1752-0606.2009.00121.x. http://doi.wiley.com/10.1111/j.1752-0606.2009.00121.x. 
  75. ↑ Stratton, P. (2016). The Evidence Base of Family Therapy and Systemic Practice.
  76. ↑ Hogue, Aaron; Henderson, Craig E.; Ozechowski, Timothy J.; Robbins, Michael S. (2014-09). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013". Journal of Clinical Child & Adolescent Psychology 43 (5): 695–720. doi:10.1080/15374416.2014.915550. ISSN 1537-4416. http://www.tandfonline.com/doi/abs/10.1080/15374416.2014.915550. 
  77. ↑ Hogue, Aaron; Henderson, Craig E.; Ozechowski, Timothy J.; Robbins, Michael S. (2014-09). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use: Updates and Recommendations 2007–2013". Journal of Clinical Child & Adolescent Psychology 43 (5): 695–720. doi:10.1080/15374416.2014.915550. ISSN 1537-4416. http://www.tandfonline.com/doi/abs/10.1080/15374416.2014.915550. 
  78. ↑ Hogue, Aaron; Henderson, Craig E.; Becker, Sara J.; Knight, Danica K. (2018-07-04). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons". Journal of Clinical Child & Adolescent Psychology 47 (4): 499–526. doi:10.1080/15374416.2018.1466307. ISSN 1537-4416. https://www.tandfonline.com/doi/full/10.1080/15374416.2018.1466307. 
  79. ↑ Hogue, Aaron; Henderson, Craig E.; Becker, Sara J.; Knight, Danica K. (2018-07-04). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons". Journal of Clinical Child & Adolescent Psychology 47 (4): 499–526. doi:10.1080/15374416.2018.1466307. ISSN 1537-4416. https://www.tandfonline.com/doi/full/10.1080/15374416.2018.1466307. 
  80. ↑ Hogue, Aaron; Henderson, Craig E.; Becker, Sara J.; Knight, Danica K. (2018-07-04). "Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014–2017: Outcomes, Treatment Delivery, and Promising Horizons". Journal of Clinical Child & Adolescent Psychology 47 (4): 499–526. doi:10.1080/15374416.2018.1466307. ISSN 1537-4416. https://www.tandfonline.com/doi/full/10.1080/15374416.2018.1466307. 
  81. ↑ Slesnick, Natasha; Prestopnik, Jillian L (2009-07). "Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents". Journal of Marital and Family Therapy 35 (3): 255–277. doi:10.1111/j.1752-0606.2009.00121.x. http://doi.wiley.com/10.1111/j.1752-0606.2009.00121.x. 
  82. ↑ Slesnick, Natasha; Prestopnik, Jillian L (2009-07). "Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents". Journal of Marital and Family Therapy 35 (3): 255–277. doi:10.1111/j.1752-0606.2009.00121.x. http://doi.wiley.com/10.1111/j.1752-0606.2009.00121.x. 
  83. ↑ Stratton, Peter; Borcsa, Maria (2016). Origins and Originality in Family Therapy and Systemic Practice. Cham: Springer International Publishing. pp. 235–245. ISBN 978-3-319-39060-4. http://dx.doi.org/10.1007/978-3-319-39061-1_14. 
  84. ↑ Stratton, Peter; Borcsa, Maria (2016). Origins and Originality in Family Therapy and Systemic Practice. Cham: Springer International Publishing. pp. 235–245. ISBN 978-3-319-39060-4. http://dx.doi.org/10.1007/978-3-319-39061-1_14. 
  85. ↑ Robbins, Mike; Sexton, Tom; Weeks, Gerald (2004-03-01). Handbook of Family Therapy. doi:10.4324/9780203490419. http://dx.doi.org/10.4324/9780203490419. 
  86. ↑ Sexton, Thomas L.; Datchi, Corinne (2014-09). "The Development and Evolution of Family Therapy Research: Its Impact on Practice, Current Status, and Future Directions". Family Process 53 (3): 415–433. doi:10.1111/famp.12084. http://doi.wiley.com/10.1111/famp.12084. 
  87. ↑ Darwiche, Joëlle; de Roten, Yves (2015-03). "Couple and Family Treatments: Study Quality and Level of Evidence". Family Process 54 (1): 138–159. doi:10.1111/famp.12106. http://doi.wiley.com/10.1111/famp.12106. 
  88. ↑ Gurman, Alan S.; Burton, Mark (2014-10). "Individual Therapy for Couple Problems: Perspectives and Pitfalls". Journal of Marital and Family Therapy 40 (4): 470–483. doi:10.1111/jmft.12061. http://doi.wiley.com/10.1111/jmft.12061. 
  89. ↑ Sexton, Thomas L.; Datchi, Corinne (2014-09). "The Development and Evolution of Family Therapy Research: Its Impact on Practice, Current Status, and Future Directions". Family Process 53 (3): 415–433. doi:10.1111/famp.12084. http://doi.wiley.com/10.1111/famp.12084. 
  90. ↑ Sexton, Thomas L.; Datchi, Corinne (2014-09). "The Development and Evolution of Family Therapy Research: Its Impact on Practice, Current Status, and Future Directions". Family Process 53 (3): 415–433. doi:10.1111/famp.12084. http://doi.wiley.com/10.1111/famp.12084. 
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