Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide
Family-Based Approaches

Family-based approaches to treating adolescent substance abuse highlight the need to engage the family, including parents, siblings, and sometimes peers, in the adolescent’s treatment. Involving the family can be particularly important, as the adolescent will often be living with at least one parent and be subject to the parent’s controls, rules, and/or supports. Family-based approaches generally address a wide array of problems in addition to the young person’s substance problems, including family communication and conflict; other co-occurring behavioral, mental health, and learning disorders; problems with school or work attendance; and peer networks. Research shows that family-based treatments are highly efficacious; some studies even suggest they are superior to other individual and group treatment approaches.59 Typically offered in outpatient settings, family treatments have also been tested successfully in higher-intensity settings such as residential and intensive outpatient programs. Below are specific types of family-based treatments shown to be effective in treating adolescent substance abuse.

Brief Strategic Family Therapy (BSFT)

BSFT is based on a family systems approach to treatment, in which one member’s problem behaviors are seen to stem from unhealthy family interactions. Over the course of 12–16 sessions, the BSFT counselor establishes a relationship with each family member, observes how the members behave with one another, and assists the family in changing negative interaction patterns. BSFT can be adapted to a broad range of family situations in various settings (mental health clinics, drug abuse treatment programs, social service settings, families’ homes) and treatment modalities (as a primary outpatient intervention, in combination with residential or day treatment, or as an aftercare/continuing-care service following residential treatment).60

Family Behavior Therapy (FBT)

FBT, which has demonstrated positive results in both adults and adolescents, combines behavioral contracting with contingency management to address not only substance abuse but other behavioral problems as well. The adolescent and at least one parent participate in treatment planning and choose specific interventions from a menu of evidence-based treatment options. Therapists encourage family members to use behavioral strategies taught in sessions and apply their new skills to improve the home environment. They set behavioral goals for preventing substance use and reducing risk behaviors for sexually transmitted diseases like HIV, which are reinforced through a contingency management (CM) system. Goals are reviewed and rewards provided at each session.61

Involving the family can be particularly important in adolescent substance abuse treatment.

Functional Family Therapy (FFT)

FFT combines a family systems view of family functioning (which asserts that unhealthy family interactions underlie problem behaviors) with behavioral techniques to improve communication, problem-solving, conflict resolution, and parenting skills. Principal treatment strategies include (1) engaging families in the treatment process and enhancing their motivation for change and (2) modifying family members’ behavior using CM techniques, communication and problem solving, behavioral contracts, and other methods.62

Undertreating a substance use disorder will increase the risk of relapse.

Multidimensional Family Therapy (MDFT)

MDFT is a comprehensive family- and community-based treatment for substance-abusing adolescents and those at high risk for behavior problems such as conduct disorder and delinquency. The aim is to foster family competency and collaboration with other systems like school or juvenile justice. Sessions may take place in a variety of locations, including in the home, at a clinic, at school, at family court, or in other community locations. MDFT has been shown to be effective even with more severe substance use disorders and can facilitate the reintegration of substance abusing juvenile detainees into the community.63

Multisystemic Therapy (MST)

MST is a comprehensive and intensive family- and community-based treatment that has been shown to be effective even with adolescents whose substance abuse problems are severe and with those who engage in delinquent and/or violent behavior. In MST, the adolescent’s substance abuse is viewed in terms of characteristics of the adolescent (e.g., favorable attitudes toward drug use) and those of his or her family (e.g., poor discipline, conflict, parental drug abuse), peers (e.g., positive attitudes toward drug use), school (e.g., dropout, poor performance), and neighborhood (e.g., criminal subculture). The therapist may work with the family as a whole but will also conduct sessions with just the caregivers or the adolescent alone.64