This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of. or was observed, using drugs. Subjects were randomly assigned to a strategic structuralsystems engagement (experimental) condition or to an engagement-as-usual (control) condition.Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared wiih 25"! of subjects in the control condition.Recent research has suggested that strategic, structural, family interventions are highly effective in the treatment ot multiple substance abusing adolescents (Szapocznik. Kurtines, Foote, Perez-Vidal, & Hervis, 1983. However, although family interventions may be more effective than individual interventions in treating drug abuse (Kaufman* Kaufman, 1979: Stanton, 1980, the engagement of families of drug abusers remains a serious problem. Stanton and his collaborators (Stanton, 1979;Stanton & Todd, 1981) have suggested that the problem of engaging drug abusers in treatment has been one of the most urgent obstacles to service delivery with this population. Our prior research (Szapocznik, Kurtines etal., 1983 has revealed that a substantial proportion of clients are lost prior to the first treatment session, thus confirming the difficulties inherent in engaging drug abusers in treatment. For example, in a project that investigated the treatment efficacy of drug-abusing adolescents, only 250 client families of approximately 650 initial contacts actually came in for a screening interview. Of this number, only 145 completed the intake procedure and only 72 completed treatment. Clearly, our data show that a very large proportion of client families who initially seek treatment are not engaged in therapy. Recognition of the problem of engagement has resulted in a number of attempts to develop strategies for recruiting drug abusers and their families in treatment (e.g..

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This study compares the efficacy of Bicultural Effectiveness Training (BET), a new intervention modality, and Structural Family Therapy (SFT), an established treatment approach. Cuban American families experiencing intercultural and intergenerational differences in which an adolescent member manifested symptoms of conduct disorder and/or social mal-adjustment were the subjects. The experimental intervention condition, BET, uses culture as content around which to bring about changes in the family's style of relating. The comparison (control) condition, SFT, is an approach which also focuses on changing the family's style of relating but, in comparison to BET, it is more process oriented and may use any content that emerges from the family. The relative effectiveness of the two family intervention modalities was determined by the degree to which improvement was achieved, as assessed by treatment outcome instruments designed to measure family interactional patterns (structure), family levels of acculturation and biculturalism, and adolescent behavior problems and psychopathology. The findings indicated that families/adolescents in both treatment groups demonstrated significant pre-post treatment changes in the hypothesized direction. This finding is important since BET is a standarized method of service delivery that is attractive to families, is easily replicable, and has the potential for broad distribution, making it useful to early intevention and prevention approaches.

Structural family therapy, psychodynamic child therapy, and a recreational control condition were compared for 69 six-to-twelve-year-old Hispanic boys who presented with behavioral and emotional problems. The results suggest that the control condition was significantly less effective in retaining cases than the two treatment conditions, which were apparently equivalent in reducing behavioral and emotional problems as well as in improving psychodynamic ratings of child functioning. Structural family therapy was more effective than psychodynamic child therapy in protecting the integrity of the family at 1-year follow-up. Finally, the results did not support basic assumptions of structural family systems therapy regarding the mechanisms mediating symptom reduction.

More than 20 years of research has shown that addiction is clearly treatable. Addiction treatment has been effective in reducing drug use and HIV infection, diminishing the health and social costs that result from addiction, and decreasing criminal behavior. The National Institute on Drug Abuse (NIDA), which supports more than 85 percent of the world's research on drug abuse and addiction, has found that behavioral approaches can be very effective in treating cocaine addiction. To ensure that treatment providers apply the most current scientifically supported approaches to their patients, NIDA has supported the development of the "Therapy Manuals for Drug Addiction" series. This series reflects NIDA's commitment to rapidly applying basic findings in real life settings. The manuals are derived from those used efficaciously in NIDA-supported drug abuse treatment studies. They are intended for use by drug abuse treatment practitioners, mental health professionals, and all others concerned with the treatment of drug addiction. The manuals present clear, helpful information to aid drug treatment practitioners in providing the best possible care that science has to offer. They describe scientifically supported therapies for addiction and provide guidance on session content and how to implement specific techniques. Of course, there is no substitute for training and supervision, and these manuals may not be applicable to all types of patients nor compatible with all clinical programs or treatment approaches. These manuals should be viewed as a supplement to, but not a replacement for, careful assessment of each patient, appropriate case formulation, ongoing monitoring of clinical status, and clinical judgment. The therapies presented in this series exemplify the best of what we currently know about treating drug addiction. As our knowledge evolves, new and improved therapies are certain to emerge. We look forward to continuously bringing you the latest scientific findings through manuals and other science-based publications. We welcome your feedback about the usefulness of this manual series and any ideas you have about how it might be improved.

This report describes a treatment intervention for enhancing intercultural adjustment in Cuban American families. Bicultural Effectiveness Training (BET) is a clearly defined and easily replicable, culturally sensitive intervention that targets on a specific problem area: intergenerational conflicts and conduct disorders in adolescents, either provoked or exacerbated by the stress of acculturation and cross-cultural adaptation. Previous research on acculturation, biculturalism and adjustment are reviewed and the basic and theoretical features of the BET model are discussed. The BET intervention modality described in this paper was designed to capitalize on certain features of culture conflict in order to ameliorate acculturative stress. By reducing culture conflict and acculturative stress BET enhances adjustment in Cuban American families and reduces conduct disorders in adolescents. BET teaches family members that skills for effective functioning in different value contexts (cultural or otherwise) can be viewed as complementary and enriching to the individual.

This report presents additional data for the effectiveness of conducting family therapy through one person. Data are presented on 35 Hispanic families. Results are reported separately for pre-post and pre-post versus follow-up. The findings provide further evidence for the effectiveness of one-person family therapy and also further clarify previously reported results.

This article describes a theoretically based structural family assessment procedure designed for use in evaluating therapy outcome. The standardized procedure for eliciting family interaction consists of the administration of three family tasks. The family's interactional patterns on the tasks are evaluated along six dimensions of structural family functioning: Structure, Flexibility, Resonance, Developmental Stage, IdentifiedPatienthood, and Conflict Resolution. A manual has been developed for standardizing ratings for research applications. The measure demonstrated good interrater and internal consistency reliability. Available evidence for the content, factor, and construct validity of the measure is presented. Clinical outcome research studies conducted with the measure provide evidence that the measure is sensitive to different types of structural family intervention modalities and that it discriminates between a structural family intervention versus a no treatmentlwait list control condition as well as between a structural family intervention versus an individual psychotherapy treatment modality. Finally, the measure has been demonstrated to be nonreactive under both treatment and wait list conditions. For nearly two decades our program of research has focused on applying systems theory to what has emerged as a remarkably recalcitrant clinical problem, that is, Drs.