Brief strategic family therapy versus treatment as usual: Results of a multisite randomized trial for substance using adolescents.

Abstract

Objective To determine the effectiveness of brief strategic family therapy (BSFT; an evidence-based family therapy) compared to treatment as usual (TAU) as provided in community-based adolescent outpatient drug abuse programs. Method A randomized effectiveness trial in the National Drug Abuse Treatment Clinical Trials Network compared BSFT to TAU with a multiethnic sample of adolescents (213 Hispanic, 148 White, and 110 Black) referred for drug abuse treatment at 8 community treatment agencies nationwide. Randomization encompassed both adolescents’ families (n = 480) and the agency therapists (n = 49) who provided either TAU or BSFT services. The primary outcome was adolescent drug use, assessed monthly via adolescent self-report and urinalysis for up to 1 year post randomization. Secondary outcomes included treatment engagement (≥2 sessions), retention (≥8 sessions), and participants’ reports of family functioning 4, 8, and 12 months following randomization. Results No overall differences between conditions were observed in the trajectories of self-reports of adolescent drug use. However, the median number of days of self-reported drug use was significantly higher, χ2(1) = 5.40, p < .02, in TAU (Mdn = 3.5, interquartile range [IQR] = 11) than BSFT (Mdn = 2, IQR = 9) at the final observation point. BSFT was significantly more effective than TAU in engaging, χ2(1) = 11.33, p < .001, and retaining, χ2(1) = 5.66, p < .02, family members in treatment and in improving parent reports of family functioning, χ2(2) = 9.10, p < .011. Conclusions We discuss challenges in treatment implementation in community settings and provide recommendations for further research.

An Adapted Brief Strategic Family Therapy for Gang-Affiliated Mexican American Adolescents

“…Interestingly, akin to another recent effectiveness study, this study did not identify a significant difference between the BFST condition and the control group on the primary outcome of adolescent illicit drug use over time (Robbins et al, 2011). However, unlike the Robbins et al (2011) study, baseline levels of reported drug use in this study were not low.…”

Randomized Trial of Family Therapy Versus Nonfamily Treatment for Adolescent Behavior Problems in Usual Care

“…Both efficacy and effectiveness trials of manualized FT (e.g., Robbins et al, 2011) regularly find that FT surpasses alternative treatments and TAU in treatment engagement. The failure of UC-FT to outperform UC-Other in this study may be due in large part to the researcher’s use of intensive linkage procedures to facilitate completion of the first intake session by all participants.…”

“…In the current study, UC-Other effects were indistinguishable from UC-FT for parent-reported symptomatology; for adolescent-reported symptoms other than substance use, UC-Other showed gains over time that were simply outpaced by UC-FT. One commonality among recent studies with favorable TAU results (e.g., Robbins et al, 2011; Southam-Gerow et al, 2010; Weisz et al, 2009) is that agency therapists were randomly assigned to study condition, which effectively eliminates numerous provider-centered biases that may have worked against TAU in other studies. Of course therapist randomization was neither feasible nor desirable in the current study, given its fully naturalistic design.…”

“…It is reliable and valid for alcohol and illegal drug use (Sobell & Sobell, 1996) and has proven sensitive to change in numerous studies with diverse adolescent samples (e.g., Liddle et al, 2008; Robbins et al, 2011; Waldron et al, 2001). Adolescents reported on the number of days they had used any alcohol or illegal drugs in each month of the follow-up period.…”

“…In youth mental health, two recent studies testing manualized cognitive-behavioral therapy (CBT) versus TAU, in which community therapists were randomly assigned to treatment condition, produced identical results: CBT and TAU showed equivalent improvement in depression (Weisz et al, 2009) and anxiety (Southam-Gerow et al, 2010), and treatment effects within both conditions were comparable to that documented in CBT trials involving research therapists. Using a similar design, Robbins et al (2011) found that BSFT, implemented by community therapists with full QA support from model experts, performed equivalently to TAU in reducing adolescent drug use. These results remind us that relatively little is known about how EBIs perform in clinically representative conditions (Weisz et al, 2013b).…”