TABLE 2.
Summary of process-outcome studies derived from controlled trials of family-based treatments for adolescent substance use
| Process study | Treatment models |
Sample N: sex, ethnic status |
Parent study | Main findings |
|---|---|---|---|---|
| Schmidt et al., 1996 | MDFT | 29: 72 per cent male, 55 per cent EA |
Liddle et al., 2001 | Observed improvements in parenting practices predicted decreased drug use and behaviour problems |
| Huey et al., 2000a | MST | 54: 80 per cent male, 54 per cent EA, 46 per cent AA |
Henggeler et al., 2002 | Treatment adherence predicted improved family relations and decreased delinquent peer affiliation, which in turn were related to reduced delinquency |
| Shelef et al., 2005 | MDFT | 65: 85 per cent male, 47 per cent EA, 47 per cent AA |
Dennis et al., 2004 | Observed parent therapeutic alliance predicted premature termination; observed adolescent alliance predicted drug use, and this relation was moderated by parent alliance |
| Tetzlaff et al., 2005 | MET/CBT-5 MET/CBT-12 FSN ACRA MDFT |
430: 83 per cent male, 61 per cent EA, 30 per cent AA |
Dennis et al., 2004 | Adolescent therapeutic alliance predicted decreased drug use at 3 and 6 months post- intake but did not predict longer drug use trajectories; treatment satisfaction did not predict use |
| Diamond et al., 2006 | MET/CBT-5 MET/CBT-12 FSN ACRA MDFT |
400: 81 per cent male, 61 per cent EA, 32 per cent AA |
Dennis et al., 2004 | Adolescent-rated, but not therapist-related, early session therapeutic alliance predicted reduced drug use and related problems; neither set of alliance ratings was associated with treatment attendance |
| Hogue et al., 2006b | MDFT CBT-I |
100: 81 per cent male, 68 per cent AA, 20 per cent EA, 12 per cent HA |
Liddle et al., 2008 | In MDFT, observed early session parent therapeutic alliance predicted reduced drug use and behaviour problems; observed early adolescent alliance was related to change in behaviour problems; in CBT, adolescent alliance did not predict outcome |
| Hogue et al., 2006a | MDFT | 63: 83 per cent male, 71 per cent AA, 19 per cent EA, 10 per cent HA |
Liddle et al., 2008 | Observed family-focused treatment techniques predicted improved internalized distress and family cohesion, and also improved behaviour problems and family conflict when adolescent focus was high; observed adolescent-focused techniques predicted improved cohesion and conflict |
| Robbins et al., 2006 | MDFT (therapeutic alliance) |
30 (adolescents and their families): 80 per cent male, 80 per cent AA, 17 per cent EA, 3 per cent HA |
MDFT RCT |
There is no relationship between therapeutic alliance and treatment response; both adolescent–therapist and mother–therapist alliances discriminated between dropout and completed families |
| Hogue et al., 2008 | MDFT CBT-I |
136: 81 per cent male, 70 per cent AA, 20 per cent EA, 10 per cent HA |
Liddle et al., 2008 | In CBT, observed treatment adherence predicted decreased drug use; in CBT and MDFT, adherence predicted reduced behaviour problems (linear effect) and internalized distress (curvilinear effect); observed therapist competence did not predict outcome in either group |
Note: Studies are listed in order of publication year, from earliest to most recent. Treatment process variables derived from non-participant observational measures are prefaced with ‘observed’.
MDFT = Multidimensional Family Therapy; MST = Multisystemic Therapy; MET/CBT-5/12 = Motivational Enhancement Therapy plus Cognitive-behavioural Therapy–Group (5 or 12 sessions); FSN = Family Support Network; ACRA = Adolescent Community Reinforcement Approach; CBT-I = Cognitive-behavioral Therapy–Individual
HA = Hispanic American; EA = European American; AA = African American.
In a related study with the same sample, Schoenwald et al. (2000) examined the relation between subdimensions of treatment adherence and the mediating variables (family functioning, parental monitoring, peer relations) described in the Huey et al. (2000) study.