Multidimensional Family Therapy (MDFT) is a family-based treatment for adolescents with substance abuse problems. The program consists of outpatient, multi-component therapy provided by trained therapists in both individual and family settings. Topics addressed by MDFT include the adolescent’s perceptions of drugs’ harmfulness, emotional regulation processes, parents’ parenting, and interactional patterns. Results from experimental evaluations have shown MDFT to be more effective than other treatments at decreasing drug use, delinquency, internalized distress, externalizing symptoms, disruptive school behavior, and affiliation with delinquent peers, increasing academic performance, and improving family functioning.
DESCRIPTION OF PROGRAM
Target population: Adolescents with drug abuse problems
The program has been used over 16 years in areas such as San Francisco, Illinois, Miami, and Philadelphia. It functions as an outpatient, family-based treatment, providing adolescents with individual and family therapy. The program focuses on both the adolescent as an individual, as a member of a family, and as a member of a peer group. Along with the adolescent, parents and family members are examined as individuals and in relation to the adolescent. The therapists who lead the sessions are trained through reading about the therapy, watching videos of other therapists in session, and live supervision of sessions. Therapy takes place in weekly sessions over a 3- to 6-month period.
Certification for MDFT therapists costs $4,500 and takes six months. Combined therapist and supervisor certification costs about $6,000 and takes eleven months. Yearly recertification for therapists and supervisors starts at $300. The average cost for MDFT for each youth is between $2,000 and $9,000. Information about training and implementation can be found at the developer’s website: http://www.med.miami.edu/ctrada/x7.xml
EVALUATION(S) OF PROGRAM
Study 1: Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejada, M. (2001). Multidimensional Family Therapy for Adolescent Drug Abuse: Results of a Randomized Clinical Trial. American Journal of Drug and Alcohol Abuse, 27(4), 651-688.
Evaluated population: A total of 182 adolescents, ages 13-18 years, using any illegal substanceoutside of alcohol three or more times per week were evaluated. Of the adolescents, 80 percent were male, 51 percent were white, non-Hispanic, 18 percent were African American, and 15 percent were Hispanic.
Approach: Adolescents were randomly assigned to one of three treatment groups: Multidimensional Family Therapy (MDFT), Multifamily Educational Intervention (MEI), and Adolescent Group Therapy (AGT). Sixteen sessions of MDFT were delivered in an office setting on a weekly basis. Both individual and family sessions were often used in a single treatment session. The therapist made the content of the session personally meaningful to the parent and teen by exploring all areas of the teen’s life and history. Therapists then focused session work on the teen’s communication skills, decision making, and problem solving. The therapist also helped parents distinguish between exerting influence versus control over their child. The final month of therapy focused on applying skills learned in therapy to real-world environments.
The Multifamily Educational Intervention (MEI) treatment involved three to four families together in a session. The families engaged in group discussions that consisted of skill building exercises, individual family problem solving, stress reduction, learning about risk and protective factors, improving family organization, limit setting, and family communication. Families were encouraged to celebrate the meeting of goals with each other. During sessions, adolescents would be involved, with parents present but only listening, and vice versa. Individual therapy sessions were available upon request of the family or therapist in case of emergencies, but were limited to two per family.
Adolescent Group Therapy (AGT) emphasized the development of individual communication, self-control, self-acceptance, and problem solving. Two therapists led groups of six to eight adolescents in 90 minute sessions. Participation and trust were built through group discussions and skill-building exercises. Activities in therapy and homework assignments were given to adolescents to improve social skills. Maintenance of skills and relapse prevention issues were discussed among the adolescents.
The therapists in the three conditions were recruited from local professional organizations and community clinics. Eighty percent had obtained master’s degrees and 20 percent had doctoral degrees.
The researchers assessed participants’ for drug use, problem behaviors, grade point average (GPA), and family functioning at post-test and 6- and 12-months after treatment completion.
Results: Adolescents in each of the three treatments demonstrated improvement over time for all four outcomes. The MDFT group showed the largest reduction in drug use and maintained the reduced rate through six- and twelve-month follow-ups. Along with reduced drug use, the MDFT group improved on measures of academic achievement and family functioning. The AGT group also had a constant decline in drug use from intake to follow-up. However, the AGT group’s dropout rate (48%) was higher than MDFT (30%) and MEI (34%). The AGT group’s impact on drug use was not as strong as the effect observed in the MDFT treatment, but there was a decrease in overall drug use. MEI had the weakest impact in terms of drug use, school performance, and family functioning.
Study 2: Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A., & Henderson, C. E. (2004). 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, 49-63.
Evaluated Population: A total of 80 adolescents, aged 11 to 15 years old, referred for outpatient treatment for substance abuse at a community mental health center in Miami participated in this study. The sample was 73 percent male, 42 percent Hispanic, 38 percent African-American, 11 percent Haitian or Jamaican, 3 percent white non-Hispanic, and 4 percent other.
Approach: Subjects were randomly assigned to MDFT or peer-group therapy (comparison treatment). Both treatments occurred twice weekly for 3 to 4 months. The peer-group therapy was based on cognitive-behavioral therapy and social learning principles, and was lead by a therapist at the community mental health center. MDFT was conducted mostly in the homes of the adolescents. Externalizing symptoms, internalizing symptoms, family cohesion, family conflict, delinquency of self and peers, school problems, grades, and drug use were assessed at the beginning of treatment, 6 weeks after intake, and at the end of treatment.
Results: Positive impacts were found for externalizing symptoms, family cohesion, association with delinquent peers, disruptive school behavior, and marijuana use. Marginal impacts were found for internalizing symptoms, school conduct problems, and delinquency.
Study 3: Liddle, H.A., Rowe, C.L., Dakof, G.A., Henderson, C.E., & Greenbaum, P.E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 12-25.
Evaluated population: See Study 2 (above).
Approach: Data were collected on the same outcomes listed for Study 2. This study examined the long-term outcomes at 6 and 12 months after intake.
Results: Positive impacts were found for substance use, delinquent acts, arrests and probation, internalized distress, family interactions, affiliation with delinquent peers, grades, and school conduct grades.
Study 4: Liddle, H. A., Dakof, G. A., Turner, R. M., Henderson, C. E., & Greenbaum, P. E. (2008). Treating adolescent drug abuse: A randomized trial comparing multidimensional therapy and cognitive behavioral therapy. Addiction, 103, 1660-1670.
Evaluated population: A total of 224 drug-using youth (12 to 17.5 years old) were evaluated. The sample was 81 percent male, 72 percent African American, and had an average age of 15 years old. Seventy-five percent of the sample met DSM-IV criteria for cannabis dependence.
Approach: Eligible participants were referred to the study from the juvenile justice system, child welfare service agencies, schools, and other sources. A 90-minute baseline assessment was completed with parents and youth by trained staff at the start of the study. Follow-up assessments were conducted at termination of treatment and 6 and 12 months following treatment termination. Participants were randomly assigned to either Cognitive Behavioral Therapy (CBT) or Multidimensional Family Therapy (MDFT) treatment conditions. The study did not include a no-treatment control group. Both treatments were delivered in 60-90 minute weekly, office-based sessions. Treatments were identical in duration, dose, and delivery format. The study assessed frequency of drug use and psychological involvement in drug use.
Results: Both treatments led to significant decreases in frequency of cannabis use and substance abuse problem severity and marginally significant decreases in alcohol use. Additionally, MDFT was superior to CBT in a number of ways. Participants in the MDFT condition retained treatment gains more effectively at the 6-and 12-month follow-ups, used fewer drugs other than cannabis and alcohol, and were more likely to report minimal substance use (zero or one occasion) at the 12-month follow-up than participants in the CBT condition.
SOURCES FOR MORE INFORMATION
Liddle, H. A., Dakof, G. A., Parker, K., Diamond, G. S., Barrett, K., & Tejada, M. (2001). Multidimensional Family Therapy for Adolescent Drug Abuse: Results of a Randomized Clinical Trial. American Journal of Drug and Alcohol Abuse, 27(4), 651-688.
Liddle, H. A., Dakof, G. A., Turner, R. M., Henderson, C. E., & Greenbaum, P. E. (2008). Treating adolescent drug abuse: A randomized trial comparing multidimensional therapy and cognitive behavioral therapy. Addiction, 103, 1660-1670.
Liddle, H.A., Rowe, C.L., Dakof, G.A., Henderson, C.E., & Greenbaum, P.E. (2009). Multidimensional family therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77, 12-25.
Liddle, H. A., Rowe, C. L., Dakof, G. A., Ungaro, R. A., & Henderson, C. E. (2004). 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, 49-63.
Dr. Gayle Dakof
Center for Treatment Research on Adolescent Drug Abuse (CTRADA)
University of Miami Miller School of Medicine
P.O. Box 019132
Miami, FL 33101
KEYWORDS: Adolescents (12-17), Youth, Young Adults (18-24), Academic Achievement, Cost, Black/African American, Clinic/Provider Based, Counseling/Therapy, Family Therapy, Parent/Family Component, Marijuana/Illicit/Prescription Drugs, Alcohol Use, Parent-Child Relationship, Delinquency, Mental Health Other, Behavioral Problems Other
Program information last updated 3/9/2016