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.

Figures

Figure 1

CONSORT flowchart. PI = principal investigator; BSFT = brief strategic family therapy; TAU = treatment as usual.

Figure 2

Median days of drug use by timepoint and treatment condition. BSFT = brief strategic family therapy; TAU = treatment as usual.

Figure 3

Trajectories of parent reports of family functioning by treatment condition. BSFT = brief strategic family therapy; TAU = treatment as usual.