Therapy with substance abusing adolescents and their families: a comparison of three treatment conditions

Abstract

Research questions were raised regarding "recreational" substance use with an adolescent population. The purpose of this research was to determine which conjoint treatment modality was most effective in the treatment of adolescent substance abuse.

Based on a review of the literature, three major treatment modalities have been utilized in the conjoint treatment of adolescent substance abuse: family therapy, adolescent group therapy, and educational groups. Because of the lack of comparative research, the specific aims of this outcome study were to assess the impact of family systems therapy (FST), traditional group therapy (TGT), and family life education (FLE) on the substance abusing behavior of adolescents and on the dynamics of the families of these adolescents. The family systems therapy (or FST) was based on strategic and structural family therapies. The traditional group therapy (or TGT) was representative of approaches currently used to treat adolescent substance abusers and was based on Adlerian psychology, Reality Therapy, and three models of social skills training. The family life education (or FLE) was educational in nature and consisted of information commonly disseminated in substance education programs. All three treatment conditions utilized a social unit as intervention; the differences appeared in both the theoretical formulations of the conditions as well as the pragmatic application of each modality.

Based on past research with other problems that utilized family systems therapy, positive change was expected within the FST condition not only with the adolescent, but also within the family on various interactional levels. Specifically, several hypotheses were formulated predicting the FST to be significantly more effective than TGT and FLE in: (1) decreasing the use of substances among adolescent abusers; (2) improving subject families' overall satisfaction with family life; and (3) improving subject families' abilities to cope with internal and external stress.

The research study, funded by the National Institute on Drug Abuse (Joanning, Quinn, Fischer, and Arredondo. 1984) provided the source of outcome data utilized in this study and employed a pretest-posttest design. The relative impact of treatment was assessed through the use of chi-square analysis, analysis of covariance and, when appropriate, repeated measures analysis of variance. The primary analyses focused on the results of urinalyses taken at pretest and posttest on the identified patients (IPs) in each treatment condition and the IPs' written self-reports of substance use. No significant pre-post differences were found between treatment conditions on any of the hypotheses related to substance use. This may, however, have been an artifact of the data. Also, none of the hypotheses regarding family stress or satisfaction were supported.

One hypothesis was supported: there was no differential dropout rate between groups. Several factors could be used to explain this result: sound theoretical conceptualization of treatment, careful administrative recruitment of subject families, and cautious inclusion criteria based on substance use level all may have contributed to this result. Based on the results, none of these variables (age of IP, gender of IP, race of parent[s], education level of parent[s], family income, relation to IP, grades, and number of parents in the household) can be used as reasons for excluding certain types of families from treatment. A conclusion from this is that there is no research justification for excluding families from any of these three treatment conditions because of race, education or any other variable listed above.

Recommendations for future research include ethnographic research on family experiences with substance abuse and therapy, development of multiple indicators for the evaluation of outpatient, nonaddictive substance use, and the development of new models that combine elements from several treatment conditions for multiple impact on the presenting problems.