The cost of treating substance use disorders: individual versus family therapy

This study examined the cost of substance use disorders treatment in a large healthcare organization. A survival analysis demonstrated that family therapy utilised the least number of sessions (M = 2.41) when treating substance use disorders followed by individual therapy (M = 3.38) and mixed therapy (M = 6.40). Family therapy was the least costly of the three types, at $124.55 per episode of care for a client, with individual therapy costing $170.22 and mixed therapy $319.55. The ratio of family therapists utilising family therapy was more than three to one compared to other licensed professionals. The percentages of clients coming back for more than one episode of care are fewest for family therapy (8.9%) followed by mixed therapy (9.5%) and individual therapy (12.0%).     

Ethnic differences in psychiatric disorders among adolescent substance abusers in treatment

The present study describes the diagnostic profile of over 800 adolescents admitted to residential therapeutic community programs for treatment of drug abuse and related problems. The relationship between race/ethnicity and psychiatric disturbance is examined, and the association among these factors to outcome is investigated. Over 90% of the sample had a DSM-III-R nonsubstance diagnosis. There were significant differences among the race/ethnic groups on attention deficit-hyperactivity and the disruptive behavior and affective disorders. In general, African-American adolescents yielded the lowest rates of disturbance across all categories of disorders. There was no relationship among race/ethnicity, psychiatric disturbance, and 1-year posttreatment outcomes.     

Family factors and adolescent substance use: models and mechanisms

This article considers the relation of family factors to adolescent substance use, with a focus on the specific pathways by which family factors have their effects. We review findings on four types of variables (family substance use, parental support and monitoring, parent-child conflict, and family life events) and discuss theoretical models of how family risk and protective factors are related to adolescents' outcomes. The evidence favors a transactional model in which family factors have largely mediated effects on adolescent substance use through relations to adolescents' self-control, life events, and peer affiliations; interactions between variables are also prominent. We discuss the implications of mediated effects for theoretical models of human development and consider how the transactional approach opens avenues for preventive intervention.     

The integration of individual and family therapy

It is time to put an end to the separation in training programs between individual and family therapy. Competent therapists should be able to think at an intrapsychic and circular level concurrently. Training programs should maintain their current major focus and develop their minor area of expertise sufficiently so that their graduates can practice both individual and family therapy and choose whichever modality is more appropriate to the case at the time. Bridge concepts, essential differences, and some integrative approaches in individual and marriage and family therapy are discussed.     

Effects of family therapy for substance abuse: A systematic review of recent research

One of the most serious psychosocial problems worldwide is substance abuse because of its repercussions not only on the physical and psychological health of the abuser but also on their relational functioning. Among the well-established therapeutic approaches for the treatment of substance abuse is family therapy, which, in addition to influencing personal variables, promotes changes in family dynamics. The main objective of this study is to review the scientific literature published from 2010 to the present on the efficacy and effectiveness shown by family-based treatment approaches for substance use problems both in adolescent and adult samples. In addition, the effect on secondary variables such as family functioning and behavioral problems is evaluated. The empirical evidence accumulated in the last decade and reviewed in the present study indicates that the incorporation of family members in the treatment of substance abuse produces benefits by diminishing consumption and improving family functioning. Limitations of this study and of the research reviewed are discussed and directions for future research are provided.     

Depressed youth: treatment outcome and changes in family functioning in individual and family therapy

This study explores the role of family functioning in therapeutic change in focused individual psychodynamic psychotherapy (FIPP) and time‐limited systems integrative family therapy (SIFT) for depressed children and adolescents. After a screening process, 72 participants aged 8 to 15 were randomized to either FIPP or time‐limited SIFT. Assessments took place prior to, at the end of, and 6 months after treatment. Families in both SIFT and FIPP showed a small but significant and sustained improvement in family functioning by the end of treatment in both mothers' self‐reports and family therapists' assessments. Better family functioning at baseline in mothers' self‐reports and improved family functioning during SIFT, as assessed by family therapists, predicted a sustained decrease in self‐reported depressive symptoms. Results indicated that time‐limited SIFT may be more effective with younger children and in patients without a diagnosis of double depression than adolescents.     

Wilderness family therapy: An innovative treatment approach for problem youth

We present a treatment program (The Family Wheel) designed to integrate wilderness therapy interventions with family therapy for the treatment of troubled adolescents. The Family Wheel program was conducted in the high desert of southern Idaho. Participation in this four-day program required parents and their adolescent children to engage in an intensive experiential family therapy while camping and trekking in the wilderness. An evaluation of the program revealed positive outcomes for the programs' participants. The theory, research, and pragmatics of conducting such an innovative program are discussed.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.     

Predictors of treatment attendance and adherence to treatment recommendations among individuals receiving Cognitive Behavioral Therapy for Insomnia

ABSTRACT

Insomnia disorders affect up to 10% of adults and are associated with other health problems and poor quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment; however, its effectiveness is hindered by poor attendance and adherence to treatment recommendations. The present study sought to identify predictors of attendance and adherence in CBT-I. Participants were 108 adults with insomnia disorder. Participants were primarily female (71.3%), middle aged (mean age = 50.5), and Caucasian (92.6%). Demographic variables, physical health problems, Beck Anxiety Inventory, Center for Epidemiologic Studies Depression-Revised scale, and Insomnia Severity Index were used to predict attending three or more sessions and adherence to consistent bedtime and waketime. Higher age was associated with better attendance and less deviation in bed and wake times. Anxiety and depression symptoms were associated with less attendance, and depression was also associated with more deviation in waketimes. To promote better attendance and adherence in treatment, depression or anxiety symptoms should be addressed before or during CBT-I. Identifying and tailoring CBT-I treatments toward the needs of different age groups may also improve attendance and adherence.     

Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration,inpatient, and residential placement

The development of more effective and less costly family- and community-based services to serve as alternatives to out-of-home placements of children is an important priority in the reform of mental health services for children and adolescents. Within the context of a randomized trial with 118 substance abusing or dependent juvenile offenders, we examined the incremental costs of multisystemic therapy (MST) and related these costs to observed reductions in days of incarceration, hospitalization, and residential treatment at approximately 1 year postreferral. Results showed that the incremental costs of MST were nearly offset by the savings incurred as a result of reductions in days of out-of-home placement during the year. The need to validate effective treatments for youth with serious clinical problems and to link the costs of treatment     

Attachment-based family therapy for depressed adolescents: programmatic treatment development

Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. ABFT is a promising new treatment for depressed adolescents and more research on it is warranted.     

Family structure, family disruption, and profiles of adolescent religiosity

Youth in the United States are experiencing increasing numbers of family transitions as parents move in and out of marriages and cohabiting relationships. Using three waves of survey data from the National Study of Youth and Religion, I examine the relationship between family structure, parental breakup, and adolescent religiosity. A person-centered measure of the religiosity of adolescents is used to identify youth as Abiders, Adapters, Assenters, Avoiders, or Atheists and to assess movement of youth between the religious profiles between 2003 and 2008. Wave 1 family structure is not significantly related to religious change among adolescents at Wave 3. In contrast, the experience of a parental breakup is related to a change in religious profiles over time. Parental breakup is associated with religious decline among Abiders and Adapters, youth characterized by high levels of religious salience. However, among Assenters who are marginally tied to religion, a parental breakup or divorce is associated with increased religious engagement.     

Program for advanced studies in integrative psychotherapy: Family,couple, and individual therapy (an interdisciplinary program)

This article describes briefly an advanced program in integrative marital and family therapy and individual psychotherapy established at the Hebrew University of Jersusalem in 1993–94 and its first two years of successful operation.     

Paternal correlates of adolescents' running away behaviors: Implications for adolescent development and considerations for intervention and treatment of adolescent runaways

In recent years, research concerned with deviance in adolescent behaviors has become increasingly focused on the extent to which fathers influence their children's development. The present study, using an interdependent and mediational model of parent-child correlates, examined the interrelationships between father personality attributes and adolescents' running away behaviors. Two hundred adolescents (96 males; 104 females) from lower middle class homes and their fathers cooperated in the study. Findings showed that there are specific father attributes and socialization characteristics and adolescent personality attributes which interact significantly to influence adolescents' running away behaviors. Specific predictors of male and female adolescents' running away were examined and identified by means of discriminant function analyses. The results were interpreted within the framework of a mediational model. Implications of the findings were discussed for adolescent development and intervention programs for adolescents and their fathers.     

Maternal attitudes towards pre-natal substance abuse,medical care,and treatment in a historically disadvantaged South African community

This study explored maternal substance abuse and the access to pre-natal medical care and treatment for substance abuse during pregnancy. Respondent mothers (n?=?102; mean age?=?27.8 years, SD?=?10.9 years) were from Mitchell’s Plain, a historically disadvantaged South African community. The mothers completed a mixed methods interview on the context and influences of their substance abuse during their pregnancy. Findings suggest that these mothers adopt the drug taking behaviour in their social environment. Women with prior histories of substance abuse were active consumers and dependent on drugs while childbearing. These findings may be important for possible intervention strategies among this particular group of vulnerable women.     

Availability to peer group treatment in residential care as a function of relational ethics

Forty-five adolescent boys from abusive and depriving homes were not doing well in positive peer culture residential care. Despite their backgrounds, given a modified form of the Relational Ethics Scale, they indicated that their relational life with their families of origin was trustworthy, fair, and worthy of continued devotion. In contrast, on the Firo-B these same boys demonstrated distrust of others outside of their families and an unwillingness to get involved. These results support the inference from contextual family theory that peer group interventions cannot bypass identification and resolution of the injustices that took place in the family of origin.This project was fully supported by Teen Ranch, Inc., Marlette, MI 48453.     

Experiences of mandated reporting among family therapists: a qualitative analysis

Mandated reporting of child abuse by Family Therapists (FTs) has been examined by the authors in two previous studies. The first study found that mandated reporting issues negatively affected FTs abilities to maintain a systemic focus. The second study surveyed types and frequencies of negative experiences of FTs with mandated reporting. A 46-item questionnaire was administered to 101 FTs. Results were significant for four of the items. The respondents also provided 116 comments related to mandated reporting experiences. This study provides a qualitative analysis of the written comments of the respondents regarding their xexperiences with mandated reporting of child abuse.     

Violent, nonviolent, and substance-related offending over the life course in a cohort of males and females treated for substance misuse as youths

Most studies on adolescent offending heterogeneity are based on general population samples, and few include individuals with substance misuse or look specifically at substance-related offending. It is also unclear how offender subtypes develop after young adulthood or how offending heterogeneity varies between genders. This study aimed to identify subgroups of offending among adolescents with misuse problems and to examine associations with offending in adulthood. The study included 1,992 females and males that consulted a clinic for adolescents with misuse problems between 1968 and 1971. Latent Class Analyses were conducted to identify subgroups based on violent and nonviolent offending before age 20. Participants were then followed until age 50 and reexamined regarding violent, nonviolent, and substance-related crimes. Associations between subgroups before age 20 and subgroups age 21-50 were examined. Before age 20, three subgroups were identified among the females and six among the males. Males were more specialized in their offending and demonstrated higher levels of offending. Results pointed to both stability and decrease of violent and nonviolent offending, and to the emergence of substance-related offending in adulthood in both genders. The connection between substance-related crimes and general delinquency in adulthood among individuals treated for substance misuse suggests that interventions should also address substance misuse for reducing the overall volume of crime. This study also highlights the importance of including females in research on offending heterogeneity.     

Multiple family groups for adult cancer survivors and their families: a 1-day workshop model

With marked advances in early detection and aggressive multimodality treatment, many adult cancers are now associated with good prognoses for disease-free survival. A burgeoning literature examining posttreatment quality-of-life issues has highlighted the numerous challenges experienced by patients and families in the aftermath of cancer treatment, further underscoring a need for new family-based psychosocial support interventions for cancer survivors and their families. This paper describes the clinical protocol for one such intervention, a 1-day "workshop" version of a multiple family group (MFG) for head and neck cancer survivors and their families. Data are reported from our experiences in running five 1-day workshops. Families uniformly reported that they were highly satisfied with their MFG participation, leading us to conclude that the abbreviated 1-day MFG model we are advocating is a promising family-focused support intervention for cancer survivors and their families.