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Behavioral Therapies Development Program - Effective Drug Abuse Treatment Approaches

Multisystemic Therapy (MST)

Multisystemic Therapy (MST; Henggeler et al., 1998) is a family- and home-based treatment that addresses the known factors associated with serious antisocial behavior in children and adolescents. With regard to adolescent drug abuse, these factors pertain to characteristics of the adolescent (e.g., favorable attitudes toward drug use), family (e.g., poor discipline, family conflict, parental drug abuse), peers (e.g., association with drug using peers), school (e.g., dropout, poor performance), and neighborhood (e.g., criminal subculture). To promote service access and maximize the generalization of treatment gains, MST is provided via a home-based model of service delivery by clinicians with low caseloads. Hence, MST attempts to comprehensively address risk factors and build protective factors by providing intense treatment in the natural environments that adolescents and their families function -- homes, schools, and neighborhood settings.

In light of the success of MST in reducing long-term rates of rearrest and out-of-home placement for violent and chronic juvenile offenders (Henggeler, 1997a), the capacity of MST to reduce adolescent drug use and abuse in these studies (Henggeler et al., 1991), and the similar clinical and service system issues posed by serious juvenile offenders and adolescents who abuse drugs (Henggeler, 1997b), a study was conducted to determine the effects of MST on substance abusing and dependent juvenile offenders (Henggeler, Pickrel, & Brondino, 1998). Several favorable findings emerged from this project. First, treatment dropout was virtually eliminated in the MST condition, with fully 98% of youths and families completing a full course of treatment (Henggeler, Pickrel, Brondino, & Crouch, 1996). Second, adolescent drug use was significantly reduced at posttreatment, and such reductions were maintained for males at a 6-month follow-up.

Third, at 12-months postreferral, MST reduced incarceration by 46% and total days in out-of-home placement by 50%. A cost analysis showed that MST program costs were offset by reduced out-of-home placement by 12 months postreferral (Schoenwald, Ward, Henggeler, Pickrel, & Patel, 1996). On the other hand, MST was only half as effective as in previous studies in decreasing the criminal of the juvenile offenders. Several current MST research projects are addressing adolescent substance abuse and dependence. In general, these projects are examining ways in which outcomes can be improved for adolescents and substance abusing parents of young children through, for example, devoting greater attention to treatment fidelity and integrating successful treatment strategies (e.g., the community reinforcement approach) from the adult drug treatment literature. In addition, a long-term follow-up study is being conducted to examine the 5-year outcomes of youths and families participating in the aforementioned randomized trial of MST with substance abusing and dependent juvenile offenders.

Henggeler, S. W. (1997a). Juvenile justice bulletin -- Treating serious antisocial behavior in youth: The MST approach. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

Henggeler, S. W. (1997b). The development of effective drug abuse services for youth. In J. A. Egertson, D. M. Fox, & A. I. Leshner (Eds.), Treating drug abusers effectively (pp. 253-279). New York: Blackwell Publishers.

Henggeler, S. W., Borduin, C. M., Melton, G. B., Mann, B. J., Smith, L., & Hall, J. A., Cone, L., & Fucci, B. R. (1991). Effects of multisystemic therapy on drug use and abuse in serious juvenile offenders: A progress report from two outcome studies. Family Dynamics of Addiction Quarterly, 1, 40-51.

Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1998). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportability. Manuscript submitted for publication.

Henggeler, S. W., Pickrel, S. G., Brondino, M. J., & Crouch, J. L. (1996). Eliminating (almost) treatment dropout of substance abusing or dependent delinquents through home-based multisystemic therapy. American Journal of Psychiatry, 153, 427-428.

Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford Press.

Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Pickrel, S. G., & Patel, H. (1996). MST treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient, and residential placement. Journal of Child and Family Studies, 5, 431-444.

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