Family involvement is a key component to success in treatment for teen substance use disorder, according to a review of recent research by an expert at the Center on Addiction.
“Our review has shown that programs that involve families are the most effective,” said Aaron Hogue, Ph.D., Director of Adolescent and Family Research at the Center on Addiction. He recently spoke about treatment for adolescent substance use at the National Academy of Sciences, Engineering, and Medicine in Washington, D.C.
As the opioid epidemic grows, there is great demand for treatment for opioid use disorder for teens and young adults, Hogue noted. “We know the most effective treatment is medication-assisted treatment, which combines medications with behavioral interventions,” he said. “This review helps treatment providers know which types of behavioral interventions will have the greatest impact.”
He noted that more than 90 percent of teens who meet diagnostic criteria for a substance use disorder do not receive appropriate treatment.
Hogue conducted a cumulative review of experimental studies on outpatient behavioral treatment adolescent substance use. He reported in the Journal of Clinical Child and Adolescent Psychology that ecological family-based treatment is the most effective. This type of treatment targets multiple systems—family, school, peers, juvenile justice—within which teens develop.
As with other types of family therapy, ecological family-based treatment engages teens and families to make long-term changes, addresses individual, family, peer and community-level influences, and reduces problem behaviors.
The ecological model of family therapy aims to change relationships, Hogue explained. “It looks to change the meanings in how behaviors are interpreted. For instance, if a teen were to say, ‘My mom doesn’t trust me – she’s always asking me where I’m going,’ a therapist might reframe it by saying, ‘It sounds like your mom cares about what you’re doing and is worried about you hanging out with the people or going places that will lead to negative outcomes.’ It helps shift how the teen understands the behavior, from being inappropriately controlling to being worried and showing concern.” This doesn’t mean one interpretation is truer than another, but it broadens the understanding of meanings and relationships, Hogue said.
Other types of treatment that were found to be effective included individual cognitive-behavioral therapy and group cognitive-behavioral therapy. These types of therapy help identify, recognize and avoid thought processes, behaviors and situations associated of alcohol or other drugs, and develop better problem-solving and coping skills.
The review found behavioral family-based treatment was “probably” effective. This type of therapy works to improve communication and support and reduces conflict between families that have a member with addiction. Behavioral-based family treatment is focused on increasing the communication and coping skills of family members, Hogue said.
Motivational interviewing was also found to be “probably” effective. This approach bolsters motivation to change substance use behaviors and encourages planning for change and then making and maintaining changes in behavior.
Families looking for therapy should ask how much family involvement there is, Hogue advised. “Am I expected to attend a few sessions at the beginning or end of treatment? Should I be in the building for every session and come in periodically for review and updates? Or am I expected to attend most or all sessions because the focus in on the entire family as a team?” he said. “One approach isn’t necessarily preferable to another, but whichever approach you take, you need to be fully committed to it in order to maximize its effectiveness.”