Distilling the Core Elements of Family Therapy for Adolescent Substance Use: Conceptual and Empirical Solutions

ABSTRACT

This article describes several barriers to widespread dissemination of manualized family-based treatments for adolescent substance use (ASU). We then offer a highly promising solution for adopting and sustaining family therapy in usual care: distilling the core practice elements of empirically validated family therapy models for ASU. We present a conceptual distillation of family therapy for ASU grounded in existing observational fidelity measures for three manualized models, a process that yielded four core elements: Family Engagement, Relational Reframing, Family Behavior Change, and Family Restructuring. We then introduce an innovative empirical method for distilling core elements that can serve as a template for rigorous distillation of other treatment approaches. Finally, we discuss how core elements can enhance family therapy services within the diverse workforce of usual care for ASU.

KEYWORDS:

• adolescent substance use
• core elements
• usual care

Acknowledgments

The authors would like to thank Bruce Chorpita, Olga Hervis, Silvia Kaminsky, Michael Robbins, Ashli Sheidow, and Holly Waldron for their invaluable contributions to the ideas presented.

Funding

Preparation of this article was supported by the National Institute on Drug Abuse (R01DA037496; PI: Hogue).

Notes

1. In recent years the MDFT purveyor organization developed a revised observational fidelity tool to promote MDFT dissemination and implementation, the MDFT Intervention Inventory (Rowe et al., 2013), which is more model-specific than the Therapist Behavior Rating Scale.

2. The self-report fidelity measures utilized in MST studies (see Henggeler, Pickrel, & Brondino, 1999; Schoenwald, Sheidow, & Letourneau, 2004) assess global intervention principles rather than discrete treatment techniques and thus do not lend themselves to core element distillation.