Drug Abuse and Multidimensional Family Therapy Research Proposal

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Drug Abuse and Multidimensional Family Therapy: Literature Review Only

Review of the Relevant Literature

By any measure, substance abuse represents a serious problem in the United States today among adolescents and adults alike, but younger people in particular can experience some life-altering changes as a result of such abusive practices. According to Burrow-Sanchez (2006), although many adolescents, and perhaps most, experiment with drugs at some point, not all of them go on to abuse drugs in ways that adversely affect their lives. In this regard, Burrow-Sanchez notes that, "Although some experimentation with substances is typical for many young people, fortunately most adolescents who experiment with drugs do not go on to develop substance abuse problems later in life. A small portion of adolescents, however, do develop problems with substances that substantially affect their development and future adult lives" (p. 283). Other authorities, though, suggest that the problem of adolescent drug abuse is more severe than this characterization suggests and the types of substances abused are varied. For instance, Sharma (2006) emphasizes that, "In United States, substance use and abuse among adolescent population accounts for significant morbidity and mortality. Alcohol and tobacco are the usual drugs of choice among adolescents, followed by marijuana, stimulants, hallucinogens and inhalants" (p. 88).Buy full Download Microsoft Word File paper
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Research Proposal on Drug Abuse and Multidimensional Family Therapy Assignment

Because the impact of substance abuse on those adolescents who do succumb to the draw of drugs can be so severe, it is little wonder that clinicians have attempted to identify treatment modalities and clinical interventions that are effective for this group. Among the more promising approaches that have emerged in recent years is multidimensional family therapy developed by Howard Liddle and further refined by his associates since its introduction. According to Liddle (1999), "Family-based treatments for adolescent drug abuse and related behavior problems have been developed and evaluated with success. Empirical support exists for the efficacy of family-based treatments, and process studies have begun to identify mechanisms by which these treatments may achieve their effects" (p. 521). A description of the tenets of the multidimensional family therapy approach is provided below.

Description of Multidimensional Family Therapy

Because resources by definition are scarce and treating adolescents for serious conditions such as substance abuse affords little room for experimentation or false starts, identifying effective treatment approaches has assumed new importance and relevance in recent years. According to Coombs (2005), "The new models of family therapy that have evolved are based on the growing research evidence that suggests that while family therapy is effective for a wide range of clinical problems, all approaches may not be equally efficacious" (p. 359). Among the numerous treatment modalities to emerge in recent years that have been determined effective, a growing number of practitioners are turning to multidimensional family therapy as a comprehensive approach to treating specific syndromes and problems associated with adolescent substance abuse, as well as delinquency, and externalizing disorders (Sexton, Weeks & Robbins, 2003). In this regard, Liddle and his associates developed the multidimensional family therapeutic approach which integrates concepts of individual development in adolescents with various structural concepts and concepts from traditional substance-use treatment (Liddle et al., 2001).

Multidimensional family therapy is described by Essau (2003) as "a multicomponent family intervention designed to treat adolescent substance abuse and problem behaviors" (p. 290). The multidimensional family therapeutic approach is aimed at four primary areas for intervention as follows:

The intrapersonal and interpersonal functioning of the adolescent;

The intrapersonal and interpersonal functioning of the parent;

Parent-adolescent interactions; and,

Interactions between family members and influences outside the family system (Essau). The focus of the multidimensional family therapy approach, then, relates to both the adolescent as well as the other family members who will inevitably be affected by such drug abusive behaviors by the adolescent as well as who may be contributing to the problem in the first place. By focusing on these specific problems in an individualized fashion, the multidimensional family therapeutic approach provides a robust clinical intervention alternative for treating adolescent drug abuse. For example, Essau adds that, "Individual symptoms are addressed in context, and changes in the individual such as decreasing maladaptive behaviors and increasing prosocial functioning are assumed to result from changes in the family system. Treatment tends to last between 14 to 16 sessions over 6 months" (p. 290). Clinicians with some experience in treating adolescents for this complicated problem will readily attest that 6 months represents a highly effective treatment regimen and the cost effectiveness of this treatment modality compared to other approaches appears to be one of its major drawing points for many practitioners. For example, Smith and Hall (2008) recently observed, "Adolescent substance abuse continues to be a societal problem for which we need high quality, cost-effective treatments. That is, substance use and abuse by adolescents is associated with a more rapid progression into addiction, delayed entry into adult roles (that is, adult relationships, employment, and so forth), and high societal costs" (p. 185).

According to Sexton et al., multidimensional family therapy provides clinicians with a useful framework in which to identify how and when to bridge intervention strategies to provide the "most bang for the therapeutic buck." In this regard, these authors report, "Integrative approaches [such as multidimensional family therapy] typically assume a biopsychosocial model of human functioning. Rather than focusing on which aspect of human beings represents the crucial causal determinant of psychological health or difficulty, integrative approaches feature both/and inclusiveness" (p. 207). In other words, the multidimensional family therapy approach focuses on the provision of individualized treatment using the best of what is available from the growing body of psychotherapeutic approaches including pharmacological interventions, but with a clear goal of providing treatment that is specific to the needs of the adolescent. As Sexton and his colleagues emphasize, "The crucial question becomes not which is the 'right' conceptualization, but which level of explanation is most helpful to the treatment of the individual case. At least some, and in most cases much, attention is given to the powerful set of common factors found across psychotherapies" (p. 207).

As the name implies, multidimensional family therapy represents a comprehensive approach to treating adolescent substance abuse, which is clearly a complicated and multidimensional problem. According to Sexton and his associates, "Multidimensional family therapy for adolescent substance abuse is built from the ground up around the treatment of specific disorders" (p. 207). Therefore, by drawing on what is known to work in various clinical settings, multidimensional family therapy is able to deliver personalized clinical interventions that can assist adolescents and their families in overcoming the fundamental issues that may be contributing to the substance abuse problem from the outset. In this regard, Sexton and his colleagues note that, "Howard Liddle and colleagues' multidimensional family therapy for adolescent substance abuse combines ingredients drawn from structural and strategic family therapy, individual developmental psychology, cognitive-behavior therapy, and traditional education-oriented substance-abuse counseling" (p. 211).

Likewise, according to Liddle (1999), "Multidimensional family therapy is an outpatient, family-based treatment developed for multiproblem adolescents, in particular those teenagers presenting with drug and behavior problems. The approach strives for a consistent and clinically practical connection among its organizational levels: theory, principles of intervention, and intervention strategies and methods" (p. 521). For example, Liddle (1997) also describes how the theoretical boundaries of this family-based treatment have been amplified to include "developmental and ecological theory, including developmental psychopathology theory" (p. 529) as well as the requirement to address "the intrapersonal and extrafamilial factors that contribute to the development of dysfunction as well as factors that facilitate development, and... To improve our understanding of the interactions and processes within and across these domains" (p. 529).

The approach advocated by Liddle and other proponents of multidimensional family therapy, then, are predicated empirical knowledge concerning dysfunctional and normative adolescent and family development; the clinical interventions used by the multidimensional family therapy approach seek to focus on the various ecologies of adolescent development and within this framework, attempt to treat the circumstances and processes that are known to produce or to contribute to continuing dysfunctional behaviors (Liddle, 1999). In addition, Liddle notes that, "Although the same developmental challenges may be common to all adolescents and their families, we work to understand the differential and idiosyncratic individual adolescent and family expressions of these generic developmental challenges" (p. 521). Further, Liddle also emphasizes the individualized nature of this treatment modality and explains that practitioners using this intervention seek to "understand the unique manifestations of developmental competence and detours with each case" (p. 521).

Taken together, the foregoing descriptions suggest that multidimensional family therapy approaches will be different in virtually every clinical setting, and this observation is congruent with other authorities who report that this approach to treating drug abuse can include a wide range of treatment modalities. For instance, according to Coombs (2005), depending on the individual needs of the patient, multidimensional family therapy can include any or all of the following:

Sometimes controlling destructive symptoms and at other times emphasizing awareness of presenting problems;

Using medications both to control symptoms, at times, and also to enhance communication and… [END OF PREVIEW] . . . READ MORE

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