Family based therapy plus cognitive behavioural therapy (CBT) was better than CBT alone or family therapy alone for reducing adolescent drug abuse.

Treatment outcomes for adolescent substance abuse at 4– and 7–month assessments. QUESTION: Does cognitive behavioural therapy (CBT), functional family therapy (FFT), combined FFT and CBT, or a group psychoeducational intervention reduce adolescent substance abuse? Design Randomised (unclear allocation concealment*), unblinded*, controlled trial with 7 months of follow up. Patients 120 adolescents who were 13–17 years of age (mean age 16 y, 80% boys), lived at home with a primary caretaker willing to participate in the study, and met DSM-IV criteria for a primary substance abuse disorder (primarily illicit drug use). Exclusion criteria were need for services beyond outpatient treatment, evidence of a psychotic or organic state, or a sibling in the study. Follow up was 88% at 4 months and 89% at 7 months. Intervention Adolescents were allocated to 1 of 4 groups: FFT (n=30), individual CBT (n=31), combined FFT and CBT (n=29), or a group intervention (n=30). FFT consisted of 12 weekly sessions of a systems oriented, behaviourally based family therapy with 2 phases: engaging families in treatment and enhancing motivation for change, and implementing behavioural changes in the family. Individual CBT consisted of motivational enhancement (2 sessions) and skills modules (10 sessions), including communication training, problem solving, peer refusal, and relapse prevention. The joint intervention consisted of weekly sessions of FFT and individual CBT. The group intervention provided education about substance abuse and its treatment and prevention (eight 90 min sessions). Proportion of youths achieving minimal use (ie, use on < 10% of the days reported using the Timeline follow back interview). A 4 x 3 repeated measures analysis of variance was done. At 4 months after treatment, FFT, joint FFT and CBT, and CBT alone showed reductions in adolescent marijuana use. At 7 months after treatment, FFT alone, joint FFT and CBT, and the group intervention showed reductions in marijuana use. When the FFT and joint conditions were combined for analysis, more adolescents in the combined family conditions than in the group condition changed from heavy to minimal marijuana use at 4 months (p < 0.013) but the difference was not statistically significant at 7 months (p < 0.128) (table). Combined family therapy plus CBT was better than CBT alone for increasing minimal use in adolescents at 7 months (p < 0.028) but the difference was not statistically significant at 4 months (table). Conclusion In adolescents with substance abuse, family based therapy, particularly in combination with cognitive …