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Multidimensional Family Therapy (MDFT) is a family-based treatment and substance-abuse prevention program developed for adolescents with drug and behavior problems. The multidimensional perspective suggests that symptom reduction and enhancement of prosocial and appropriate developmental functions occur by facilitating adaptive developmental events and processes in several domains of functioning. The treatment seeks to significantly reduce or eliminate an adolescent’s substance abuse and other problem behavior and to improve overall family functioning through multiple components, assessments, and interventions in several core areas of life. The objectives for the adolescent include transformation of a drug-using lifestyle into a developmentally normative lifestyle and improved functioning in several developmental domains. The objectives for the parent include blocking parental abdication by facilitating parental commitment and investment, improving the overall relationship and day-to-day communication between parent and adolescent, and increasing knowledge about and changes in parenting practices (e.g., limit-setting, monitoring, appropriate autonomy granting).
There are two intermediate intervention goals for every family: helping the adolescent achieve an interdependent attachment bond to parents and family, and helping the adolescent forge durable connections with prosocial influences such as schools, peer groups, and recreational and religious institutions.
Several studies have been conducted on Multidimensional Family Therapy in a variety of community-based clinical settings, targeting a range of populations. In the first trial, 182 clinically referred marijuana- and alcohol-abusing adolescents were randomized to one of three treatments: MDFT, adolescent group therapy (AGT), or multifamily educational intervention (MFEI). The amount of treatment in all three treatment conditions was controlled so that each treatment consisted of 14 to 16 weekly, office-based therapy sessions. A theory-based multimodal assessment strategy measured symptom changes and prosocial functioning at intake, termination, and 6 and 12 months following termination. Participants were drug-using adolescents who at the time of intake had, on average, a 2½-year history of drug use. Eighty percent were male. Fifty-one percent were white non-Hispanic, 18 percent African-American, 15 percent Hispanic, and 16 percent other ethnicities. Forty-eight percent came from single-parent households, 31 percent two-parent, and 21 percent stepparent. Median yearly family income was $25,000. Youths were primarily polydrug users, coupling near daily use of marijuana and alcohol with weekly use of cocaine, hallucinogens, or amphetamines. Sixty-one percent were on juvenile probation.
A second trial examined MDFT in comparison with Cognitive-Behavioral Therapy (CBT). Two-hundred twenty-four adolescents referred to a community clinic for substance abuse treatment were randomly assigned to one of the two treatments. The final sample was primarily male (81 percent), African-American (72 percent), and low income (38 percent reported total yearly family incomes of less than $10,000; 23 percent between $10,000 and $20,000)—with 41 percent of families on public assistance. Seventy-five percent were referred from the juvenile justice system, with 55 percent on juvenile probation at the time of intake. Self-reported adolescent drug use and adolescent-reported and parent-reported externalizing and internalizing symptomatology were assessed at intake and again at 6 and 12 months following treatment termination. The analyses employed Hierarchical Linear Models (commonly known as HLM) and progressed through two different stages.
A prevention intervention version of MDFT has been tested in a controlled prevention trial that evaluated immediate postintervention outcomes for a group of at-risk, innercity young adolescents and their families. The sample was recruited from a community youth program and randomly assigned to the treatment (n=61) or control group (n=63). The sample was 56 percent female, with a mean age of 12½ years, and was 97 percent African-American. Four variables—self-competence, family, school, and peer functioning—were assessed.
The first evaluation demonstrated that MDFT resulted in the greatest and most consistent improvements in adolescent substance abuse and associated behavior problems. The MDFT group had the greatest number of youth with a clinically significant change in drug use—45 percent versus 32 percent in AGT and 26 percent in MFEI. Only adolescents in the MDFT group reported significant improvements in family competence and grade point average. MDFT also was better at keeping adolescents in treatment; 30 percent failed to complete treatment compared with 34 percent in MFEI and 48 percent in AGT.
When compared with CBT, MDFT was shown to have longer lasting treatment effects. Both therapies reduced symptomatology from pretreatment to posttreatment across the three domains that were tested: drug use, externalizing symptoms, and internalizing symptoms. However, only adolescents who received MDFT were able to maintain these changes after the termination of treatment.
When MDFT is used for prevention the results also show positive changes. When compared with controls, adolescents and their families who received MDFT showed gains on four key indicators of adolescent well-being: increased self-concept, increased family cohesion, increased bonding to school, and decreased association with antisocial peers. The treatment group also showed evidence of reversing negative developmental trends.
Hogue, Aaron T., Howard A. Liddle, Dana Becker, and Jodi Johnson–Leckrone. 2002. “Family-Based Prevention Counseling for High-Risk Young Adolescents: Immediate Outcomes.” Journal of Community Psychology 30(1):1–22.
Liddle, Howard A. 1999. “Theory Development in a Family-Based Therapy for Adolescent Drug Abuse.” Journal of Clinical Child Psychology 28(4):521–32.
———. 2001. “Advances in Family-Based Therapy for Adolescent Substance Abuse.” NIDA Research Monograph 182: Problems of Drug Dependence 2001: Proceedings of the 63rd Annual Scientific Meeting, the College on Problems of Drug Dependence, Inc. Bethesda, Md.: National Institute on Drug Abuse.
Liddle, Howard A., Gayle A. Dakof, Kenneth Parker, Guy S. Diamond, Kimberley Barrett, and Manuel Tejeda. 2001. “Multidimensional Family Therapy for Adolescent Drug Abuse: Results of a Randomized Clinical Trial.” American Journal of Drug and Alcohol Abuse 27(4):611–88.
Liddle, Howard A., and Aaron T. Hogue. 2000. “A Family-Based, Developmental–Ecological Preventive Intervention for High-Risk Adolescents.” Journal of Marital and Family Therapy 26(3):265–79.
Liddle, Howard A., Cynthia L. Rowe, Gayle A. Dakof, and Jennifer Lyke. 1998. “Translating Parenting Research Into Clinical Interventions for Families of Adolescents” Clinical Child Psychology and Psychiatry 3(3):419–43.
Liddle, Howard A., Cynthia L. Rowe, Tanya J. Quille, Gayle A. Dakof, Dana Scott Mills, Eve Sakran, and Hector Biaggi. 2002. “Transporting a Research-Based Adolescent Drug Treatment Into Practice.” Journal of Substance Abuse Treatment 22(4):231–43.
Schmidt, S.E.; Howard A. Liddle; and Gayle A. Dakof. 1996. “Changes in Parenting Practices and Adolescent Drug Abuse During Multidimensional Family Therapy.” Journal of Family Psychology 10:12–27.
Howard A. Liddle
Department of Epidemiology and Public Health, Treatment Research on Adolescent Drug Abuse
University of Miami, School of Medical Center
1400 10th Avenue NW, 11th Floor, Mail Stop M–711
Miami, FL 33136
Phone: (305) 243-6434
Fax: (305) 243-3651
E-mail: hliddle@med.miami.edu
Web site: http://phs.os.dhhs.gov/ophs/BestPractice/mdft_miami.htm
