Brief strategic family therapy ™ for adolescent drug abusers: A multi-site effectiveness study - Robbins, Szapocznik, et al. (2009)

This study was designed to investigate the efficacy of Brief Strategic Family Therapy (BSFT) for treating substance abuse in adolescents. It used populations in communities across the U.S. and had a comparison group receiving "treatment as usual" from agencies in those communities, which could include individual therapy, group therapy, parent training, non-manualized family therapy, and case management. The design specified a minimum "dose", or duration of treatment, in order to make the conditions more comparable. The sample size was fairly large (480 adolescents) and diverse, with a wide distribution across different family structures, socio-economic statuses, and ethnicities (Hispanic: 44%, White: 30%, Black: 23%). The sample was mostly male (about 3 males: 1 female). In addition to outcomes for substance use, secondary outcomes for behavior and family functioning were measured. The models for statistical analysis are discussed and are quite thorough; accounting for random effects such as differences between treatment sites.

Overall, the study is quite impressive. It covers a wide geographical area and includes a diverse sample. The statistical methods are well thought out. The problem of adolescent substance abuse is an important one, which can have lifelong implications. I was excited to find how effective BSFT is for this problem. I was particularly interested in how effective it might be for individuals in the demographic categories which are too often underrepresented in such research (individuals from low SES or who identify as ethnic minorities). But then... where are the results?!

It seems that only preliminary data is presented in this paper. While the study anticipated treatment completion at the four month mark, only 18% of families had completed treatment at that point. In fact, even at the 12 month time point nearly 20% in the treatment as usual condition were still in treatment along with just over 10% of those in the BSFT condition.

So, what can I take away from an incomplete study? One idea is that, while manualized treatments are valuable for guiding treatment with empirical evidence, the application of such treatments in "real world" situations is sometimes subject to complications. Individual needs may require a tailored approach, which can still be guided by a manual, but may call for more sessions or additional techniques/skills not included in the manual originally. I wonder how this therapy was developed and whether the population it was developed with had particular needs that differ for some of the participants of this study. I would be very interested in the outcomes of this study, not only to answer the initial questions I had, but additionally to learn whether the extra sessions or variations in fidelity to the manual changed outcomes. If my ideas about why the treatments may have needed to be extended are correct (I'm just making an assumption), this study also serves as evidence for the need to focus more research on underserved populations in order to better understand their needs and develop effective treatment methods.