اثرات خانواده درمانی کوتاه استراتژیک (BSFT) بر روی مصرف مواد مخدر والدین و ارتباط بین پدر و مادر و نوجوانان معتاد

Background The effects of family therapy for adolescent substance use on parent substance use have not been explored. Objectives To determine the effects of Brief Strategic Family Therapy® (BSFT®) on parent substance use, and the relationship between parent substance use and adolescent substance use. Design 480 adolescents and parents were randomized to BSFT or Treatment as Usual (TAU) across eight outpatient treatment programs. Methods Parent substance use was assessed at baseline and at 12 months post-randomization. Adolescent substance use was assessed at baseline and monthly for 12 months post-randomization. Family functioning was assessed at baseline, 4, 8, and 12 months post-randomization.

Brief Strategic Family Therapy ® (BSFT®) is a manualized family intervention, developed over three decades of interplay between theory, research and practice, to correct family interactions associated with adolescent substance use and related behavior problems. BSFT (Szapocznik et al., 2003 and Szapocznik and Kurtines, 1989) has been shown to be efficacious in engaging and retaining adolescents/family members in treatment (Coatsworth et al., 2001, Santisteban et al., 1996 and Szapocznik et al., 1988), reducing adolescent drug use (Santisteban et al., 2003), and improving family functioning (Santisteban et al., 2003 and Szapocznik et al., 1989). The effectiveness of BSFT was tested in a national multisite randomized clinical trial across eight community treatment centers within the National Drug Abuse Treatment Clinical Trials Network (CTN) (Robbins et al., 2011 and Robbins et al., 2009). This study showed that when comparing BSFT to treatment as usual (TAU), trajectories of drug use did not differ over time across conditions from baseline through 12 month follow up. However, median drug use days at 12 months differed significantly between conditions, favoring BSFT (Robbins, Feaster, Horigian, Rohrbaugh, et al., 2011). In this same study, BSFT was found to be more effective than TAU in improving family functioning. More importantly, adherence to the BSFT model predicted engagement, retention, family functioning and drug use (Robbins, Feaster, Horigian, Puccinelli, et al., 2011). This paper is a secondary analysis of the BSFT effectiveness study. It examines the effects of BSFT in reducing parental substance use and evaluates the association of parental and adolescent substance use. Numerous studies have shown that when parents use alcohol and other drugs, children are more likely to use drugs and are two to nine times more likely to become substance abusers later in life (Adger, 2000, Biederman et al., 2000, Catalano and Hawkins, 1996, Catalano et al., 1999 and Johnson and Leff, 1999). Research reveals that maladaptive family interactions including inadequate parenting practices and poor parent–child relationships may result from parent substance use (Arria et al., 2012, Barnard and McKeganey, 2004, Kamon et al., 2006 and Keller et al., 2005) and are strongly associated with adolescent substance use (Brook et al., 2010 and Weiss et al., 2011). Parenting interventions for substance using parents yielded positive results in parenting practices and parental substance use reductions, even when parental substance use was not directly targeted by the parenting intervention. Focus on Families ( Catalano et al., 1999) which supplemented methadone treatment with family training and case management, resulted in improved parenting skills and reduced drug use in parents. Rotheram-Borus and colleagues' coping skills intervention for HIV + parents and their adolescent children resulted in decreased unprotected sex, alcohol use, and contact with the criminal justice system in parents at two years post-intervention ( Rotheram-Borus, Lee, Gwadz, & Draimin, 2001), and reduced negative family events, decreased externalizing and internalizing problems in adolescents, and improved problem solving in parents at four years ( Rotheram-Borus et al., 2003). Thus parenting interventions with drug using parents have improved not only parenting, but also the parents' substance use. While the above interventions targeted parenting in substance using parents, other interventions have targeted adolescent substance use by improving family functioning more broadly. Improvements in family functioning are the target of family focused and family based interventions for adolescent substance use such as Functional Family Therapy (FFT-Alexander et al., 1976 and Alexander et al., 2000) Multidimensional Family Thearpy (MDFT- Liddle, 2002 and Liddle et al., 2001), Multi Systemic Therapy (MST-Henggeler et al., 2002, Henggeler et al., 1999 and Sheidow and Henggeler, 2008) and BSFT. However, a search in MEDLINE, and PsycINFO for randomized clinical trials including terms “multisystemic family therapy”, “functional family therapy”, “multidimensional family therapy”, and “parental drug use” found no publications on the effects of these models on parent substance use. The proposed study aimed to build on a systematic program of research on BSFT. We hypothesized that 1) when compared to Treatment as Usual, BSFT would significantly reduce parental substance use, 2) such reductions would likely be mediated by improvements in family functioning, 3) adolescents whose parents use substances would be more likely to use drugs, and might be more difficult to treat and 4) that reductions in parent substance use would be associated with reductions in adolescent substance use.