Treating Adolescent Substance Abuse Using Family Behavior Therapy E-Book

Brad Donohue

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 338

Veröffentlichungsjahr: 2011

Beschreibung

Praise for Treating Adolescent Substance Abuse Using Family Behavior Therapy "This is an extremely positive and strength-focused text that provides therapists with a structure and the tools to implement interventions that have a long history of promoting the types of clinical changes desired by family members and community stakeholders."--From the Foreword by Scott W. Henggeler, PhD, Professor, Department of Psychiatry and Behavioral Sciences, and Director, Family Services Research Center, Medical University of South Carolina "Kudos to Donohue and Azrin for writing a book that includes all the materials needed to implement FBT with adolescents, including prompting checklists, handouts, and worksheets."--Karol Kumpfer, PhD, Professor, Health Promotion & Education, and Chair, International Study Abroad Committee, College of Health, University of Utah, and former director, SAMHSA's Center for Substance Abuse Prevention "Treating Adolescent Substance Abuse Using Family Behavior Therapy is an important resource for those who wish to provide an empirically supported, strengths-based, behavioral treatment for adolescents with substance-use problems and their parents." --Susan Harrington Godley, RhD, Senior Research Scientist and EBT Coordinating Center Director, and Mark D. Godley, PhD, Director, Research & Development, Chestnut Health Systems "In my practice with adolescents, FBT has proven exceptionally effective in drawing families closer together and yielding improved outcomes. This remarkably supportive approach helps young people develop critical skills necessary to live a fulfilling and drug-free lifestyle. This book clearly illustrates how to implement the interventions with ease and exemplifies the deeply gratifying experience of FBT."--Stephen A. Culp, MEd, NCC, LPCC, Addiction Services Therapist, Comprehend, Inc., Maysville, KY Listed in multiple national clearinghouses, including SAMHSA's National Registry of Evidence-based Programs and Practices and the CEBC, Family Behavior Therapy (FBT) is a scientifically supported treatment for adolescent substance abuse and its many associated problems. Written by Brad Donohue and Nathan Azrin--the premier researchers and practitioners of FBT--Treating Adolescent Substance Abuse Using Family Behavior Therapy is the first book of its kind to provide mental health professionals with the practical, step-by-step guidance needed to use this evidence-based treatment. Filled with case studies, checklists, worksheets, and handouts, this essential guide features: * Strategies to assist in effective goal-setting, treatment plans, and family management * Motivational enhancement exercises to encourage youth into a problem-free lifestyle * Methods to effectively address contextual issues such as noncompliance and culture * Standardized treatments to assist in eliminating problems that coexist with substance abuse, including unemployment, depression, behavioral misconduct, and family dysfunction * An accompanying CD-ROM contains all the book's record-keeping forms, checklists, assignments, progress notes, agendas, and worksheets in a customizable format.

Leseprobe

Contents

Foreword

Preface

Acknowledgements

Chapter 1: Introduction to Family Behavior Therapy

Overview

Chapter at a Glance

Historical and Theoretical Background

Empirical Background

Appropriate Intervention Settings and Referrals

General Approach and Structure to Treatment

Concluding Remarks

Supporting Materials for Chapter 1: Introduction to Family Behavior Therapy

Chapter 2: Infrastructure

Overview

Infrastructure and Quality Assurance

Concluding Remarks

Supporting Materials for Chapter 2: Infrastructure

Chapter 3: Therapeutic Style, Techniques, and Implementation Strategies

Overview

Chapter at a Glance

Therapeutic Style and Approach

Organization of Treatment Materials

Concluding Remarks

Chapter 4: Establishing Effective Agendas for Treatment Sessions

Overview

Goals for Intervention

Materials Needed

Procedural Steps for Implementation

Concluding Remarks

Supporting Materials for Chapter 4: Establishing Effective Agendas for Treatment Sessions

Chapter 5: Probing Negative and Positive Consequences to Determine Core Motivation

Goals for Intervention

Materials Needed

Procedural Steps for Implementation

Concluding Remarks

Supporting Materials for Chapter 5: Probing Negative and Positive Consequences to Determine Core Motivation

Chapter 6: Establishing and Rewarding Goal Attainment With Family Support

Overview

Goal for Intervention

Materials Needed

Procedural Steps for Implementation

Concluding Remarks

Supporting Materials for Chapter 6: Establishing and Rewarding Goal Attainment With Family Support

Chapter 7: Developing a Successful Treatment Plan

Overview

Goal for Intervention

Materials Needed

Procedural Steps for Implementation

Concluding Remarks

Supporting Materials for Chapter 7: Developing a Successful Treatment Plan

Chapter 8: Reviewing Past Appreciations to Improve Current Relationships

Overview

Supporting Materials for Chapter 8: Reviewing Past Appreciations to Improve Current Relationships

Chapter 9: Improving Communication With Positive Requests

Overview

Concluding Remarks

Supporting Materials for Chapter 9: Improving Communication With Positive Requests

Chapter 10: Restructuring the Environment to Facilitate a Drug-Free Lifestyle

Overview

Goals for Intervention

Materials Required

Procedural Steps for Treatment Implementation

Concluding Remarks

Supporting Materials for Chapter 10: Restructuring the Environment to Facilitate a Drug-Free Lifestyle

Chapter 11: Using Self-Control to Manage Negative Behaviors, Thoughts, and Feelings

Overview

Goals for Intervention

Materials Required

Procedural Steps for Treatment Implementation

Concluding Remarks

Supporting Material for Chapter 11: Using Self-Control to Manage Negative Behaviors, Thoughts, and Feelings

Chapter 12: Gaining Employment

Overview

Goals for Intervention

Materials Required

Procedural Steps for Implementation

Concluding Remarks

Supporting Material for Chapter 12: Gaining Employment

Chapter 13: Concluding Treatment and Planning for Success

Overview

Goals for Intervention

Materials Required

Procedural Steps for Treatment Implementation

Concluding Remarks

References

About the Authors

Author Index

Subject Index

About the CD-ROM

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Library of Congress Cataloging-in-Publication Data:

Donohue, Brad.

Treating adolescent substance abuse using family behavior therapy : A step-by-step approach / Brad Donohue, Nathan Azrin.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-62192-9 (alk. paper : paper/cd-rom); 978-1-118-16395-5 (eMobi); 978-1-118-16394-8 (ePub); 978-1-118-16393-1 (ePDF)

1. Teenagers—Substance use—Treatment. 2. Substance abuse—Treatment. 3. Family psychotherapy. 4. Behavior therapy. I. Azrin, Nathan H., 1930- II. Title.

[DNLM: 1. Adolescent. 2. Substance-Related Disorders—therapy. 3. Behavior Therapy. 4. Family Therapy. WM 270]

RJ506.D78D66 2012

362.29'18—dc23 2011025465

Foreword

This comprehensive clinical specification of Family Behavior Therapy (FBT) for substance-abusing adolescents has the potential to make a substantive contribution to the public health and has been long awaited. Adolescent substance abuse leads to many serious short- and long-term deleterious outcomes for the youths, their families, and society. Although federal entities such as the National Institute on Drug Abuse have devoted considerable resources to the development and validation of effective treatments for adolescent substance abuse, the gap between science and practice remains very wide.

The most promising treatments for adolescent substance abuse have not been widely transported among substance abuse treatment providers, and the vast majority of substance abuse treatment services provided in community settings have not demonstrated effectiveness. Thus, a clear need exists for greater availability of effective substance abuse treatments to community providers.

FBT is as an efficient option for treating adolescent substance abuse. In part, this prospective is based on the promising results from FBT clinical trials and the demonstrated effectiveness of the adult counterpart on which FBT is derived (i.e., the Community Reinforcement Approach). The potential, however, is also based on the intensive emphasis that FBT devotes to engaging caregivers in the treatment of their adolescents. Decades of correlational, longitudinal, and experimental (i.e., clinical trials) research have shown the central roles that caregivers play in the development, maintenance, and attenuation of serious antisocial behavior in adolescents; and FBT leverages this knowledge throughout its intervention protocols.

Perhaps the clearest way to substantiate my very favorable view of FBT is to enumerate the many strengths of the model as presented in this book:

The authors intentionally specified FBT in ways that should make it relatively easy to learn and implement. For example, session guidelines, therapist checklists, and useful forms are provided to guide implementation.Multiple options are available for training in FBT, including self-instruction, workshops provided by FBT experts, and ongoing clinical consultation.The intervention protocols draw on the long and successful traditions of the behavioral therapies (e.g., contingency management) and cognitive behavioral therapies (e.g., problem-solving skill training, communication training).Research has shown that high treatment fidelity is often essential to achieving favorable clinical outcomes in the implementation of evidence-based treatments. This book provides session checklists that enable therapists to assess their fidelity to FBT implementation standards after every session.The authors encourage and provide methods for assessing consumer satisfaction, a rarity in even the evidence-based practice community.The authors also encourage the assessment of key clinical outcomes, using validated self-report and biological (i.e., urine drug screens) measures. Such outcome monitoring can verify the direction of treatment or suggest that other strategies used in FBT be considered.The clinical style of FBT is extremely positive and strength focused, with a clear emphasis on engaging youths and caregivers in treatment. For example, strategies are provided for changing in-session conflict into constructive problem solving, and each session is structured to positive aspects of family relations and treatment progress.Therapists are given pragmatic, easy-to-understand tools to address treatment noncompliance, in-session conflict, and lack of productivity. Such problems emerge in almost every clinical case and can derail treatment gains if not addressed satisfactorily.The proscribed interventions are direct and efficient, yet very positive. Moreover, motivational interviewing-like strategies are specified to address issues that might not respond to more directive efforts. In short, the book provides an engaging balance of approaches that provide the flexibility needed to address a range of presenting problems, challenges, and family contexts.The contingency management intervention described in the book is especially well conceived—evidence of the extensive experience that the authors have in implementing this approach with families and teaching the model to clinicians.Importantly, to promote sustainability and ecological validity, the family generates and provides the contingencies for the adolescent in the FBT contingency management intervention. This approach contrasts favorably with many other contingency management interventions in the field where contingencies (e.g., vouchers) are provided by the treatment program.The structure of the FBT program is logical and flexible. Certain universal interventions are provided to all youths and families (e.g., motivational interventions), but the sequence of subsequent interventions is determined by family members. Such flexibility is consistent with family empowerment.It bears repeating: FBT promotes positive interactions among family members and between the clinician and family members from beginning (e.g., every session starts by reviewing positive outcomes) to end (e.g., the final session celebrates clinical progress).

In conclusion, Drs. Donohue and Azrin have done an outstanding job of putting onto paper the intricacies of their exemplary FBT approach. As noted earlier, this is an extremely positive and strength-focused text that provides therapists with a structure and the tools to implement interventions that have a long history of promoting the types of clinical changes desired by family members and community stakeholders.

Scott W. Henggeler, PhD

Professor, Department of Psychiatry and Behavioral Sciences

Director, Family Services Research Center

Medical University of South Carolina

April 29, 2011

Preface

In 2006, the Program Review Manager for the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry of Evidence-Based Programs and Practices (NREPP), Stephen Gardner, invited Nate and me to complete an application to have FBT listed as an evidence-based treatment (EBT) in their newly formulated National Registry of Evidence-Based Programs and Practices (NREPP). Stephen explained that community agencies were experiencing difficulties adopting EBTs, and NREPP was being developed to assist in identifying best programs and practices. After our application was successfully reviewed, we were immediately inundated with calls and emails from mental health administrators who were interested in FBT training. Many queried if we had developed self-study methods to assist them in affordably learning the nuts and bolts of FBT. At that time we didn’t have much in the way of dissemination materials such as books, videos depicting FBT implementation, interactive web sites, and so on. We did, however, have carefully developed prompting checklists depicting the step-by-step procedures involved in conducting FBT (i.e., “cheat sheets”). Our treatment providers (TPs) had used these checklists during therapy sessions in our clinical trials to prompt specific intervention procedures. We were initially hesitant to introduce them to TPs in the community because our research team hadn’t tested our checklists in these settings. However, we were ultimately encouraged to do so after Scott Henggeler and his colleagues scientifically demonstrated the utility of this approach in TPs who had learned to implement contingency management within multisytemic therapy (MST). In disseminating FBT, we experienced overwhelming positive feedback from TPs about the prompting checklists. However, our checklists lacked appropriate context (e.g., sufficient rationales, implementation examples, cultural adaptations), which led TPs to be overly dependent on FBT trainers.

One of the persons who helped us initially disseminate FBT into community settings was a coinvestigator on a clinical trial involving FBT, Dan Allen. With Nate’s support, Dan agreed to assist in writing the first book about FBT based on the aforementioned prompting checklists (i.e., Treating Adult Substance Abuse Using Family Behavior Therapy). Now, several months later, we are excited to have completed Treating Adolescent Substance Abuse Using Family Behavior Therapy. Similar to the first book, this treatment manual was developed to flexibly and effectively address substance abuse utilizing a straightforward and theoretically sound behavioral intervention that is family based. Importantly, the intervention includes multiple components that are each capable of treating a wide range of problem behaviors in youth, such as illicit drug and alcohol abuse, family discord, school/work attendance, and conduct and mood disorders. Each component is organized into a series of therapeutic instructions, with each instruction building upon the next. TPs are free to exercise their own positive style when implementing each step, and they often integrate information between steps to assist in clarification, engagement, and so on. Other innovative features of FBT include its tight integration of (a) standardized and time-efficient goal-setting procedures that are tied to specific drug use triggers and competing rewards; (b) pragmatic methods to assist TPs in assessing their own estimates of treatment integrity; (c) ongoing standardized methods of assessing the extent to which clients participate and are satisfied in therapy; (d) standardized client record-keeping procedures and accompanying quality assurance system; and (e) strong evidence base in treating drug abuse and other associated problem behaviors. Each of these factors is very important to treatment delivery, although very few programs do so reliably.

This book, therefore, reviews procedures involved in the implementation of FBT as applied to the very distinctive and difficult-to-treat adolescent substance abuse population. FBT for adolescents involves the administration of validated assessment methods and well-established behavioral intervention components (i.e., Consequence Review, Level System, Treatment Planning, Reciprocity Awareness, Positive Request, Environmental/Stimulus Control, Self-Control, Job-Getting Skills Training). Each intervention component is systematically described in Chapters 5 through 12. Each intervention component includes an overview of the intervention approach, rationale for the intervention, required materials, and detailed description of the intervention procedures (including implementation dialogue between TP and client/family). Within each chapter, case examples and completed worksheets assist in bringing the interventions to life. This systematic organization permits readers to quickly identify and skim through parts of each chapter that may be particularly relevant. For instance, if a TP is about to implement the Self-Control intervention, and is not confident in how to initiate a practice trial, the TP can quickly review dialogue in the respective section where these instructions are detailed within the text. All necessary materials that will be required to implement FBT are listed in the back of each chapter, including the prompting checklists, handouts, and worksheets. At the back of the book there is a quiz that may be completed after the book is read to assist in gaining continuing education units (CEUs) that are required by most major TP licensing boards.

This book is primarily intended for TPs and instructors who teach substance abuse treatment in their courses. Indeed, there is ample information available to suggest that students who go on to become TPs need intensive training in evidence-based therapies, such as FBT, and that these interventions should be integrated within their class curriculums. Along these lines, we have developed a course format that is consistent with this book and freely available to instructors who are interested in teaching FBT. Relevant to this FBT class curriculum, each chapter represents an intervention component (e.g., Self-Control) that may be taught during an academic week. We hope you find the book rewarding and the interventions exciting to implement.

Brad Donohue

Nathan Azrin

Acknowledgments

We would like to acknowledge our families for their encouragement in writing this book, as well as our colleagues and students for their assistance in developing this Family Behavior Therapy approach. We are especially grateful for the continued support of the National Institute on Drug Abuse, as well as the National Institute of Mental Health in permitting us to evaluate the efficacy of FBT in randomized controlled trials. We are indebted to the folks at John Wiley & Sons, particularly Rachel Livsey, Amanda Orenstein, and Kim Nir for their professional perspective, unrivaled assistance, and aptitude throughout the publication process. We also would like to thank the following colleagues who reviewed this book and provided valuable feedback: C. Aaron McNeece, Professor Emeritus, Florida State University; Ken Winters, Professor, University of Minnesota; Lin Fang, Assistant Professor, University of Toronto; Eric Wagner, Professor, Florida International University; and David Springer, Professor, University of Texas, Austin.

CHAPTER 1

Introduction to Family Behavior Therapy

Overview

This chapter provides an overview of the application of Family Behavior Therapy (FBT) as applied to adolescents. First, the historical, theoretical, and empirical underpinnings of FBT are reviewed to assist in understanding its conceptualization and development during the past 20 years. We then describe youth and their families who are most likely to benefit from FBT, and offer recommendations in determining a method of assessment to assist in treatment planning. Although content of each of the FBT intervention components is extensively reviewed in Chapters 4 through 13, a summary of each intervention component is provided in this chapter. The method of using our relatively novel prompting checklists to guide treatment providers (TPs) in intervention implementation is reviewed, and procedures involved in the assessment of treatment integrity are underscored.