Program Profile: Multisystemic Therapy - Substance Abuse

This version of multisystemic therapy is for adolescents with substance abuse and dependency issues. This program is rated Effective. Treatment youth showed statistically significant reductions in marijuana use and in aggressive behavior and convictions for aggressive behavior, compared with control group youth. However, no significant differences between groups were found for symptoms of mental health, criminal behavior, or alcohol or cocaine use.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Multisystemic Therapy (MST) aims to enhance a families’ capacity to keep track of adolescent behavior and instill clear rewards and punishments for positive and negative or irresponsible behavior. When dealing with adolescents, MST frequently concentrates on reducing youths’ involvement in delinquent and substance-using behavior and replacing negative peers with prosocial peers who do not engage in problem behavior. Therapists concentrate on developing family structure and natural rewards or incentives to encourage desired healthy behaviors and attachment to prosocial peers.

This variant of MST targets adolescents who have been diagnosed as substance abusing or substance dependent according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM–IV. This program can be used with youths who have other mental or physical conditions or deficiencies as well. Although the emphasis is on juveniles, MST operates by incorporating the patients’ family and friends and addressing all potential spheres of behavioral influence.

Program Activities

MST interventions concentrate on the individual, family, peer, school, and social network variables that are linked with behavioral problems. These interventions draw heavily from strategic family therapy, structural family therapy, behavioral parent training, and cognitive behavioral therapies to address behavioral issues in a holistic and comprehensive manner.

MST is generally delivered at home. This type of service delivery reduces barriers that prevent families from accessing services. Therapists have small caseloads of four to six families. They are available 24 hours a day, 7 days a week, and provide services when it is convenient for the patient and the family. Treatment typically lasts 4 months, with multiple therapist–family contacts occurring each week. MST therapists concentrate on parental skills and building natural support systems of families, friends, and community members. While working on strengths, therapists also address roadblocks to therapy and healing such as parental substance use and strife.

Study

Henggeler and colleagues (2002) used a randomized clinical trial with a 4-year follow-up assessment to determine the effect of this tailored Multisystemic Therapy (MST) had on substance-abusing and -dependent juveniles in South Carolina. A total of 118 juveniles were recruited for this study. No youths were excluded for preexisting mental or physical health issues or deficiencies.

Fifty-six percent of participants met the DSM–III–Revised criteria for substance abuse, 44 percent met the criteria for substance dependency, and 72 percent had been diagnosed with a mental health disorder. Most had criminal histories—with an average of 2.9 prior arrests. The average age was 15.7, and approximately 80 percent of the sample was male. Fifty percent were African American, 47 percent were white, and 3 percent were from other ethnic backgrounds. Nearly the entire sample lived in either a two-parent (50 percent) or single-parent (40 percent) household, with the remainder living with a nonbiological parent/caregiver (10 percent). Participants and their families were economically disadvantaged, with 25 percent of parents unemployed. The median income of the other families ranged from $15,000 to $20,000.

Participants were randomly assigned to MST (n = 43) or the control condition (n = 37). MST therapists were master’s-level clinicians supervised by child and adolescent psychiatrists. Sessions followed the home-based model of service delivery, allowing for services to be administered in the community (home, school, or neighborhood center). This model also entails low caseloads, allowing for intensive provision of comprehensive services to each family for 4 to 6 months with 24-hour/7-days-a-week availability of therapists. The control group received usual community services. This consisted of referral to a community-based substance abuse treatment center, where participants attended weekly 12-step-style group meetings along with residential and inpatient services as needed.

Baseline assessments revealed a statistically significant difference between the MST treatment group and the control group. Those in the treatment group were older and reported more frequent marijuana use than control participants. These baseline differences were accounted for in the analyses conducted at the 4-year follow up. In total, there were four data collections or assessments: baseline, 6-months posttreatment, 12-months posttreatment, and 48-months (4 years) posttreatment. Eighty participants, 68 percent of the original sample, completed all of the assessment periods, and this data was used for the outcome analysis. Analyses revealed that dropouts did not differ significantly from those who completed the study.

This final sample had slightly different characteristics from the original recruitment sample. The final sample were older, with an average age of 19.6. The majority were male (76 percent), and all were either African American (60 percent) or white (40 percent). Slightly fewer than half (48 percent) had not received a high school diploma or a GED, and only 12 percent had completed any college or vocational schooling. More than one third (38 percent) of participants reported no income. More than half (52 percent) had at least one child of their own, and about the same percentage lived with their parents or other family members (56 percent).

Criminal behavior was measured using the Self-Report Delinquency Scale, which included aggressive crimes (e.g., assaults, robberies) and property crimes (theft, property damage/vandalism). In addition, official criminal convictions were collected from the South Carolina Law Enforcement Division. Substance abuse was measured by self-report and biological measures (urine and hair analyses). Psychiatric symptoms were measured with the externalizing and internalizing scales from the Young Adult Self-Report (YAS) scale.

Chi-square analysis, multivariate analysis of covariance (MANCOVAs), and one-way analysis of covariances (ANCOVAs) were used to determine the impact of the MST variant on criminal behavior, illicit drug use, and psychiatric symptoms.

Study

Henggeler and colleagues (2006) examined three different intervention conditions compared with a control condition. The interventions were 1) standard drug court (DC), 2) drug court plus Multisystemic Therapy (MST) services (DC/MST), and 3) drug court plus MST and contingency management services (DC/MST/CM). The comparison condition was family court (FC). This CrimeSolutions review focused only on the youth in the DC/MST group and the youth in the FC comparison group.

Participants were recruited from the Department of Juvenile Justice (DJJ) in Charleston County, S.C. To be included in the study adolescents had to meet the following criteria: 1) be 12 to 17 years old, 2) have been diagnosed as substance abusing or dependent according to the DSM–IV, 3) be on formal or informal probationary status, and 4) reside in Charleston County with at least one parent/guardian. Juveniles were excluded if they were already involved in some form of substance abuse treatment or if a family member had already received MST treatment. No youths were excluded for prior mental or physical health issues or deficiencies.

Recruitment procedures created a study sample of 161 families. These families were then randomly assigned to one of four conditions: DC (38 families), DC/MST (38 families), DC/MST/CM (43 families), and FC or the comparison condition (42 families).

In the FC comparison condition, youths were assigned to family court rather than any of the drug court interventions. Youths appeared in FC once or twice annually. These participants were directed to attend group treatment for 1½ hours, 4 days a week, for 12 weeks.

The DC condition offered all of the same therapeutic services as the family court, but these were delivered under the structure of a drug court. The largest notable difference in the delivery systems was the urine drug screens and behavioral reports filled out by caregivers and counselors before the weekly appearances in drug court.

The DC/MST condition operated similarly to the DC condition, except it included MST treatment. The DC/MST/CM condition included the aforementioned MST services but also with contingency management (CM) practices. CM is empirically driven and uses functional analyses to identify problems and guide the intervention. It uses pragmatic and goal-oriented intervention strategies to remove barriers to a substance-free life and build support structures to promote individual sobriety. All therapy programs were delivered by trained therapists with similar years of experience and background working with juveniles. This ensured consistent fidelity and treatment across the intervention and control groups.

Measures of alcohol and drug use were obtained through self-reports (form 90) and biological measures (urine screening). Criminal activity was measured with the Self-Report Delinquency scale, and arrests were tracked through the South Carolina DJJ. Additionally, externalizing and internalizing behaviors were measured with the Child Behavior Checklist. Service outcomes were measured by the number of youths who completed/graduated drug court requirements and the number of out-of-home placements and the Service Utilization Survey. To graduate from drug court, youths must have had clean urine screens for the past 5 weeks and attend school or work regularly.

Subgroup Analysis

Henggeler and colleagues (2006) conducted additional analyses to determine whether demographic, clinical, and baseline substance use variables moderated the effect of Multisystemic Therapy (MST) Substance Abuse on the primary outcomes. As no significant moderator effects were found, these variables did not affect the treatment outcomes.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Brown, Tamara Lynette, Scott W. Henggeler, Sonja K. Schoenwald, Michael J. Brondino, and Susan G. Pickrel. 1999. “Multisystemic Treatment of Substance-Abusing and -Dependent Juvenile Delinquents: Effects on School Attendance at Posttreatment and 6-Month Follow-Up.” Children’s Services: Social Policy, Research, and Practice 2:81–93.

Henggeler, Scott W., Susan G. Pickrel, and Michael J. Brondino. 1999. “Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes, Treatment Fidelity, and Transportability.” Mental Health Services Research 1:171–84.

Cullen, Francis T. 2002. “Rehabilitation and Treatment Programs.” In Crime: Public Policies for Crime Control, Second Edition, edited by J.Q. Wilson and J. Petersilia. San Francisco, California: ICS Press, 253–89.

Schaefer, Lacey, Francis T. Cullen, and John E. Eck. 2016. Environmental Corrections. A New Paradigm for Supervising Offenders in the Community. Thousand Oaks, California: Sage.

Schaefer, Lacey. 2018. “Environmental Corrections: An Application of Environmental Criminological Theories to Community Corrections Practices.” Advancing Corrections Journal 5–2018.

Schaefer, Lacey. 2013. “Environmental Corrections: Making Offender Supervision Work.” Unpublished doctoral dissertation. Cincinnati, Ohio: University of Cincinnati.

Following are CrimeSolutions-rated programs that are related to this practice:

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Externalizing behavior
	Drugs & Substance Abuse - Multiple substances
	Mental Health & Behavioral Health - Psychological functioning
	Education - Academic achievement/school performance

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?