Howard Liddle

Disconnection and disengagement are frequent characteristics of interactions between parents and adolescents who present with substance use disorders. Excessive blame, defensiveness, and recrimination characterize day-to-day interactions within these families. Developmental psychopathology research reveals both shortand long-term effects of negative emotional patterns between parents and adolescents on the young person’s development, as well as on the parents’ functioning and their parenting practices in particular. Persistent expression and experience of negative emotions are also associated with poor treatment outcome, as they act as barriers to treatment engagement and change. This article demonstrates how research-based knowledge can guide therapeutic strategy and how emotions can be transformed in an empirically supported, family-based treatment: multidimensional family therapy. Transcripts with commentary from an adolescent, a parent, and from family therapy sessions illustrate emotion-related interactional transactions and interventions.

Background and aims Clinicians and researchers are increasingly interested in investigating excessive use of video gaming recently named Internet gaming disorder (IGD). As is the case with extensively researched adolescent problem behaviors such as substance use disorder, several studies associate IGD with the young person’s family environment and the parent–adolescent relationship in particular. Evidence-based treatments for a range of adolescent clinical problems including behavioral addictions demonstrate efficacy, the capacity for transdiagnostic adaptation, and lasting impact. However, less attention has been paid to developing and testing science-based interventions for IGD, and at present most tested interventions for IGD have been individual treatments (cognitive behavioral therapy). Methods This article presents the rationale for a systemic conceptualization of IGD and a therapeutic approach that targets multiple units or subsystems. The IGD treatment program is based on th...

This article summarizes the 30+-year evidence base of Multidimensional Family Therapy (MDFT), a comprehensive treatment for youth substance abuse and antisocial behaviors. Findings from four types of MDFT studies are discussed: hybrid efficacy/effectiveness randomized controlled trials, therapy process studies, cost analyses, and implementation trials. This research has evaluated various versions of MDFT. These studies have systematically tested adaptations of MDFT for diverse treatment settings in different care sectors (mental health, substance abuse, juvenile justice, and child welfare), as well as adaptations according to treatment delivery features and client impairment level, including adolescents presenting with multiple psychiatric diagnoses. Many published scientific reviews, including meta-analyses, national and international government publications, and evidence-based treatment registries, offer consistent conclusions about the clinical effectiveness of MDFT compared with...

Background: Multidimensional family therapy is the most researched family based intervention for adolescent substance abuse. Research and coverage: Funded continuously since 1985 in a series of controlled trials, process studies, economic analyses, and implementation studies, MDFT has achieved positive outcomes at post treatment and at various follow-up periods at one year and beyond when compared to a variety of active treatments, including cognitive behavior therapy, group counseling, multifamily groups, as well as in comparisons against services as usual. MDFT is a treatment system rather than a one size fits all model, having been adapted for testing and implementation in a variety of U.S. locations and in a multinational controlled trial in Europe over the past 5 years (Berlin, Paris, Brussels, The Hague, and Geneva). Studies have tested MDFT in juvenile justice settings such as drug courts, detention centers, residential treatment, as well as in outpatient treatment offered in...

Abstract 1. This chapter provides an overview of the subspecialty within family psychology of family psychology intervention science and proposes areas of future study and expansion. The authors conclude that further work is required to develop reliable and valid measures that can be applied to the diversity of families as well as methodologies that can consider the variety of family structures and relationship patterns. The development of ways to successfully recruit and retain participants in longitudinal studies, particularly those from ...

This book was first published in 2006. Adolescent drug abuse is one of the most challenging disorders to treat. It impacts on schools, community-based programs, mental health and medical facilities, and juvenile justice settings. This book provides practitioners, program developers and policy makers with practical information for improving outcomes in adolescent substance abuse. The authors cover a range of issues, including empirically based treatment development protocols, how to incorporate innovative treatment models into diverse clinical settings; research advances; interventions with special populations, culturally based intervention guidelines, and recommendations for practice and policy.

Abstract 1. Originally published in Contemporary Psychology: APA Review of Books, 1988, Vol 33 (3), 202-204. Reviews the books, The Handbook of Family Psychology, and Therapy, Vol. 1 edited by Luciano L'Abate (1985). A historic document, The Handbook of Family Psychology and Therapy, Vols. 1 and 2 provides a grand tour of the multiple content domains of family psychology. The editor has assembled a diverse and respected corps of contributors to examine a central conceptual issue in family psychology: the ...

In their research report, Loukas et al. report that parental al-coholism is prognostic of childhood behavior problems, both directly, through genetic and modeling effects, and indirectly, through parental distress and physical problems. They hypothesized that the heightened rate of behavior problems in young children of alcoholics could be traced to the combination of negative interactions with the alcoholic parent (eg, abuse, neglect) and the generalized stress involved in living with an alcoholic (eg, chaotic and unpredictable ...

Treatment research in the adolescent substance abuse specialty has evolved rapidly in the past decade. Family therapies are emerging as “best practice” treatments for adolescent substance abuse (Ozechowski & Liddle, 2000). This paper presents an overview of Multidimensional Family Therapy (MDFT), an outpatient, empirically supported, family-based approach to the treatment of adolescent substance abuse and associated mental health and behavioural problems (Liddle, 2002a). MDFT integrates the clinical and ...

Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA or CSAT. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, DHHS.

... Nancy Angelovich, MA7, Rodney Funk, BS1, David Hodgkins, MCSE1, Tracy L. Karvinen, MA1, Jodi J. Leckrone, MA4, Susie Mindel-Panichelli ... c) have used marijuana in the past 90 days (or 90 days prior to being in a controlled environment), and d) meet ASAM (1996) patient ...

Treatment research in the adolescent substance abuse specialty has evolved rapidly in the past decade. Family therapies are emerging as "best practice" treatments for adolescent substance abuse (Ozechowski & Liddle, 2000).␣ This␣ paper presents an overview of Multidimensional Family Therapy (MDFT), an outpatient,

Background and aims: Social variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapiesmultidimensional family therapy (MDFT) and family therapy as usual (FTAU)-on their impact on the prevalence of IGD and IGD symptoms. Methods: Eligible for this randomised controlled trial comparing MDFT (N 5 12) with FTAU (N 5 30) were adolescents of 12-19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Ph enix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months. Results: Both family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child's gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU. Discussion and Conclusions: Family therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study. Trial registration number: ISRCTN 11142726.

Objective: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. Method: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive-behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age ϭ 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT-detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age ϭ 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. Results: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. Conclusions: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes.

The conference objective was to characterize and articulate the developmental status of the research specialty in adolescent drug abuse treatment. Specifically, we aimed to explore the specialty's readiness to adopt or adapt existing treatment development models, and to develop new empirical and clinical frameworks. A broader function of the conference was to disseminate the latest research-based work on a range of core topics in adolescent substance abuse treatment to a diverse audience. With a diversity of research and clinical interests, viewpoints, and settings represented, we hoped that the conference would facilitate dialogue and specify unanswered empirical questions and points of controversy. In addition, if issues of this kind could be addressed successfully, additional advances in the adolescent substance abuse treatment research specialty could occur. In the weeks after the terrorist attacks, amidst threats of continued violence, fears of flying, and the anthrax outbreak only miles from the conference venue, serious questions emerged: could the conference proceed at all, and if it did, would more than a handful of participants attend? We held the meeting and the participants turned up. We were relieved and amazed to see that there was standing room only throughout the 2-day event, and that participants and presenters came from across the USA to attend. The conference exceeded all expectations. The capacity turnout and enthusiastic discussions following the presentations testified to the fact that research on adolescent substance abuse treatment had come of age and had taken its place in the substance abuse field. There was a sense of looking back, reviewing progress, and taking stock of where we had come as a field in our

This study was designed to establish and validate a multidimensional empirically based typology of clinically referred adolescent substance abusers. A total of 141 adolescent substance abusers, most of whom were male, African-American, and juvenile justice involved, comprised the study sample. Youth and their parents completed comprehensive assessments at intake to treatment, discharge, and at 6 months and 12 months post-discharge from treatment. Adolescents were classified based on individual and family risk factors, associated problems, and severity of substance use. Variables included in the 2-stage cluster analysis included adolescents' substance use, psychiatric disorders, and legal involvement; peer substance use; family substance abuse; parental psychopathology; and family conflict. Three groups emerged: Juvenile

This study introduces an observational measure of fidelity in evidence-based practices for adolescent substance abuse treatment. The Therapist Behavior Rating Scale-Competence (TBRS-C) measures adherence and competence in individual cognitive-behavioral therapy and multidimensional family therapy for adolescent substance abuse. The TBRS-C assesses fidelity to the core therapeutic goals of each approach and also contains global ratings of therapist competence. Study participants were 136 clinically referred adolescents and their families observed in 437 treatment sessions. The TBRS-C demonstrated strong interrater reliability for goal-specific ratings of treatment adherence, modest reliability for goal-specific and global ratings of therapist competence, evidence of construct validity, and discriminant validity with an observational measure of therapeutic alliance. The utility of the TBRS-C for evaluating treatment fidelity in field settings is discussed.

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings. Family-based treatment (FBT) is the most thoroughly studied behavioural treatment modality for adolescent substance abuse (ASA) (Becker and Curry, 2008). The extensive empirical support for FBT has been described in comprehensive literature reviews (Deas and Thomas,

Background-Contemporary intervention models use research about the determinants of adolescent problems and their course of symptom development to design targeted interventions. Because developmental detours begin frequently during early-mid adolescence, specialized interventions that target known risk and protective factors in this period are needed. Methods-This study (n = 83) examined parenting practices as mediators of treatment effects in an early-intervention trial comparing Multidimensional Family Therapy (MDFT), and a peer group intervention. Participants were clinically referred, low-income, predominantly ethnic minority adolescents (average age 14). Assessments were conducted at intake, and six weeks after intake, discharge, and at 6 and 12 months following intake.

The link between treatment techniques and long-term treatment outcome was examined in an empirically supported family-based treatment for adolescent drug abuse. Observational ratings of therapist interventions were used to predict outcomes at 6 and 12 months posttreatment for 63 families receiving multidimensional family therapy. Greater use of in-session family-focused techniques predicted reduction in internalizing symptoms and improvement in family cohesion. Greater use of family-focused techniques also predicted reduced externalizing symptoms and family conflict, but only when adolescent focus was also high. In addition, greater use of adolescent-focused techniques predicted improvement in family cohesion and family conflict. Results suggest that both individual and multiperson interventions can exert an influential role in family-based therapy for clinically referred adolescents. Keywords family therapy; process-outcome research; treatment techniques; adolescent substance abuse Psychotherapy process research examines in-session client and therapist behaviors with the goal of understanding the causes and course of change during treatment. The identification of process components that are favorably linked with outcome is instrumental to the development of efficacious treatment models (Orlinsky, Ronnestad, & Willutzki, 2004). Moreover, efforts to transport research-tested models into standard clinical settings will be greatly enhanced when more is known about which aspects of multifaceted treatments actually do the work of crafting change, and how. Theory-guided process research can advance treatment development and dissemination by illuminating the ingredients, mechanisms, and clinical conditions of effective therapy (Liddle, 2004), efforts that are also critical to successful dissemination and adoption of evidence-based psychotherapies (Weisz & Kazdin, 2003).

The relation between specific therapy techniques and treatment outcome was examined for 2 empirically supported treatments for adolescent substance abuse: individual cognitive-behavioral therapy and multidimensional family therapy. Participants were 51 inner-city, substance-abusing adolescents receiving outpatient psychotherapy within a larger randomized trial. One session per case was evaluated using a 17-item observational measure of model-specific techniques and therapeutic foci. Exploratory factor analysis identified 2 subscales, Adolescent Focus and Family Focus, with strong interrater reliability and internal consistency. Process-outcome analyses revealed that family focus, but not adolescent focus, predicted posttreatment improvement in drug use, externalizing symptoms, and internalizing symptoms within both study conditions. Implications for the implementation and dissemination of individual-based and family-based approaches for adolescent drug use are discussed.

This entry is our account of a selected by Drug and Alcohol Findings as particularly relevant to improving outcomes from drug or alcohol interventions in the UK. The original was not published by Findings; click on the Title to obtain copies. Free reprints may also be available from the authors-click prepared e-mail to adapt the preprepared e-mail message or compose your own message. Links to source documents are in blue. Hover mouse over orange text for explanatory notes. The Summary is intended to convey the findings and views expressed in the. Below is a commentary from Drug and Alcohol Findings.

An economic evaluation of five outpatient adolescent treatment approaches (12 total site-byconditions) was conducted. The economic cost of each of the 12 site-specific treatment conditions was determined by the Drug Abuse Treatment Cost Analysis Program (DATCAP). Economic benefits of treatment were estimated by first monetizing a series of treatment outcomes and then analyzing the magnitude of these monetized outcomes from baseline through the 12month follow-up.

This study suggests that systematic discussion of culturally salient content in therapy sessions can positively influence engagement (i.e., therapy participation and therapeutic alliance) with clinically referred African American adolescent males. In a sample of 18 African American adolescent males participating in 187 videotaped psychotherapy sessions, the in-session discussion of research derived, developmentally and culturally related content themes (anger/rage, alienation, respect, and journey from boyhood to manhood) were found to be positively associated with therapist-adolescent alliance and adolescent engagement. Discussions that focused on issues of trust and mistrust were found to negatively predict ratings of therapist-adolescent relationship, and discussions of racial identity/racial socialization were found to have no association with adolescent engagement. These findings provide clues about (a) how culturally responsive treatments can be developed, and (b) in this era of manualized therapies, the possibility of enhancing therapeutic outcomes by tailoring treatment protocols at specific levels of content focus and detail. Psychosocial treatments do not work equally well with all clinical problems or client groups. A major review found that among several ethnic minority groups, treatment outcomes were worse with African American clients

The authors examined the relations between adolescent-therapist and mother-therapist therapeutic alliances and dropout in multidimensional family therapy for adolescents who abuse drugs. The authors rated videotapes of family therapy sessions using observational methods to identify therapist-adolescent and therapist-mother alliances in the first 2 therapy sessions. Differences in adolescent and mother alliances in families that dropped out of therapy and families that completed therapy were compared. Results indicate that both adolescent and mother alliances with the therapist discriminated between dropout and completer families. Although no differences were observed between the 2 groups in Session 1, adolescents and mothers in the dropout group demonstrated statistically significantly lower alliance scores in Session 2 than adolescents and parents in the completer group. These findings are consistent with other research that has established a relationship between therapeutic alliance and treatment response.

The impact of early therapeutic alliance was examined in 100 clients receiving either individual cognitive-behavioral therapy (CBT) or family therapy for adolescent substance abuse. Observational ratings of adolescent alliance in CBT and adolescent and parent alliance in family therapy were used to predict treatment retention (in CBT only) and outcome (drug use, externalizing, and internalizing symptoms in both conditions) at post and 6-month follow-up. There were no alliance effects in CBT. In family therapy, stronger parent alliance predicted declines in drug use and externalizing. Adolescents with weak early alliances that subsequently improved by midtreatment showed significantly greater reductions in externalizing than adolescents whose alliances declined. Results underscore the need for ongoing developmental calibration of intervention theory and practice for adolescent clinical populations.

This exploratory, process-research study identified, articulated, and measured therapist behaviors associated with improving initially poor therapistadolescent alliances in multidimensional family therapy (MDFT). A list of preliminary alliance-building interventions was generated from MDFT theory and adolescent development research. This list was then refined through the observation of videotaped MDFT sessions. A sample of five improved and five unimproved alliance cases was then drawn from a larger treatment study. Participants were primarily African American, male, adolescent substance abusers and their families. Coders rated the first three sessions of each case (30 sessions) to

The nature and extent of changes in parenting and the link between parental subsystem changes and reduction in adolescent substance abuse and problem behaviors were examined in a sample of 29 parents and their drug-abusing adolescents. Participants completed 16 sessions of multidimensional family therapy. Over two thirds of the parents showed moderate to excellent improvement in parenting. Chi-square goodnessof-fit analyses revealed a statistically significant association between improvement in parenting and reduction in adolescent drug use and behavior problems. Results of this exploratory study provide qualified support for a fundamental tenet of family therapy-that change in the parental subsystem is related to improvement in the problem behavior of adolescents.

Videos are available at the MDFT website. Therapists, supervisors and trainers, as well as program administrators discuss their experiences with the MDFT program.

MDFT videos have been produced by the Hazelden Foundation, the American Psychological Association, and Alexander Street Press.  See MDFT Videos on YouTube http://www.youtube.com/user/CTRADA and at www.mdft.org

Video of MDFT - Published on Nov 25, 2016
Illustrates interventions in four MDFT Domains - adolescent, parent, family, and extra-familial.
Video has audio and slide content inserts describing key therapist behaviors.
Viewer can navigate to particular sections ("chapters") of the video according to the timings provided below.

Video Chapters:

1. Introduction 00:00
2. MDFT Illustrated 12:25
3. First session with adolescent 13:45
4. First session with mother 22:10
5. Howard and school counselor meeting 39:05
6. First family session - mother & adolescent 45:37
7. Session with adolescent 2 months into treatment 50:30
8. Session with mother 2 months into treatment 58:00
9. Family session two months into treatment 1:07:20
10. Final family session 1:17:30
11. Closing 1:23:50
12. Credits and MDFT information 1:24:33

Clinical video of MDFT, an evidence-based treatment for youth substance abuse and delinquency.

Information on MDFT at www.mdft.org Go there for MDFT news and updates, background, training opportunities, clinical publications, manuals, and research papers. Also visit MDFT Facebook page.

MDFT research summarized here: http://www.mdft.org/mdft/media/files/...

MDFT International Dissemination here:
http://www.mdft.org/mdft/media/files/...

MDFT News
October 2017. Members of the original International Cannabis Need for Treatment (INCANT) Study, including Henk Rigter, the INCANT PI from The Hague, Netherlands, are collaborating with MDFT International again on a multi-site, cross-national research project to treat Internet Gaming Disorders (IGD). The study’s clinical sites are in Paris, France (Paris Descartes CPSC - Institut de Psychologie, and Dupre Clinic), and Geneva, Switzerland (Phenix Foundation). This photo includes project members who met for an MDFT-IGD treatment development meeting in Geneva, September 24, 25, 26. From left, Nathalie Bastard (Paris), Celine Bonnaire (Paris), Philip Nielsen (Geneva), Cecilia Soria Dupuis (Geneva), Olivier Phan (Paris), Howard Liddle (Miami).

October 2017. A new publication from Dr. Cindy Rowe and MDFT developer Dr. Howard Liddle was published in the newest edition of Cognitive Therapy with Children and Adolescents. The Anatomy of Cognitions in Multidimensional Family Therapy outlines aspects of the MDFT intervention that specifically target cognitions in adolescents. The article is a companion piece to Dr. Liddle's 1994 piece, The Anatomy of Emotions in Family Therapy with Adolescents.

May 2017. Two federal grants from SAMHSA were awarded for MDFT services in Wisconsin and Connecticut. The WI Department of Health Services (DHS) and the CT Department of Children & Families (DCF) will use the money to fund MDFT services for youth with substance abuse and/or mental health disorders.

The Wisconsin DHS will use its funds to create the Wisconsin Youth Treatment Initiative, which will focus on transitional aged youth (ages 16-25). The grant provides $760,000 annually for four years starting September 30, 2017, and the Wisconsin Youth Treatment Initiative will collaborate with MDFT International to train four MDFT teams at four clinical centers throughout the state.

Connecticut DCF will use the funds for MDFT services integrated with medication-assisted treatment, the first MDFT program of its kind. They will receive $3.1 million for the program.