Family-based treatments are effective for substance abuse

Family-based treatments are effective for substance abuse and conduct disorders in children and adolescents, according to a new, ten-year research review released this week. The treatment also helps reduce the behavior problems associated with attention deficit hyperactivity disorder (ADHD) and shows promise in treating depression and anxiety.

"There are some myths about family therapy, and one of them is that it's not effective," said Allan Josephson, M.D., chief executive officer of the Bingham Child Guidance Center in Louisville and co-author of the study. "However, the empirical support for its success has been growing. This paper documents that counseling and working with families is not only an intuitively good idea--there's scientific evidence for its effectiveness in specific conditions."

Dr. Josephson spoke today in New York City at the American Medical Association and National PTA media briefing, Back to School: Child and Adolescent Health. The study will be published in the September issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

In the paper, Dr. Josephson and co-author Guy Diamond, Ph.D., associate professor of psychiatry at the University of Pennsylvania School of Medicine and director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia, examine most of the randomized clinical trials over the past decade that included parents in the treatment of child and psychiatric disorders--the definition of family therapy.

They found evidence that two types of family-based treatments are effective for conduct disorders, which may cause children or teens to be aggressive, destroy property or otherwise violate established rules. The first, parent management training (PMT), teaches parents techniques to promote good behavior in their children. These may include using positive reinforcement, awarding points for good conduct or working with children to develop problem-solving skills. Studies have shown that PMT can be effective for conduct disorders for as long as 14 years. Behavioral family therapy (BFT) is similar to PMT but also includes methods to reduce family factors that may contribute to a child's disruptive behavior, such as stress in the parents' lives or the child's personality.

Family therapy also has been shown to be as good or better than other types of treatment in reducing drug use and related behavior problems among children and adolescents with substance abuse. Though the treatment doesn't seem to help much with core ADHD symptoms, such as difficulty staying focused, family training in stress, anger management, communication and school advocacy can reduce the behavior problems normally associated with the condition, said Dr. Josephson, who is also professor and chief of the Division of Child and Adolescent Psychiatry at the University of Louisville School of Medicine.

More research is needed to prove family therapy's effectiveness for disorders like depression and anxiety, but the outlook is promising. For many conditions, involving parents in the treatment process can make therapy or medications more effective, encourage children and adolescents to comply with the health care provider's recommendations, get them more engaged in the process and help maintain any benefits that are gained, Dr. Josephson said. Family therapy is often provided by psychologists, social workers or other specialists, although psychiatrists also should be trained to assess young patients' families even if they do not always treat them and may refer them to another non-medical specialist for treatment.

The research only makes sense, said Dr. Josephson, given that the context in which children grow up influences their mental health. Certain family situations, such as substance abuse or marital conflict, can cause problems for young people. In the opposite direction, if a child has a biologically based psychiatric disorder such as autism, that illness will likely affect the way the entire family interacts. Either way, family therapy can help parents adjust their behavior to best manage their child's condition while a physician or mental health professional treats the child individually with medications or behavioral methods.

"Those involved with the diagnosis and treatment of mental disorders have been reluctant to discuss family issues in depth," Dr. Josephson said. "They're afraid to blame the family, and at times, it seems pharmacology may have replaced working with the family. But the family has not gone away and its influence remains as powerful as ever."