Substance Abuse

Article excerpt

Liddle and Dakof's (1995) comprehensive review of the status of family-based treatment for drug abuse concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed.

Developing and disseminating effective treatments for drug abusers represents one of the nation's most urgent public health priorities (Leshner, 1997). In the United States, 14 million individuals (6.3% of the population) age 12 and over report current use of an illicit drug, with almost 10% of youth aged 12 to 17 reporting illicit drug use in the past 30 days (Substance Abuse and Mental Health Services Administration [SAMHSA], 2001). Not only does drug abuse devastate the lives of youth and adults alike, but it costs the United States over 100 billion dollars each year in health and crime costs, an estimated 50% increase since 1985 (National Institute on Drug Abuse [NIDA], 1998). Although less than 5% (only about 4 billion dollars) of this figure is accounted for by treatment costs (NIDA, 1998), the need for services continues to increase for marijuana, heroin, and amphetamine abusers (SAMHSA, 1999). Trends also indicate that the need for treatment will continue to increase for older adults as the baby boomer generation ages (SAMHSA, 1999). Among youth, surveys indicate that perceived harmfulness of regular marijuana and LSD use and disapproval of heroin use are decreasing, and availability of club drugs such as ecstasy is on the rise (Johnston, O'Malley, & Bachman, 2001). Further, the fact that 60% of treatment admissions for drug abuse represent repeat treatment episodes suggests that treatments delivered in standard community practice are having little long-term impact (SAMHSA, 1999). Young substance abusers not only fail to receive empirically supported treatments, but the majority who need help never receive services of any kind (Dennis, 2002). Thus, the quest to develop and disseminate more effective treatments for this significant public health problem continues to be a top priority for practitioners, researchers, policy makers, and federal funding agencies (e.g., Crits-Cristoph & Siqueland, 1996; NIDA, 2002).

Specific aspects of family life and family relationships have strong and consistent connections to the initiation, exacerbation, and relapse of drug problems. Relationship factors such as poor parent-adolescent relationships consistently predict adolescent drug use across cultures and time (Brook, Brook, Arencibia-- Mireles, Richter, & Whiteman, 2001) even more so than salient factors such as family structure (Friedman, Terms, & Glassman, 2000). Parenting practices including low monitoring, ineffective discipline, and poor communication are also important factors in the initiation and maintenance of drug abuse problems among youth (Liddle, Rowe, Dakof, & Lyke, 1998; McGillicuddy, Rychtarik, Duquette, & Morsheimer, 2001), although parenting clearly interacts with a host of other social and emotional factors in predicting the onset of drug abuse and related problems (Dishion & Kavanagh, 2000). Other family variables have been shown to exert a strong protective influence against drug problems (Morojele & Brook, 2001). For instance, youth whose parents strongly disapprove of drug use are significantly less likely to report current use of an illicit drug (SAMHSA, 2001). …