Academic journal article Journal of Marital and Family Therapy

Predictors of Substance Use and Family Therapy Outcome among Physically and Sexually Abused Runaway Adolescents

Academic journal article Journal of Marital and Family Therapy

Predictors of Substance Use and Family Therapy Outcome among Physically and Sexually Abused Runaway Adolescents

Article excerpt

There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual. Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting family systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions.

INTRODUCTION

The National Child Abuse and Neglect Data System (NCANDS) reported that in 2002 an estimated 1,800,000 referrals were made alleging child abuse or neglect to state and local child protective services agencies. Of these referrals, 896,000 children were determined to be victims of child abuse by the Child Protective Services (CPS) agencies. Even with this high number of youth and families affected by abuse, the consensus within the literature is that there are few rigorously designed treatment evaluation studies for maltreated youth (Cohen & Mannarino, 1998; James & Mennen, 2001; Stevenson, 1999). Several researchers have noted that treatment efforts are still in the early stage of development, and more attention is needed for identifying effective interventions (Finkelhor & Berliner, 1995; Kolko, 1996; Swenson & Spratt, 1999). To that end, this study examined substance abuse treatment outcome and its predictors among physically and/or sexually abused adolescents.

It has been suggested that there is no special sexually abused children's syndrome or symptom characteristic of a majority of such children (Finkelhor & Berliner, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993). Physical and/or sexual abuse affects diverse sets of youth with a wide range of ages, backgrounds, and associated symptom presentations. Problem behavior patterns vary by age as well, with running away or substance use typical of older children and nightmares and anxiety more typical of younger children (Finkelhor & Berliner, 1995).

Stevenson (1999) and Beutler and Hill (1992) suggest that the lack of a specific childhood abuse syndrome and the diversity of those affected calls into question whether specific therapies are required for abuse or whether treatment should focus on the presenting symptoms rather than on child abuse specifically. These authors question whether therapy should focus on the youth's history of physical and/or sexual abuse or on issues, such as depression or substance abuse, that prompt treatment seeking. Finkelhor and Berliner (1995) conclude that, because of the diversity among abused children and families, it is unlikely that any one therapy will be effective for all children and families. These researchers note that treatment evaluation with a homogeneous group with similar symptoms allows an intervention to be systematically administered and evaluated. This study included a relatively homogeneous group of physically and/or sexually abused adolescents as they had run away from home and were substance abusing.

Child Sexual and Physical Abuse

Finkelhor and Berliner (1995) reviewed 29 studies examining treatment outcome with sexually abused children and adolescents. Of these, five published studies used an experimental design in which children were randomly assigned to a treatment condition; only two of the studies (Baker, 1987; Monck et al., 1994) included adolescent participants. In both studies, client outcomes improved with treatment, though outcomes were similar across conditions.

More recently, Cohen and colleagues (Cohen, Deblinger, Mannarino, & Steer, 2004; Cohen & Mannarino, 1998, 2000) compared the efficacy of trauma-focused, cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder and other emotional/behavioral problems in children aged 8 to 14 years who had a history of sexual abuse. …

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