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Familientherapie alsFrühintervention bei drogenabhängigen Jugendlichen,jungen Erwachsenen und deren Müttern - Effektstärken undindividuelle Verbesserungsquoten bei den Therapie-Beendern
Abstract
Zusammenfassung: Fragestellung: Welche kurzfristigen Effekte einer familientherapeutischen Fruhintervention (der «Eppendorfer Familientherapie») bei Familien mit einem polytoxikoman drogenabhangigen Jugendlichen bzw. jungen Erwachsenen sind in einer multikriterialen Evaluation beobachtbar? Methodik: Die eingesetzte Familientherapie ist ambulant und abstinenz-orientiert. Das Design ist prospektiv, naturalistisch und misst pra-post-Effekte. Es beginnen 86 Familien die Therapie (86 drogenabhangige Indexpatienten, IP, im fruhen Suchtstadium, 76 Mutter, 57 Vater, 36 Geschwister). Zu 5 Zielkriterien werden intraindividuelle Verbesserungsquoten von IP und Muttern berichtet (Sucht-Status, Familienfunktion, Psychopathologie, Psychosoziale Integration, Therapiezufriedenheit), jeweils in Patientenangaben und Expertenbeurteilungen. Ergebnisse: Die Behandlung haben n = 62 (72%) der IP regular beendet. Bei 45 dieser 62 (73%) ergeben sich signifikante intraindividuelle Besserungen im Sucht-Status. IP und Mutter weisen i...
... However, urinalyses showed that most of them had been using drugs. Thus, we selected a control group of non-drug using siblings of heroin dependent adolescents from an earlier study Thomasius, 2004;Thomasius, Sack, et al., 2005). Since we did not find any opioid abusers in nightclubs, and it was impossible to recruit them from the ''heroin-scene,'' we relied on a clinical sample from the outpatient drug treatment unit at the University Medical Center. ...
... Group 4: Controls A group of N ¼ 22 non-clinical, non-drug using controls was compared to the three SUD-groups. These were siblings of heroin dependent youth, taking part in an outpatient family therapy study Thomasius, 2004;Thomasius, Sack, et al., 2005). Thirty-nine of a total of 65 siblings participated in treatment. ...
Earlier studies indicated a relation between fearful-avoidant attachment and substance abuse. This study compares attachment representations (Family Attachment Interview; Bartholomew & Horowitz, 19916.
Bartholomew , K. and
Horowitz , L. M. 1991. Attachment styles among young adults: a test of a four-category model. Journal of Personality and Social Psychology, 61(2): 226–244. [CrossRef], [PubMed], [Web of Science ®]View all references) of three groups of substance abusers and non-clinical controls. Heroin abusers (N = 22) were mainly fearful-avoidant, ecstasy abusers (N = 31) were preoccupied, fearful-avoidant and dismissing-avoidant, cannabis abusers (N = 19) were mainly dismissing and secure, and controls (N = 22) were mainly secure. Groups did differ in their level of psychosocial functioning (GAF) (cannabis > ecstasy > opioids). Differences in attachment prevailed when GAF was controlled. Based on the self-medication hypothesis we understand the preferences for specific substances to be influenced by specific attachment strategies. Heroin seems to be used as an emotional substitute for lacking coping strategies. Cannabis seems to be used to support existing deactivating and distancing strategies. Ecstasy abuse was related to insecure attachment but not to a specific attachment strategy.
Fragestellung: Nach der Anerkennung der ST durch den Wissenschaftlichen Beirat Psychotherapie (2009) stellt sich die Frage, wie die ST im ausdifferenzierten deutschen Suchthilfesystem starker genutzt werden kann. Methodik: Dieser einleitende Artikel gibt einen kurzen Uberblick uber die Entwicklung und die evidenzbasierten Varianten der Systemischen Therapie (ST) im Bereich der Substanzstorungen. Ergebnisse: Die ST ist ein psychotherapeutisches Verfahren, das psychische Storungen in ihrem interaktionellen Kontext versteht und behandelt. Sie beschaftigt sich bereits seit uber 40 Jahren mit der Therapie von Substanzstorungen, ausgehend von den fruhen strukturell-strategischen Ansatzen uber das klassisch systemische Mailander Modell und losungsorientierte Ansatze bis zu den in den letzten Jahren in den USA evaluierten ST-«Marken» wie Multidimensional Family Therapy, Multisystemic Therapy, Functional Family Therapy oder Brief Strategic Family Therapy. Schlussfolgerung: Die ST hat eine Vielzahl therapeutischer ...
Hintergrund: Die Eppendorfer Familientherapie (EFT; Thomasius, 2004) ist eine abstinenzorientierte, nicht-substituierende ambulante Fruhintervention, die Elemente systemischer, losungsorientierter und strukturell-strategischer Ansatze integriert. Methodik: Eine Stichprobe von N = 86 Familien mit einem drogenabhangigen Jugendlichen oder jungem Erwachsenen (14–25 Jahre) wurde in einem «pra–post»-Design mit Zwei-Jahres-Katamnese untersucht. Die Ergebnisse wurden mit den Daten entsprechender Referenzgruppen und einer in einer therapeutischen Gemeinschaft (TG) behandelten Vergleichsgruppe (N = 38) verglichen. Ergebnisse: Beide Behandlungsformen verbesserten den Suchtstatus, die psychische Symptombelastung und die familiaren Beziehungen bei den Therapiebeendern. Zur Katamnese waren die Ergebnisse stabil oder zeigten weitere Verbesserungen. Die EFT erreichte eine Haltequote von 72 % (TG: 37 %). Schlussfolgerungen: Die Studie weist darauf hin, dass systemisch-familientherapeutische Ansatze auch bei jungen Drogena...
A new approach to assessing family attachment patterns is presented, using a composite measure of individual attachment representations based on the Bartholomew Attachment Interview. A cluster analysis yielded three different patterns in a sample of N = 37 families with a drug dependent adolescent (age 14 - 25) and both biological parents. A "triangulated" pattern (mothers: preoccupied; fathers: dismissing; adolescents: fearful) was found in 65% of the sample. A total of 19% showed an "insecure" pattern (mothers, fathers, and adolescents: fearful) and 16% a "near-secure" pattern (mothers and adolescents: secure; fathers preoccupied). Preliminary comparisons between these groups indicate differences in comorbid psychiatric disorders, in individual and family functioning, but not in addiction severity. There is a trend towards differences in outcome of family therapy. Implications for treatment and further research are discussed.
The present paper describes an effectiveness-study to analyze the effectiveness of psychotherapeutic treatments. In the documentation phase of three years 24 therapists documented 93 psychotherapies. The patients represent a general population of health care takers. The treatments have an average duration of 45 appointments over 62 weeks. Good results are being achieved within this short period of treatment. The reduction of symptoms (global severity index GSI of SCL-90-R) reaches a high effectsize; regarding their symptoms 46 % of the patients can be considered as cured and 74 % as cured or improved.
© Georg Thieme Verlag KG Stuttgart · New York.
Twenty-six youth received six months of treatment (mean of 15 sessions) after random assignment to either a supportive counseling program or to a newly designed behavioral treatment. The behavioral program included several procedures to restucture family and peer relations and to control urges. Drug use was measured by urinalysis, supplemented by family report and self-report. The results showed that during the last month, 9% of youth receiving supportive counseling were abstinent vs. 73% of youth receiving the new behavioral treatment. A greater reduction of drug use was also apparent when measured in terms of urinalysis data alone, days per month of drug use, or overall number of months of abstinence. Improved functioning of youths in the behavioral program was evidenced by significantly greater school/work attendance, improved youth- and partent-relationship satisfaction ratings, improved conduct ratings, decreased depression, and decreased frequency of alcohol use as compared to youth in the supportive counseling program.
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 goodness-of-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. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Drug abuse is an enormous public health problem with consequences not only for individuals using drugs but also for families, communities, and society. Moreover, research evidence and clinical experience agree that drug abuse is one of the more difficult problems to treat. Despite considerable research on the connection between family factors and drug use, and the existence of family therapy models for drug abuse, comparatively few controlled efficacy studies have been conducted. This article presents a critical review of controlled treatment outcome research in the area of family therapy for drug abuse in both adults and adolescents. A number of studies from different clinical research groups demonstrate that different versions of family intevention can engage and retain drug users and their families in treatment, significantly reduce drug use and other related problem behaviors, and enhace particular domains of prosocial functioning. Moreover, a smaller number of comparative efficacy studies have shown family therapy to be more effective than nonfamily therapies. Family therapy of adolescent drug abuse is more developed at present than family therapy of adult drug abuse. Although the results of the reviewed studies are promising, a blanket confirmation of family therapy's efficacy for drug abuse cannot be made at this time because of the relatively small number of studies and the noted methodological limitations of the studies published to date. Nonetheless, substantial progress in this clinical research area has occurred, and if research and funding support continue or can expand, significant breakthroughs in the treatment of drug abuse with family-based treatments are possible.
Hypothesized that it would be possible to achieve the goals of family therapy (structural family change and symptom reduction) by working primarily with 1 family member. 37 Hispanic families with a drug-using member were assigned to conjoint or 1-person therapy. Data were analyzed using a mixed-design (repeated measures plus a between-group independent variable) ANOVA, with treatment as the between-group independent variable and time of assessment (intake, termination, and follow-up) as the repeated measure. Results indicate that both conditions were highly effective in improving family functioning and that 1-person family therapy was slightly more effective in reducing identified patient symptomatology. Clinical and practical issues and implications for the current theory and practice of family therapy are discussed. (20 ref)
This meta-analysis of 163 randomized trials (including 59 dissertations) examines a number of questions not studied in previous syntheses. These include differences in outcome associated with different theoretical orientations, differences between marital and family therapies versus individual therapies, the clinical significance of therapy outcome, differences between marital versus family therapies in both outcomes and problems treated, and the effects of various substantive and methodological moderators of therapy outcome. The review concludes with some observations about the methodological status of this literature.
To review family-based treatment research. A growing body of research and several meta-analytic reviews demonstrate that family-based treatments are effective for a variety of child and adolescent disorders. In addition, an emerging tradition of family-based process research has begun to identify important ingredients of effective family psychotherapy. This article reviews these advances and their implications for future research.
Selected studies on the treatment of schizophrenia, depression, anxiety, eating disorders, attention deficit, conduct disorder, and substance abuse are reviewed, as well as several process research and meta-analytic studies.
Family-based therapies have been shown to be effective for treating schizophrenia, conduct disorder, and substance abuse. Some data support their effectiveness in the treatment of eating disorders. Few studies have targeted internalizing disorders. A process research tradition is emerging, but it is in need of methodological advances. Meta-analytic studies suggest that family-based therapies are as effective as other models.
More well-designed studies with diverse populations are needed to assess accurately the effectiveness of this increasingly popular treatment approach.
The treatment outcome of drug-abusing adolescents treated with a 12-Step approach.
The study compares drug use outcome data at 6 and 12 months post-treatment among three groups of adolescents: those who completed treatment, those who did not and those on a waiting list. Also, among treatment completers, residential and outpatient samples were compared on outcome.
The treatment site is located in the Minneapolis/St Paul area of Minnesota.
Two hundred and forty-five drug clinic-referred adolescents (12-18 years old), all of whom met at least one DSM-III-R substance dependence disorder. One hundred and seventy-nine subjects received either complete or incomplete 12-Step, Minnesota Model treatment and 66 were waiting list subjects.
In addition to demographics and clinical background variables, measures included treatment involvement, treatment setting and drug use frequency at intake and follow-up.
Absolute and relative outcome analyses indicated that completing treatment was associated with far superior outcome compared to those who did not complete treatment or receive any at all. The percentage of treatment completers who reported either abstinence or a minor lapse for the 12 months following treatment was 53%, compared to 15 and 28% for the incompleter and waiting list groups, respectively.
Favorable treatment outcome for drug abuse was about two to three times more likely if treatment was completed. Also, there were no outcome differences between residential and outpatient groups. Alcohol was the most common drug used during the follow-up period, despite cannabis being the preferred drug at intake.
Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate "knowns and unknowns" regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.
This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.
Das junge Erwachsenenalter nimmt eine Brückenstellung zwischen den Jahren der Jugend und des Erwachsenseins ein. Die besonders entwicklungspsychologische Bedeutung des jungen Erwachsenenalters liegt in der Notwendigkeit, erstmals im Lebenszyklus zu einem tragfähigen Programm persönlicher Grundorientierungen und Verbindlichkeiten zu finden, die weitreichende Konsequenzen für die nachfolgenden Lebensabschnitte besitzen. Ein Vergleich zwischen seelisch gesunden und psychiatrisch erkrankten jungen Menschen erlaubt nicht nur Hinweise auf bedeutsame Entwicklungsverzögerungen, sondern auch auf leicht unerkannte Ressourcen, die in der therapeutischen und rehabilitativen Arbeit verstärkt beachtet werden können.
Familientherapien (FT) stellen angemessene Methoden der Frühintervention bei Drogenmissbrauch und -abhängigkeit von Adoleszenten dar. FT haben bei der Behandlung von Adoleszenten im Suchtbereich die höchsten Haltequoten, nämlich 7090%. FT zielen bei dieser Patientengruppe auf Drogenabstinenz bzw. eine Reduktion des Konsums. In komparativen Metaanalysen ergeben sich für FT mittlere Effektstärken bei überlegenem Outcome, sowohl in der Behandlung von Kindern als auch von Jugendlichen und jungen Erwachsenen. FT werden darum als »Anreicherung« für andere Therapieformen empfohlen; ohnehin gelten sie in der US-amerikanischen Kinder-und Jugendpsychiatrie als Standard. Inzwischen liegen Ergebnisse der bislang einzigen europäischen Studie zu einer FT mit drogenabhängigen Adoleszenten vor, der ambulanten »Eppendorfer Familientherapie (EFT)«, welche die internationale Befundlage replizieren: Die Haltequote liegt bei 72%, auf intent-to-treat-Basis verringern sich die 30-Tage-Prävalenzen des multiplen täglichen Substanzgebrauchs über die Zeitpunkte »prä-post-Katamnese-2« nach 84%63%58%. Die EFT-Stichprobe hat »post« eine gebesserte Störungs-Symptomatik, psychosoziale Integration und Familiendynamik, in der 2-Jahres-Katamnese erweisen sich diese Werte als stabil bei den Drogenpatienten wie auch ihren teilnehmenden Familienangehörigen.
Die Symptom-Checkliste SCL-90-R ist ein weltweit sehr häufig eingesetztes Selbstbeurteilungsinstrument zur Erfassung der psychischen Symptombelastung. In der vorliegenden Arbeit wird über die testtheoretische Überprüfung des Verfahrens und die bisher noch fehlende Normierung an einer für die deutsche Bevölkerung repräsentativen Stichprobe von 2179 Personen im Altersbereich von 16 bis 96 Jahren berichtet. Es konnte gezeigt werden, dass die SCL-90-R als Gesamtskala ein reliables Instrument zur Messung der globalen psychischen Symptombelastung darstellt. Die von den Autoren des Verfahrens postulierte dimensionale Struktur mit neun Skalen zur Erfassung unterschiedlicher Symptombereiche lässt sich faktorenanalytisch jedoch nicht bestätigen. Sowohl die hohen Interkorrelationen der Skalen als auch der Eigenwerteverlauf der Faktorenanalyse legt die Existenz eines varianzstarken Generalfaktors (global distress factor) nahe, der die allgemeine Symptombelastung einer Person abbildet. Eine valide Erfassung voneinander abgrenzbarer Symptombereiche mittels verschiedener Subskalen ist mit der SCL-90-R somit nicht möglich. Die mitgeteilten Normwerte beziehen sich deshalb lediglich auf die globalen Skalenkennwerte. Schlüsselwörter: SCL-90-R, testtheoretische Überprüfung, Normierung, repräsentative Bevölkerungsstichprobe Abstract.The Symptom-Checklist SCL-90-R by Derogatis (1977) is a frequently used inventory to assess psychological distress. This study presents results of the validation and standardization of the SCL-90-R based on a representative sample of the German population (2179 subjects aged 16 to 96 years). It could be demonstrated that the SCL-90-R is a reliable instrument to measure the global intensity of psychological distress. Factor analysis of the items of the questionnaire yielded a strong unrotated first factor, suggesting that a general factor (global distress factor) may be present. This, together with the fact that high intercorrelations were found between the nine original subscales, suggests that the instrument is not multidimensional. Therefore a classification of different groups of symptoms by different subscales is not possible, and the representative norms reported in this paper are limited to the global scores GSI, PST, and GSDI.
This article describes the efficacy of two family-oriented, outpatient drug interventions for 84 adolescents who had used and abused drugs. Together, the two brief drug interventions appeared to significantly reduce the drug use of nearly one-half of the adolescentts who received the two family-focused drug interventions. It is surmised that this slccess was due partly to the fact that both outpatient interventions focus on the sxystemic treatment of entire familv groups rather than being given to the adolescents as inidiv iduals. WVheti comnpared, however the family therapy intervention appears to have been effectiv e itn reducing drug use for a greater percentage of the adolescents than did the familv education intervention.
explicate four kinds of validity [statistical conclusion validity, internal validity, construct validity and external validity] / describe and critically examine some quasi-experimental designs from the perspective of these four kinds of validity, especially internal validity / argue that the quality of causal inference depends on the structural attributes of a quasi-experimental design, the local particulars of each research project, and the quality of substantive theory available to aid in interpretation / place special emphasis on quasi-experimental designs that allow multiple empirical probes of the causal hypothesis under scrutiny on the assumption that this usually rules out more threats to internal validity (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The differential effectiveness of three models of adolescent drug abuse treatment was assessed in a controlled outcome study. Family Systems Therapy (FST) was compared to Adolescent Group Therapy (AGT) and Family drug Educations (FDE). FST appeared to be more effective in stopping adolescent drug abuse than AGT or FDE, registering twice as many apparently drug-free clients than FDE and three times as many as AGT. However, a number of possible confounds make this conclusion tentative. No tretment approach was superior in altering patterns of family functioning although all three conditions improved perceived intergenerational communication.
To review and synthesize the recent scientific literature on adolescent substance abuse, covering natural history, epidemiology, etiology, comorbidity, assessment, treatment, and prevention, and to highlight areas for future research.
Studies of adolescent substance abuse were reviewed with the focus on substance abuse and dependence rather than substance use.
There has been a sharp recent resurgence in adolescent drug use. Biological factors, including genetic and temperament characteristics, as well as family environment factors, are emerging as important etiological variables. Comorbidity with other psychiatric disorders, particularly with conduct disorder, is frequent and complicates treatment. New assessment instruments are available for clinical and research use. Among treatment modalities, family-based interventions have received the most study.
The past decade has seen growth in the volume and sophistication of research on adolescent substance abuse and in the conceptualization of this problem. Further research is needed, particularly on the significance of comorbid conditions and on individualized and effective treatment approaches.
This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.
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