Strengths-Oriented Family Therapy for Adolescents with Substance Abuse Problems

Abstract

Adolescent substance abuse continues to be a societal problem for which we need high quality, cost-effective treatments. That is, substance use and abuse by adolescents is associated with a more rapid progression into addiction, delayed entry into adult roles (that is, adult relationships, employment, and so forth), and high societal costs (Chambers, Taylor, & Potenza, 2003; Kandel, Davies, Karus, & Yamaguchi, 1986; Miller, Levy, Spicer, T Liddle, 2001), this model has three unique features: (1) a pretreatment family motivational enhancement session called the Strengths-Oriented Referral for Teens (SORT) (Smith & Hall, 2007), (2) a foundation in solution-focused language and treatment techniques, and (3) a formal strengths and resources assessment in the early stages of treatment. Overall, the SOFT approach contains four main activities: (1) family-based assessment and motivational feedback (that is, SORT), (2) work with individual families that progresses through three stages, (3) multifamily groups, and (4) SOFT case management, as needed. Rationale for SOFT We have a strong rationale for why SOFT should be an efficacious treatment model for adolescents who abuse substances. First, the quality of family relationships and parenting predict adolescent drug use (Steinberg, Lamborn, Darling, Mounts, & Dornbusch, 1994). Second, family-based treatment approaches are efficacious for treating adolescents with substance abuse problems (Austin, Macgowan, W Szapocznik & Williams, 2000; Williams & Chang, 2000). Third, we identify and amplify client strengths, use solution-focused language, and employ motivational interviewing techniques. These strategies foster increases in client perceptions of self-efficacy, change talk, and commitment to treatment, which are known predictors of treatment success (Amrhein, Miller, Yahne, Palmer, & Fulcher, 2003). Fourth, adolescents presenting for substance abuse treatment have multiple clinical and psychosocial needs and many barriers to receiving treatment, which forms the rationale for providing case management services (Mensinger, Diamond, Kaminer, & Wintersteen, 2006). In summary, the SOFT model is grounded in research on how to treat adolescents with substance abuse problems. SOFT ACTIVITIES SOFT blends a pretreatment family referral session (SORT), solution-focused family therapy, parent-teenager communication skills training in multifamily groups, and case management services to comprise a multimodal intervention for adolescents who abuse substances. SORT We developed SORT, a specialized module, to engage parents and teenagers into SOFT. During SORT sessions, we use the major principles of motivational interviewing and solution-focused counseling to give results to teenagers and parents from a structured substance abuse and mental health assessment (Berg & Miller, 1992; deShazer, 1988; Miller & Rollnick, 2002).We engage adolescents and parents in a discussion of the adolescent's strengths and problems. We integrate the four core principles of motivational interviewing in the SORT session: being empathic, supporting self-efficacy, rolling with resistance, and raising awareness (Miller & Rollnick, 2002). …