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Nadelmann, E. A. (1998). Commonsense drug policy. Foreign affairs : an American quarterly review, 77(1; 01/1998), 111–126.
Abstract: The “war on drugs” and its prohibitionist, punitive strategy have failed to solve America’s drug problem. In fact, they bear much of the blame for drug-related crime, epidemic use of crack cocaine and the spread of aids through dirty syringes. Washington must begin developing policy that seeks first to reduce the harm drugs do users and society. Officials need only look at successful innovations in Europe and Australia like needle exchange, addiction treatment and supervised maintenance, and decriminalization. Public health rather than politics should be paramount.
Keywords: government and politics; AOD public policy strategy; harm reduction; prevention; HIV infection; Aids; United States
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Spapen, P., Angelidis, T., Antoniali, V., Van Gerwen, K., Pelc, I., & Verbanck, P. (2010). La thérapie familiale multidimensionnelle des adolescent(e)s dépendants du cannabis : une nouvelle approche systémique en Europe dans le cadre d'une recherche plurinationale. Thérapie familiale, 30(2), 117–132.
Abstract: Certains adolescents consommateurs de cannabis présentent une réelle assuétude qui s’accompagne le plus souvent d’une série d’autres difficultés personnelles, familiales et sociales. Un modèle intégratif de thérapie familiale adapté à cette problématique et basé sur les données de la recherche est présenté et illustré par une situation clinique. Some adolescent cannabis users develop a real addiction which is often associated with different individual, familial and social difficulties. An integrative research-based family therapy model based on the data of the research is presented and illustrated with a clinical case. Algunos adolescentes consumidores de cannabis presentan una real adicción que esta frecuentemente acompañada de una serie de otras dificultades personales, familiares y sociales. Un modelo integrador de terapia familiar adaptada a esta problemática y basada en los datos de la investigación es presentada e ilustrada por un caso clínico.
Keywords: adolescent; cannabis; addiction; treatment and maintenance; family therapy; peer
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Rhiner, B., Graf, T., Dammann, G., & Fürstenau, U. (2011). Multisystemische Therapie (MST) für Jugendliche mit schweren Störungen des Sozialverhaltens : Implementierung in der deutschsprachigen Schweiz und erste Ergebnisse. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39(1), 33–39.
Abstract: Zusammenfassung. Fragestellung: Die Arbeit widmet sich der Frage, inwiefern sich MST auf die deutschsprachige Schweiz übertragen lässt und ob sich die guten internationalen Ergebnisse hier replizieren lassen. Methodik: Es wurde eine Stichprobe von n = 70 Jugendlichen mit einer durchschnittlichen Behandlungsdauer von 155 Tagen behandelt, davon blieben 60 (85.1%) bis zum Behandlungsende in der Studie. Hiervon liegen für 38 Patienten (63.3 %) die Ergebnisse der Elternversion des SDQ sowie für 52 Patienten (86.7%) Therapeutenratings (GAF und CGI) vor. Ergebnisse: Der SDQ-Gesamtproblemwert (Elternversion) verringerte sich von 20 (Behandlungsbeginn) auf 14.6 (Behandlungsende). Im GAF verbesserte sich der Gesamtscore von 55.4 auf 70.3 und CGI von 3.6 auf 2.7 Punkte. Diese Resultate zeigen statistisch hochsignifikante Verbesserungen. In der 6-Monats-Katamnese zeigten sich Erfolgsquoten von 91% (Verbleib in Herkunftsfamilie), 94% (Verbleib in Ausbildung) und 91% (Vermeidung von Delikten) und in der 18 Monats-Katamnese entsprechende Erfolgsquoten von 80 %, 86% und 86%. Schlussfolgerungen: MST ist ein komplexes Behandlungsprogramm das sich durchaus auf den schweizerischen Kulturraum übertragen lässt. Die guten internationalen Ergebnisse konnten in unserer Stichprobe repliziert werden. Multisystemic Therapy (MST) for adolescents with severe conduct disorders in German-speaking Switzerland – implementation and first results Objective: To determine the extent to which MST can be applied in German-speaking Switzerland, and the extent to which respectable international treatment outcomes can be replicated. Method: A sample of 70 adolescents was treated for an average of 155 days. Of these adolescents, 60 (85.5%) remained in the study until the conclusion of treatment. The results of the parent version of the Strengths and Difficulties Questionnaire (SDQ) are available for 38 (63.3%) of the completers. For 52 patients (86.7 %), the therapist ratings for Values for Clinical Global Impression (CGI) and for Global Assessment of Functioning (GAF) are available. Results: The overall problem score of the parent version of the SDQ was reduced from 20 at the beginning of treatment to 14.6 at the conclusion of treatment. The overall score of theGAF improved from 55.4 to 70.3, and the CGI improved from 3.6 to 2.7 points. These results are statistically highly significant. The 6-month follow-up interview revealed treatment success rates of 91% for «adolescent remains in his family of origin,» 94% for «adolescent remains in school or vocational training,» and 91% for «adolescent does not commit chargeable offences.» The 18-month follow-up interviews show success rates of 80 %, 86%, and 86 %, respectively. Conclusions: Multisystemic Therapy is a complex treatment program that is clearly applicable in the cultural environment of Switzerland. Respectable international results were replicated in this sample.
Keywords: conduct disorder; adolescent; treatment program; family therapy; peer; juvenile delinquency; treatment method; program implementation; program evaluation; statistical data; Switzerland; german-speaking Switzerland
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Rehberg, W., Fürstenau, U., & Rhiner, B. (2011). Multisystemische Therapie (MST) für Jugendliche mit schweren Störungen des Sozialverhaltens : ökonomische Evaluation der Implementierung im deutschsprachigen Raum. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 39(1), 41–45.
Abstract: Fragestellung: Das in den USA entwickelte Therapieprogramm der Multisystemischen Therapie (MST) wurde für den deutschsprachigen Raum adaptiert und erstmals bei 70 Jugendlichen angewendet. Es wurde die Frage untersucht, ob von der Anwendung der MST Einsparungseffekte gegenüber anderen Maßnahmen zu erwarten sind. Methodik: Um neben den Prozess- und Ergebnisaspekten der therapeutischen Intervention auch allfällige ökonomische Effekte der MST beurteilen zu können, wurden jene Fachpersonen, die die Jugendlichen in die MST zugewiesen hatten danach befragt, welcher Behandlungsweg ihrer Meinung nach ohne MST wahrscheinlich gewesen wäre. Die Kostenfolgen dieser Behandlungswege wurden ermittelt und den tatsächlichen Kosten der MST gegenübergestellt. Ergebnisse: Die ökonomische Evaluation der Implementierung der MST im deutschsprachigen Raum zeigte ein deutliches Einsparungspotenzial durch diese ambulante Therapieform: Die Fallkosten für die Durchführung der MST lagen um 40% bis 64% unter den Kosten für außerfamiliäre Platzierungen, die nach Einschätzung der ZuweiserInnen ohne MST erforderlich gewesen wären. Schlussfolgerungen: Bei der Multisystemischen Therapie handelt es sich nicht nur um ein effektives, sondern auch um ein relativ kostengünstiges Verfahren zu Behandlung von Jugendlichen mit schweren Störungen des Sozialverhaltens. Multisystemic Therapy (MST) for youths with severe conduct disorders – economic evaluation of the implementation in a German-speaking environment Objective: Multisystemic Therapy (MST) was adapted for implementation in a German-speaking environment. The study evaluates the possible economic effects of MST. Method: Professionals who recommended MST for youths with severe conduct disorders were asked to evaluate the probability of other forms of interventions if MST had not been used. We investigated the costs of those other forms of treatment and compared them to the costs that had actually been incurred with MST. Results: Implementation of MST in a Germanspeaking environment showed a significant potential of cost savings compared to other intervention methods. The costs of MST per case were between 40% and 64% lower than these of standard interventions. Conclusions: MST is not only an effective, but also a cost-efficient form of evidence-based treatment for youths with severe conduct disorders.
Keywords: conduct disorder; treatment and maintenance; family therapy; peer; juvenile delinquency; treatment method; statistical data; evaluation; economic impact; Switzerland
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Sherman, C. (2010). Multidimensional family therapy for adolescent drug abuse offers broad, lasting benefits : an approach that integrates individual, family, and community interventions; outperformed other treatments. NIDA Notes, 23(3; 12/2010), 13–15.
Abstract: Comparison of the two therapies found that a year after treatment, teen participants in the MDFT group had fewer drug-related problems and showed more improvement on general measures of behavior and mental health than those teens treated with cognitive-behavioral therapy (CBT). The therapies were compared in two randomized trials sponsored by the National Institute on Drug Abuse. The first study included 224 juvenile males, predominantly African-American, average age of 15 years, and from low-income, single-parent homes, who received either MDFT or CBT. Among the participants, 75 percent were diagnosed as cannabis dependent, 20 percent were alcohol dependent, and 13 percent were dependent on other substances. The study found that while both treatments were effective at discharge, in the months following treatment, youth who received MDFT had lower scores on the Personal Experience Inventory, which measures impairment due to personal, social, educational, and legal problems tied to drug abuse, than those youth who received CBT. The second study tested the effectiveness of MDFT versus CBT in a younger group of adolescent substance abusers, average age of 13.5 years. The results of this study were similar to those of the first study, in that both MDFT and CBT were effective at discharge, but those youth who received MDFT experienced longer lasting gains than the CBT youth. The MDFT youth had significantly lower levels of drug use, had improved their academic performance, had fewer arrests and placements on probation, suffered fewer psychiatric symptoms, and reduced self-reported delinquency and their association with delinquent peers. Issues for future research are discussed.
Keywords: adolescent; AOD abuse; family therapy; treatment and maintenance; treatment method; cognitive therapy; prevention; communicable disease; juvenile delinquency; research
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Liddle, H. A., Dakof, G. A., Turner, R. M., Henderson, C. E., & Greenbaum, P. E. (2008). Treating adolescent drug abuse : a randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103(10; 10/2008), 1660–1670.
Abstract: Aim: to examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) and multidimensional family therapy (MDFT). Design: A 2 (treatment condition) x 4 (time) repeated-measures intent-to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling. Setting: Community-based drug abuse clinic in the northeastern United States. Participants: A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse. Measurements: Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day frequency of alcohol use; (iv) 30-day frequency of other drug use; and (v) 30-day abstinence. Findings: Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. Conclusion: Both interventions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.
Keywords: adolescent; AOD abuse; research; treatment and maintenance; treatment method; family therapy; cognitive behavior therapy; randomized controlled trial
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Henderson, C. E., Rowe, C. L., Hawes, S. W., & Liddle, H. A. (2009). Parenting practices as mediators of treatment effects in an early-intervention trial of multidimensional family therapy. The American Journal of Drug and alcohol Abuse, 35(4), 220–226.
Abstract: Background: Contemporary intervention models use research about the determinants of adolescent problems and their course of symptom development to design targeted interventions. Because developmental detours begin frequently during early-mid adolescence, specialized interventions that target known risk and protective factors in this period are needed. Methods: This study (n = 83) examined parenting practices as mediators of treatment effects in an early-intervention trial comparing Multidimensional Family Therapy (MDFT), and a peer group intervention. Participants were clinically referred, low-income, predominantly ethnic minority adolescents (average age 14). Assessments were conducted at intake, and six weeks after intake, discharge, and at 6 and 12 months following intake. Results: Previous studies demonstrated that MDFT was more effective than active treatments as well as services as usual in decreasing substance use and improving abstinence rates. The current study demonstrated that MDFT improves parental monitoring—a fundamental treatment target—to a greater extent than group therapy, and these improvements occur during the period of active intervention, satisfying state-ofthe- science criteria for assessing mediation in randomized clinical trials. Conclusions and Scientific Significance: Findings indicate that change in MDFT occurs through improvements in parenting practices. These results set the foundation for examining family factors as mediators in other samples.
Keywords: adolescent; AOD abuse; family therapy; peer; mediation
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Ullmann, R. (2011). Geschichte der Substitutionsbehandlung in Deutschland. Akzeptanzorientierte Drogenarbeit = Acceptance-oriented drug work, 8(21.01.2011), 1–5.
Keywords: treatment and maintenance; methadone maintenance; outpatient care; general practitioner; government and politics; history; Germany; drug substitution therapy
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Gantner, A., Spohr, B., Bobbink, A. J., & Becker, H. (2007). Pendeldiplomatie im Quadrat : Multidimensionale Familientherapie (MDFT): ein systemischer Therapieansatz für Jugendliche mit Drogenproblemen und Verhaltensauffälligkeiten, deren Eltern und Bezugspersonen. Wiener Zeitschrift für Suchtforschung, 30(4), 13–26.
Abstract: Angesichts des europaweit steigenden Behandlungsbedarfs für jugendliche Cannabisklienten und der wissenschaftlich belegten Effektivität der Multidimensionalen Familientherapie für jugendliche Drogenklienten wird im Rahmen der europäischen INCANT Studie die in den USA entwickelte Multidimensionale Familientherapie (MDFT) eingeführt und in fünf europäischen Ländern wissenschaftlich evaluiert. Die gleichzeitige Arbeit mit den Jugendlichen, den Eltern, der Familie und anderen relevanten Personen im sozialen Kontext der jugendlichen Klienten ist ein Schwerpunkt des systemischen multidimensionalen Therapieansatzes, der in diesem Beitrag vorgestellt und anhand beispielhafter Therapieverläufe nachvollziehbar gemacht wird. Erste klinische Erfahrungen aus der Studie lassen eine Bestätigung der hohen Wirksamkeit von MDFT erwarten. MDFT is a family based systemic treatment model for adolescent drug abuse and related behavior problems. The model has been tested in several U.S. RCT studies and is developed by Howard Liddle and colleagues at the “Center for Treatment Research on Adolescent Drug Abuse” (CTRADA), University of Miami Medical School. Since 2006 MDFT is being tested in an international multi-site randomized controlled trial (INCANT) in Europe. The work with family members and the extra familiar system in different settings are core pieces of the treat-ment, which will be demonstrated by examples of clinical cases. First experiences with MDFT from the German INCANT site show promising outcomes regarding the effectiveness of MDFT Treatment.
Keywords: family therapy; adolescent; cannabis; parent; counseling; study; Europe; journal article
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Kuepper, R., van Os, J., Lieb, R., Wittchen, H. - U., Höfler, M., & Henquet, C. (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms : 10 year follow-up cohort study. British medical journal, 342, 8.
Abstract: Objective To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). Design Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study). Setting Population based cohort study in Germany. Participants 1923 individuals from the general population, aged 14-24 at baseline. Main outcome measure Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). Results In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively. Conclusion Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.
Keywords: AOD use, abuse, and dependence; AOD dependence; chemical addiction; cannabis; adolescence; AODR psychosis; risk factors; Germany
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