Juveniles in Drug Courts: Evidence-Based Program

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Table of Contents

Introduction
The Reasons to Implement BSFT for Addiction Treatment
Theoretical Framework of the Program
The Goals and Basic Principles of the Program
The Domains of the Program
Outcomes Supporting the Efficacy of the Program
Conclusion
References

Introduction

The juvenile drug court is a problem-solving institution that has a huge impact on the court system. Like any other court, it requires interaction among agencies, comprehensive treatment, continuous program assessment, and development of new models for change. It is highly important to find out what programs really make a positive difference in improving life and self-perception of teenagers, and what components a successful evidence-based practice must feature (Henggeler et al., 2006).

Evidence-based intervention is the one relying on the premise that the program can prove its effectiveness through the use of scientific methods. Despite the fact that a lot of juvenile courts are now encountering financial challenges, there are still many evidence-based interventions that can be implemented without additional expenses involved (Chandler, Fletcher, & Volkow, 2009). It has been proven that the most effective among them are those that target negative family experiences and encourage the participation of parents (Carr, 2009).

Brief Strategic Family Therapy (BSFT) is a program designed to improve adolescents’ behavior by addressing family issues that are in any way connected with the problems of this or that teenager. It is a short-term approach that helps youths abusing drugs and alcohol get rid of their addiction by establishing normal communication with their families (Miller, Sorensen, Selzer, & Brigham, 2006).

Thus, the paper at hand is aimed to investigate the effectiveness of this evidence-based program that has been developed and tested for over 35 years. It will start by identifying the facts supporting the application of the program and then describe its main components including the goals, principles, and domains, as well as conceptual influences on its evolution.

The Reasons to Implement BSFT for Addiction Treatment

The program relies upon the assumption that negative behaviors can be prevented or dealt with through improving family interactions. Maladaptive patterns are targeted and transformed into new, more effective ones (Szapocznik, Schwartz, Muir, & Brown, 2012).

BSFT program is capable of addressing teenagers’ problems providing their families with the necessary means to overcome addictions and return to normal life. The risk of drug and alcohol abuse is reduced in two major ways:

through correction of ineffective communication patterns in the family;
through the implementation of skill-building strategies that could help families be strong, enduring, and supportive.

The program views a family as the most influential driving force in both development of addiction and its treatment. The changes introduced in the family environment must be continuous and self-sustaining. Thus, the program is aimed not only to eliminate problems but also to create better functioning and more closely tight families. Since family members change the way they communicate, the effects produced usually last after the treatment has been finished (Szapocznik et al., 2012).

Another reason to implement BSFT is its precision and briefness. A session with a teenager (alone or with a family member) usually lasts from 60 to 90 minutes. It is enough to complete from 8 to 16 sessions within 3-4 months. However, severe cases of drug abuse often require doubling the number of sessions and their frequency. It is very convenient for adolescents that the treatment can be exercised in any place that seems to be the most suitable: home, the therapist’s office, or community settings (Robbins et al., 2011).

BSFT is designed as an integrative model that includes both structural and strategic techniques that are used to deal with problematic behaviors. Such a combination of approaches makes the program comprehensive, problem-oriented, well-structured, and practical as it is focused mostly not on theoretical implications but on developing real changes that can reduce the risks of addiction (Robbins et al., 2011).

BSFT is a flexible program that can be transformed to adapt to different situations and different kinds and severity of substance abuse. As it has been mentioned above, treatment modalities can be chosen according to the particular needs of this or that patient (Santisteban, Suarez-Morales, Robbins, & Szapocznik, 2006).

Besides being highly personalized, the program is also context-oriented, which means that it takes into consideration backgrounds of problem teenagers in order to identify what cultural factors could have led to drug abuse (Szapocznik et al., 2012).

Theoretical Framework of the Program

BSFT is supported by theoretical evidence provided by the following conceptual frameworks (Szapocznik et al., 2012):

communicative theory, which considers that a family is one inseparable whole and the problems of one family member is a collective responsibility of all the others;
interactional family therapy, which provides a concept map featuring blueprints for successful family communication;
strategic family therapy, which features specific interventions to deal with particular cases;
Social-Ecological Theory, which treats teenagers in the small family context that is a part of the larger social context;
Cognitive Behavior Theory, which is focused on the perception of the addiction problem by different family members and the ways they are likely to act under the suggested conditions;
affective therapy, which has a primary objective of developing closer connections in the family through the pragmatic use of emotions.

The Goals and Basic Principles of the Program

The major goals BSFT pursues when it is implemented in juvenile drug courts are to eliminate addictions and to modify family interactions so that they can reinforce positive behaviors (Henggeler et al., 2006).

There are three basic principles BSFT adheres to (Santisteban et al., 2006):

It is a family-system program, which implies the interdependence of family members’ experiences that have an impact on one another. Therefore, a teenager who is addicted to drugs reflects failures in family interactions.
It considers that repetitive patterns of accepted habitual behavior of the whole family influence individual decisions of each individual member.
It is practice-oriented. The program plans interventions that can eliminate negative behavior patterns, especially those that cause drug abuse. At the same time, BSFT strives to enhance the positive aspects of family interaction.

The Domains of the Program

All the interventions the program offers can be organized into four theoretically and empirically supported domains (Robbins et al., 2011):

Joining is the domain that has a purpose to create a union with the family. The therapist is required to show respect to the family members and the way the whole family is structured.
Tracking and diagnostic enactment help elaborate a treatment plan based on the practices observed in the family. The most important condition here is that the family should behave as they normally do as if the therapist were absent.
Reframing is applied to create motivation for improvement. For this purpose, negative experiences must be brought down to a minimum.
Restructuring is performed to modify family relations so that they would be based on trust, support, and mutual respect. It also has the purpose of developing conflict-solving skills.

Outcomes Supporting the Efficacy of the Program

BSFT has proven to be effective in dealing with not only general teenager problems but also with severe cases of drug abuse. The program has undergone a number of trials and is now on the list of model programs that constitute the National Registry of Evidence-Based Programs and Practices (Robbins et al., 2011).

BSFT strategies can be successfully implemented in drug courts in order to address both intrinsic and extrinsic factors that lead to deviant behavior. The initial research was carried out with a Hispanic population of Miami. The focus group consisted of 126 teenagers who used marijuana and other substances. The results showed that BSFT was more effective than group therapy as it managed to enhance family engagement by up to 93% (Rowe, 2012).

Recently, another study, which involved 400 adolescents and their families, was tested in NIDA showing even more promising results (Santisteban et al., 2006). The number of self-reported days of substance- and drug-abuse was considerably higher in the treatment as usual condition (TAU) than in the BSFT implemented during a period of 12 months, The model is now applied to various population groups including Hispanics, African Americans, and white Americans. It has also been successfully implemented in some European drug courts (Robbins et al., 2011).

Conclusion

Brief Strategic Family Therapy (BSFT) is an evidence-based program that is designed to address teenagers suffering from drug abuse through tracing related issues (capable of provoking deviant behaviors) in the family. Juvenile drug courts using the model provide therapists with a working tool, which deals not only with consequences of drug addiction but with its route causes that can be found in family maladaptive communicative patterns.

Studies of various population groups have demonstrated the effectiveness of the model in increasing family integration in the process of treatment and retention. Despite its short-term implementation, BSFT gives long-term results as the family gradually adopts a new model of communication-based on mutual trust, respect, and support.

References

Carr, A. (2009). The effectiveness of family therapy and systemic interventions for child‐focused problems. Journal of family therapy, 31(1), 3-45.

Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system: improving public health and safety. Jama, 301(2), 183-190.

Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of consulting and clinical psychology, 74(1), 42-54.

Miller, W. R., Sorensen, J. L., Selzer, J. A., & Brigham, G. S. (2006). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of substance abuse treatment, 31(1), 25-39.

Robbins, M. S., Feaster, D. J., Horigian, V. E., Rohrbaugh, M., Shoham, V., Bachrach, K.,… & Vandermark, N. (2011). Brief strategic family therapy versus treatment as usual: results of a multisite randomized trial for substance using adolescents. Journal of consulting and clinical psychology, 79(6), 713-727.

Rowe, C. L. (2012). Family therapy for drug abuse: Review and updates 2003–2010. Journal of Marital and Family Therapy, 38(1), 59-81.

Santisteban, D. A., Suarez-Morales, L., Robbins, M. S., & Szapocznik, J. (2006). Brief strategic family therapy: Lessons learned in efficacy research and challenges to blending research and practice. Family Process, 45(2), 259–271.

Szapocznik, J., Schwartz, S. J., Muir, J. A., & Brown, C. H. (2012). Brief strategic family therapy: An intervention to reduce adolescent risk behavior. Couple and Family Psychology: Research and Practice, 1(2), 134-145.

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