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Adolescent-Focused Family Behavior Therapy (Adolescent FBT)

Topic Areas
Scientific Rating
Child Welfare Relevance
Substance Abuse Treatment (Adolescent)
2  — Supported by Research Evidence
High

About This Program

Target Population: Youth (11-17) with drug abuse and dependence, as well as other co-existing problems

For children/adolescents ages: 11 – 17

For parents/caregivers of children ages: 11 – 17

Program Overview

Adolescent FBT includes more than a dozen treatments including treatment planning, behavioral goals, contingency contracting/Level System, communication skills training, job-getting skills training, self-control, stimulus control, and tele-therapy to improve session attendance. Therapies are consumer-driven and culturally sensitive. Adolescent FBT's goal is to result in positive outcomes in such areas as alcohol and drug use, depression, conduct problems, family dysfunction, and days absent from work/school. Adolescent FBT is designed to be used with youth, multiple ethnicities, differing types of substance abuse (alcohol, marijuana, and hard drugs), and across genders. Drafts of standardized client record keeping forms and quality assurance may be customized to fit agency needs.

Program Goals

The overall goals of Adolescent-Focused Family Behavior Therapy (Adolescent FBT) are:

  • Increase avoidance of alcohol and drug use
  • Optimize mood and mental strength and stability
  • Optimize conduct
  • Optimize family functioning
  • Increase the number of days in school/work

Logic Model

The program representative did not provide information about a Logic Model for Adolescent-Focused Family Behavior Therapy (Adolescent FBT).

Essential Components

The essential components of Adolescent-Focused Family Behavior Therapy (Adolescent FBT) include:

  • Treatment Components
    • A structured Program Orientation that includes prompts to assist in gaining feedback from clients about the obtained assessment results, and providing opportunities to review issues that are common to the target population.
    • Treatment Planning options that are anchored to specific Adolescent FBT components and prioritized by the client and family.
    • Communication Skills Training exercises in which clients and their families share what they love, admire, and respect about one another, learn to make positive requests, and develop conflict resolutions skills.
    • Job-getting Skills Training to teach clients and family how to solicit and do well in job interviews.
    • A Self-Control intervention in which clients and their family learn to identify and manage triggers to problem behaviors, such as child neglect, HIV risk, drug abuse, and anger in imaginary trials.
    • A Stimulus Control intervention in which clients and their family learn to restructure their environment to eliminate or manage negative emotions and things in the environment that cause them to engage in troublesome behaviors, such as substance abuse, child maltreatment, arguments, etc.
    • Tele-therapy with clients and their significant others to assure therapy assignments and treatments are being reviewed as prescribed, and increase therapy session attendance.
  • Contextual Programming
    • Structured Pre-Training Questionnaires to be completed by therapists and administrators of the treatment agency to customize the Adolescent FBT training experience to fit the unique needs of the agency's culture.
    • Published and Non-Published Training Manuals include brief overviews and rationales of each of the intervention approaches, client worksheets and homework assignment forms, and methods of implementing the therapy components.
    • Protocol Checklists depict how to implement the Adolescent FBT treatment components, and include step-by-step instructions for therapists to utilize during their intervention sessions.
    • Training/Supervision Protocol Checklist depicts steps involved in maintaining on-going training and supervision protocol that are consistent with Adolescent FBT.
    • Forms Relevant to Client Record Keeping include standardized progress notes, treatment plans, log of contacts, monthly client progress reports to outside parties (i.e., caseworker, judges), termination reports, etc. that correspond to Adolescent FBT components.
    • Quality Assurance Monitoring forms to assure adequacy of client charting and clinic procedures.
    • Data Management System that may be used to organize program related outcome data that is relevant to Adolescent FBT.
  • Adolescent FBT has a family component where siblings/children are treated at the same time as the substance abuser.

Program Delivery

Child/Adolescent Services

Adolescent-Focused Family Behavior Therapy (Adolescent FBT) directly provides services to children/adolescents and addresses the following:

  • Alcohol and drug misuse, depression, school/work attendance problems, problem solving skill deficits, conduct problems, and problems in the family relationship

Parent/Caregiver Services

Adolescent-Focused Family Behavior Therapy (Adolescent FBT) directly provides services to parents/caregivers and addresses the following:

  • Assisting youth in their alcohol and drug misuse, depression, school/work attendance problems, problem solving skills, conduct problems, and problems in the family relationship

Recommended Intensity:

Starts with 1- to 2-hour initial outpatient once or twice in the first week then it varies depending on multiple factors that are determined between the client, client's family, and treatment provider (e.g., population, setting, intensity of treatment plan, effort).

Recommended Duration:

Typically 6 months to 1 year. It varies depending on multiple factors that are determined between the client, client's family, and treatment provider (e.g., population, setting, intensity of treatment plan, effort).

Delivery Setting

This program is typically conducted in a(n):

  • Outpatient Clinic

Homework

Adolescent-Focused Family Behavior Therapy (Adolescent FBT) includes a homework component:

All treatment components have a therapy assignment, with most including easy-to-complete forms with fill-in-the-blank spaces, check boxes, and pictures (to assist family members who have problems reading and make the forms more exciting). Practice assignments are reviewed each session to assist clients and their families in generalizing and expediting skill acquisition. Incomplete assignments are reviewed in retrospect during session to encourage future completion.

Languages

Adolescent-Focused Family Behavior Therapy (Adolescent FBT) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Protocol checklists to guide therapy implementation
  • A private place in which to conduct therapy
  • Donohue, B., & Azrin, N. H. (2011). Family Behavior Therapy: A step-by-step approach to adolescent substance abuse. Hoboken, NJ: John Wiley & Sons, Inc.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Supervisors must be state-licensed mental health professionals with an interest in supervising the intervention. They should ideally have experience in conducting evidence-based therapies, particularly cognitive-behavioral therapies, and must have professional therapeutic experience serving the population that is being targeted for treatment.

Providers should be state-licensed mental health professionals, or supervised by state-licensed mental health professionals (if permitted by law to do so). They should ideally have experience serving the population that is being targeted for treatment, and must have an interest in conducting therapy utilizing the intervention.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training usually occurs in the treatment agency, although other arrangements can be made based on agency needs and trainer availability. The website below includes links to more information about the program, including examples of free access to films of program implementation in simulated therapy sessions, empirical studies of the program, measures that have been used to examine the program, and potential trainers.

Number of days/hours:

There are a number of persons who have received extensive training in the program, and have expressed an interest in training others for a negotiated fee. Dr. Donohue may be contacted to assist in determining potential trainers (see below). Dr. Donohue receives no financial compensation from these trainers, and will not accept financial compensation from community-based agencies for assistance he may provide relevant to locating trainers. Although the training format may vary somewhat depending on who conducts the training, trainers utilize conference calls and questionnaires to assist trainers in learning about agency needs.

Training involves an initial 3 to 3.5 day workshop, two 3-day booster workshops, and 8 to 12 months of weekly on-going trainings over the phone between 60 to 90 minutes.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Adolescent-Focused Family Behavior Therapy (Adolescent FBT) as listed below:

A Preparation Guide for FBT Adoption and the Adult FBT Training Requirements Table are available to assist agencies in determining if they have the required funding and support to determine their readiness (located on the FBT website). There are training films and protocol checklists publicly available on the website to assist in determining if the intervention fits the agency's culture. Three chapters in the training manual are dedicated to methods of improving the agencies infrastructure to support FBT, including methods of recruitment, assessment of consumer satisfaction, and other strategies to assist FBT adoption. These materials are available at http://familybehaviorther.wixsite.com/familytherapy.

Formal Support for Implementation

There is formal support available for implementation of Adolescent-Focused Family Behavior Therapy (Adolescent FBT) as listed below:

Family Research & Services at the University of Nevada, Las Vegas maintains a FBT website (http://familybehaviorther.wixsite.com/familytherapy). Brad Donohue, PhD, oversees this site and assists agencies in finding training consultants. In the event that no trainers are available, or funds to facilitate training are limited, Dr. Donohue may be contacted to potentially conduct training.

Fidelity Measures

There are fidelity measures for Adolescent-Focused Family Behavior Therapy (Adolescent FBT) as listed below:

Fidelity is achieved by examining the percentage of intervention items that are completed by the provider for each intervention component (i.e., see intervention protocol checklists), according to the trainer. Reliability is assessed by comparing the trainer's score with the provider's score. This fidelity method has been psychometrically examined in peer-reviewed journal articles, including: Sheidow, A. J., Donohue, B., Hill, H. H., Henggeler, S.W., & Ford, J. D. (2008). Development of an audio-tape review system for supporting adherence to an evidence-based practice. Professional Psychology Research & Practice, 39, 553-560. For more information, see http://familybehaviorther.wixsite.com/familytherapy or contact Brad Donohue, PhD (contact information listed at end of entry).

Implementation Guides or Manuals

There are implementation guides or manuals for Adolescent-Focused Family Behavior Therapy (Adolescent FBT) as listed below:

In addition to the published treatment manual, there are training films, protocol checklists to guide intervention implementation, methods of assessing adherence, and a guide for FBT adoption. The manual and the other tools mentioned above are available through http://familybehaviorther.wixsite.com/familytherapy or Brad Donohue, PhD (contact information listed at end of entry).

Research on How to Implement the Program

Research has not been conducted on how to implement Adolescent-Focused Family Behavior Therapy (Adolescent FBT).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Azrin, N. H., McMahon, P. T., Donohue, B., Besalel, V. A., Lapinski, K. J., Kogan, E. S., Acierno, R. E. & Galloway, E. (1994). Behavior therapy for drug abuse: A controlled treatment outcome study. Behaviour Research and Therapy, 32(8), 857–866. https://doi.org/10.1016/0005-7967(94)90166-X

Type of Study: Randomized controlled trial
Number of Participants: 82 (68 Adults and 14 Youth [under 19 years])

Population:

  • Age — Mean=27.5 years
  • Race/Ethnicity — 9% Afro-American, Hispanic, or Native American
  • Gender — 68% Male and 32% Female
  • Status — Participants were recruited from agencies and through newspaper advertisements and were eligible if they had used illegal drugs at least once during the past month & during the initial 1-month assessment period, and were NOT currently under psychological treatment.

Location/Institution: Ft. Lauderdale, FL/Nova Southeastern University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to determine whether psychological interventions can be effective in the treatment of drug abuse. Participants were randomly assigned to either the behavioral [now called Adolescent-Focused Family Behavior Therapy (Adolescent FBT)] treatment group or the nonbehavioral program condition control group. Measures utilized include the Beck Depression Inventory (BDI) and Parent-Youth Happiness Scale. Urine samples were obtained each session, and one sample each month during treatment underwent urinalysis. Results indicate that illegal drug use was reduced to a greater extent by the behavioral program than the nonbehavioral. Reduction was greatest for the youth (who were typically treated with their parent[s]) who participated actively in Adolescent FBT. Youth in the treatment group averaged 8.9 months of abstinence during the 12 months of the study compared to less than one month of abstinence for youth in the control group. Limitations include the small sample size, the fact that the sample included a majority of adults rather than youth, and lack of long-term follow-up.

Length of controlled postintervention follow-up: None.

Azrin, N. H., Donohue, B., Besalel, V. A., Kogan, E. S., & Acierno, R. (1994). Youth drug abuse treatment: A controlled outcome study. Journal of Child and Adolescent Substance Abuse, 3(3), 1–16. https://doi.org/10.1300/J029v03n03_01

Type of Study: Randomized controlled trial
Number of Participants: 26

Population:

  • Age — 13–18 years
  • Race/Ethnicity — 5 African-American or Hispanic
  • Gender — 20 Male and 6 Female
  • Status — Participants were recruited from agencies, schools, and newspaper advertisements.

Location/Institution: Ft. Lauderdale, FL/Nova Southeastern University

Summary: (To include basic study design, measures, results, and notable limitations)
The study is an extension of Azin, McMahon, et al. (1994); 14 of the 26 subjects were in that study. The purpose of the study was to extend a prior study that involved both adults and youth (14 youth, or 17% of the sample size) by increasing the number of youth participants. Participants were randomly assigned to either the behavioral treatment group [now called Adolescent-Focused Family Behavior Therapy (Adolescent FBT)] or a supportive treatment program control group. In the supportive program, parents attended sessions once a month, while parents in the behavioral intervention attended each session. Measures utilized include Parent and Youth Satisfaction Scales, the Beck Depression Inventory (BDI), and the Quay Problem Behavior Checklist. In addition, a urine sample was obtained each session for urinalysis, and performed once per month during the 6-month treatment period.  Results indicate that illegal drug use was reduced by the Adolescent FBT to a relatively greater extent than by the supportive program. Alcohol use was significantly reduced in subjects receiving behavioral therapy but increased in subjects receiving supportive counseling. The behavioral program also produced significantly greater improvements, relative to the supportive program, in several areas related to drug use, including decreased depression levels, improved school/employment attendance, and improved family relationships. Limitations include a small sample size, and the lack of long-term follow up.

Length of controlled postintervention follow-up: None.

Azrin, N.H., Acierno, R., Kogan, E. S., Donohue, B., Besalel, V. A., & McMahon, P. T. (1996). Follow-up results of Supportive versus Behavioral Therapy for illicit drug use. Behaviour Research and Therapy, 34(1), 41–46. https://doi.org/10.1016/0005-7967(95)00049-4

Type of Study: Randomized controlled trial
Number of Participants: 74

Population:

  • Age — Youth: 13–18 years (57 Adults and 17 Youth, Total age range: 13–43 years)
  • Race/Ethnicity — 9 Minority Persons
  • Gender — 55 Male and 19 Female
  • Status — Participants were from a pool of subjects who had initiated treatment within the previous two years.

Location/Institution: Ft. Lauderdale, FL/Nova-Southeastern University

Summary: (To include basic study design, measures, results, and notable limitations)
The study used 64 subjects from Azin, Donohue, et al. (1994) and Azin, McMahon, et al. (1994). The purpose of the study was to follow-up on the supportive results from the previous 1994 studies. Participants were assigned randomly to either a supportive-discussion counseling program or to a directive behavioral program [now called Adolescent-Focused Family Behavior Therapy]. Measures utilized include urinalyses, self-report, and report of significant others to measure drug use. Follow-up data was obtained for subjects who had been treated in a controlled comparison of behavioral vs. supportive-discussion counseling for drug abuse. Results indicate that at the follow-up month, drugs were used at least once by more of adolescents in the supportive-discussion counseling control group than those in the Adolescent-Focused Family Behavior Therapy treatment group. Overall, in terms of the number of days of use per month, participants in the control group did not decrease drug use either by the end of treatment or at follow-up unlike the participants in the treatment group, whose drug use decreased by the end of treatment and even more at follow-up. Limitations include the mixed sample of both adults and youth, the fact that 25 subjects dropped out before follow-up data could be obtained, the high variability of follow-up lengths, and the self-report component of drug use measures.

Length of controlled postintervention follow-up: At least 6 months.

Azrin, N. H., Donohue, B., Teichner, G., Crum, T., Howell, J., & DeCato, L. (2001). A controlled evaluation and description of Individual-Cognitive Problem Solving and Family-Behaviorl therapies in dually-diagnosed conduct-disordered and substance-dependent youth. Journal of Child and Adolescent Substance Abuse, 11(1), 1–43. http://doi.org/10.1300/J029v11n01_01

Type of Study: Randomized controlled trial
Number of Participants: 56

Population:

  • Age — 12–17 years
  • Race/Ethnicity — 44 Caucasian, 9 Hispanic, 2 Other, and 1 African-American
  • Gender — 46 Male and 10 Female
  • Status — Participants were referred to the study by juvenile detention center staff, judges, probation officers, and school administrators.

Location/Institution: Ft. Lauderdale, FL/Nova-Southeastern University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the treatment efficacy of Adolescent-Focused Family Behavior Therapy in a dually-diagnosed population (Conduct Disorder and Substance Abuse Disorder). Participants were randomly assigned to receive either individual cognitive problem-solving therapy (ICPS) [now called I Can Problem Solve (ICPS)] or family-behavioral therapy [now called Adolescent-Focused Family Behavior Therapy]. Measures utilized include the Timeline Followback (TLFB) interview, which assesses the frequency of illicit drug and alcohol use, urine samples obtained during each assessment and treatment session, the Beck Depression Inventory (BDI), Eyberg Child Behavior Inventory (ECBI), and Child Behavior Checklist (CBCL). Results indicate that participants in both intervention groups showed significant improvements in their conduct and reductions in their use of illicit drugs from pretreatment to posttreatment, and these results were maintained at 6-month follow-up. However, initiation of the family intervention led to a slight reduction in hard drug use during treatment and follow-up months, whereas initiation of the ICPS resulted in an insignificant reduction in hard drug use during treatment, and an increase in hard drug use during the follow-up months. Limitations include the small sample size and lack of a “no-treatment” control condition.

Length of controlled postintervention follow-up: 6 months.

Additional References

Donohue, B., Allen, D. A., & Lapota, H. (2009). Family Behavior Therapy. In D. Springer & A. Rubin (Eds.), Substance abuse treatment for youth and adults (pp. 205-255). John Wiley & Sons, Inc.

Donohue, B., & Azrin, N. H. (2001). Family Behavior Therapy. In E. Wagner & H. Waldron (Eds.), Innovations in adolescent substance abuse intervention (pp. 205-227). Pergamon Press.

Donohue, B., & Azrin, N. H. (2011). Family Behavior Therapy: A step-by-step approach to adolescent substance abuse. John Wiley & Sons, Inc.

Contact Information

Brad Donohue, PhD
Agency/Affiliation: University of Nevada, Las Vegas
Website: familybehaviorther.wixsite.com/familytherapy
Email:
Phone: (702) 557-5111

Date Research Evidence Last Reviewed by CEBC: June 2023

Date Program Content Last Reviewed by Program Staff: February 2017

Date Program Originally Loaded onto CEBC: April 2010