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Adult-Focused Family Behavior Therapy (Adult-Focused FBT)

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

About This Program

Target Population: Adults with drug abuse and dependence, as well as other co-existing problems such as depression, family dysfunction, trauma, child maltreatment, noncompliance, employment, HIV/STIs risk behavior, and poor communication skills

Program Overview

Adult-Focused FBT includes more than a dozen treatments including management of emergencies, treatment planning, home safety tours, behavioral goals and rewards, contingency management skills training, communication skills training, child management skills training, job-getting skills training, financial management, self-control, environmental control, home safety and aesthetics tours, and tele-therapy to improve session attendance. Therapies are consumer-driven and culturally sensitive. Adult-Focused FBT is designed to be used with adults, 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. Adolescent-Focused Family Behavior Therapy (Adolescent FBT) has also been rated on this website, please click on the program name to be sent to its separate page.

Program Goals

The overall goals of Adult-Focused Family Behavior Therapy are:

  • Decrease alcohol and drug use
  • Decrease depression
  • Decrease conduct problems
  • Decrease family dysfunction
  • Decrease days absent from work/school
  • Decrease child abuse potential
  • Decrease HIV Risk Behaviors

Logic Model

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

Essential Components

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

  • Treatment Components:
    • A structured Program Orientation that includes prompts to assist in gaining feedback from clients about the obtained assessment results, and provides opportunities to review issues that are common to the target population.
    • A list of commonly experienced triggers to substance abuse and other problem behaviors that, when endorsed by clients, may be quickly switched into pre-established Behavioral Goals and Rewards through the establishment of family support systems.
    • Treatment Planning options that are anchored to specific Adult-Focused FBT components and prioritized by both the client and client's 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.
    • Child Management Skills Training in which parents learn to discipline their children by catching them being good, positive practice learning exercises, and, when necessary, provision of firm directives and undesired consequences.
    • Job-getting Skills Training to teach clients and family how to solicit and do well in job interviews.
    • A Financial Management intervention in which clients and their family learn to use a standardized worksheet with common methods of earning and saving extra income and reducing expenses.
    • 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.
    • Assurance of Basic Necessities in which potential or impending emergencies are endorsed by clients from a list, and the self-control procedure is taught to keep the family safe.
    • Home Safety and Aesthetics Tours when intervention is implemented within the home to to assist in preventing home accidents, which are the leading cause of death and serious injury in small children.
    • Environmental Control 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 Adult-Focused 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 Adult-Focused 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 Adult-Focused FBT.
    • Forms Relevant to Client Record Keeping include standardized progress notes, treatment plans, log of contacts, monthly client progress reports to outside parties (e.g., caseworker, judges), termination reports, etc. that correspond to Adult-Focused 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 Adult-Focused FBT.

Program Delivery

Parent/Caregiver Services

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

  • Alcohol and drug misuse, depression, school/work attendance problems, parenting stress, poor child management and communication skills, family dysfunction, HIV prevention, child abuse and neglect, home hazards, management of emergencies, and conduct problems in children
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: Adult-Focused FBT has treatment components directly related to raising children such as communication skills training and child management skills training in which parents learn to discipline their children by catching them being good, positive practice learning exercises, and, when necessary, provision of firm directives and undesired consequences.

Adult Services

Adult-Focused Family Behavior Therapy (Adult-Focused FBT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Alcohol and drug misuse, depression, work attendance problems, poor communication skills, and management of emergencies

Recommended Intensity:

Starts with 1 to 2-hour initial outpatient or home-based sessions once or twice in the first week then fades in frequency 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 (e.g., population, setting, intensity of treatment plan, effort) that are determined by the client, client's family, and treatment provider.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Foster / Kinship Care
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

Adult-Focused Family Behavior Therapy (Adult-Focused 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

Adult-Focused Family Behavior Therapy (Adult-Focused 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., & Allen, D. A. (2011). Family Behavior Therapy: A step-by-step approach to adult substance abuse. 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 should have professional therapeutic experience serving the population that is being targeted for treatment.

Therapists should be state-licensed mental health professionals. 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 may occur at the treatment agency. Other training sites are currently available in Pennsylvania, Nevada, California, Florida, Tennessee, Kentucky, and Idaho.

Number of days/hours:

The process begins with conference calls and questionnaires to learn the unique needs of the agency wishing to be trained. Several training options are available. The full FBT training package includes 4 modules:

  • Substance Abuse/Problem Behavior interventions
  • Family Relationship Building interventions
  • Job-Getting and Financial Management
  • Child management Skills Training (when clients are parents)

The full package is conducted across a 2.5- to 3-day workshop, a 2- to 2.5-day booster workshop 4 months after the initial workshop, a 2- to 2.5-day workshop 8 months after the initial workshop, and approximately 33 on-going telephone training meetings. When less intensive training is desired, the modules can be separated. The Substance Abuse/Problem Behavior module and Child Management Skills Training Module each requires a 2-day workshop w/ 19 on-going telephone training sessions; the Family Relationship Building module, as well as the Job-Getting and Financial Management modules each require a 1-day workshop with 7 on-going telephone training sessions.

Additional Resources:

There currently are additional qualified resources for training:

Several agencies have received training, and have indicated availability to assist in training. A current list of these agencies is available from Dr. Brad Donohue (see above contact information). Dr. Donohue has agreed to provide cost-free assistance in the identification of training services from agencies for which he receives no financial compensation as well as other publicly available resources relevant to the program.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Adult-Focused Family Behavior Therapy (Adult-Focused 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 Adult-Focused Family Behavior Therapy (Adult-Focused 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.

Fidelity Measures

There are fidelity measures for Adult-Focused Family Behavior Therapy (Adult-Focused 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. https://doi.org/10.1037/0735-7028.39.5.553

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 Adult-Focused Family Behavior Therapy (Adult-Focused 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 Adult-Focused Family Behavior Therapy (Adult-Focused 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 of drug abuse: A controlled 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

Population:

  • Age — Mean=27.5 years
  • Race/Ethnicity — 91% Not Specified and 9% African-American, Hispanic, or Native American
  • Gender — 68% Male and 32% Female
  • Status — Participants were adolescents and adults with substance use dependency who were recruited from community settings.

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 evaluate the efficacy of Adult-Focused Family Behavior Therapy (Adult-Focused FBT) in a sample of adults with substance use dependency. Participants were randomly assigned to either the behavioral (Adult-Focused FBT) or non-behavioral program conditions. Measures utilized include the Beck Depression Inventory (BDI) and the Parent and Youth Happiness Scales. Urine samples were obtained each session, and one sample each month during treatment underwent urinalysis. Results indicate that the Adult-Focused FBT intervention was more effective across sex, age, educational level, marital status and type of drug (hard drugs, cocaine, and marijuana). Greater improvement was also noted on measures of employment/school attendance, family relationships, depression, institutionalization, and alcohol use. 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. [Note: Follow-up is reported in Azrin et al. (1996).]

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 — 13–43 years
  • Race/Ethnicity — 88% Not Specified and 12% Non-Caucasian
  • Gender — 92% Male and 8% Female
  • Status — Participants were adolescents and adults with substance use dependency who were recruited from the Azrin et al. (1994) study.

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

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Azrin et al. (1994). The purpose of the study was to evaluate the efficacy of Adult-Focused Family Behavior Therapy (Adult-Focused FBT) in a sample of adolescents and adults with substance use dependency. Participants were randomly assigned to Adult-Focused FBT treatment group or to a supportive-discussion counseling program for a duration of 8 months. Measures utilized include urinalysis, self-report, and report by significant others of drug usage. Results indicate that participants in Adult-Focused FBT engaged in less substance use at follow-up than the supportive-discussion counseling program participants. Limitations include small sample size, high variability of follow-up lengths, and that 25 subjects dropped out before follow-up data could be obtained.

Length of controlled postintervention follow-up: 9 months.

Donohue, B., Azrin, N. H., Bradshaw, K., Van Hasselt, V. B., Cross, C. L., Urgelles, J., Romero, V., Hill, H. H., & Allen, D. N. (2014). A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse. Journal of Consulting and Clinical Psychology, 82(4), 706–720. https://doi.org/10.1037/a0036920

Type of Study: Randomized controlled trial
Number of Participants: 72

Population:

  • Age — Mean=29.04 years
  • Race/Ethnicity — 47% Caucasian, 25% African American, 11% Hispanic/Latino, 7% Other, 4% American Indian, 3% Asian American, and 3% Pacific Islander
  • Gender — 100% Female
  • Status — Participants were referred by child protective services due to substance abuse and child neglect.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effects of Adult-Focused Family Behavior Therapy (Adult-Focused FBT) as compared to treatment as usual community-based services (TAU). Participants were randomly assigned to Adult-Focused FBT or TAU. Measures utilized include the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID), Timeline Followback (TLFB), and the Risk Assessment Battery (RAB). Results indicate that mothers referred for child neglect not due to their children being exposed to illicit drugs demonstrated better outcomes in child maltreatment potential from baseline to 6- and 10-month postrandomization assessments when assigned to Adult-Focused FBT, as compared with TAU mothers and Adult-Focused FBT mothers who were referred due to child drug exposure. Similar results occurred for hard drug use from baseline to 6 and 10 months postrandomization. However, TAU mothers referred due to child drug exposure were also found to decrease their hard drug use more than TAU mothers of non-drug-exposed children and Adult-Focused FBT mothers of drug-exposed children at 6 and 10 months postrandomization. Limitations include the small sample size, the lack of outcome measures specific to the direct assessment of behaviors, home conditions, attitudes, and underlying belief systems of participants, and the limited length of follow-up.

Length of controlled postintervention follow-up: Approximately 4 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. (2011). Family Behavior Therapy: A step-by-step approach to adult 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: September 2022

Date Program Content Last Reviewed by Program Staff: February 2017

Date Program Originally Loaded onto CEBC: November 2010