Running Head: AN INTEGRATIVE REVIEW: FAMILY CENTERED TREATMENT 1

An Integrative Review: Family Centered Treatment

Anna Read Barth

Bon Secours Memorial College of Nursing

NUR 4122

April 11, 2017

I pledge. Anna Read Barth

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Abstract

The goal of this integrative review is to examine research studies that reflect upon the

growing epidemic of adolescent substance abuse and the effects of family based therapies

versus individual therapies on an adolescents outcome once treatment is complete.

Adolescent substance abuse continues to be public health issue throughout the world that

often leads to long-term complications that are detrimental. These complications include

but are not limited to physical illnesses, impaired academic and occupational function, or

cognitive defects (Wang et al., 2016). Unfortunately, this high-risk group has not

received consistent attention in regards to identifying the most beneficial therapeutic

modality to ensure substance abuse treatment is effective once the child returns home.

This lack of research results in limitations to this review. Additional limitations to the

review include a limited number of databases used, lack of experience, and completing

this assignment individually per course requirements. The EBSCO Discovery Services

and PubMed databases, along with various clinical journals, were utilized to obtain the

incorporated research articles. Findings indicated several positive results to

implementing family based therapy and modifications to the childs behavior. As this

horrific disease continues to take control of the lives of many adolescents, additional

research should be conducted that incorporates various time trials of follow up family

therapy to determine how long this treatment should be used to maintain the effects once

the primary rehabilitation process is complete

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An Integrative Review: Family Centered Treatment

Incorporating family based therapy in an adolescents substance abuse treatment

is empirical as an interventional modality to ensure positive results are in place once a

child has completed the assigned curriculum. Various research studies have linked

unstable family factors to the development of adolescent substance use. In efforts to

enhance family functioning during therapy and at home, treatment facilities encourage

supporting family members or guardians to participate in the adolescents substance

abuse treatment. According to the research retrieved from Bertrand et al. (2013)

positive family influence is an important dimension that should be better documented

since it has been identified as a best practice. The aim of this integrative review is to

examine pertinent literature pertaining to the identified PICO question, in adolescents

who take illicit drugs, what is the effect of individual substance abuse treatment

compared with family centered treatment services? The researchers particular interest in

pediatrics, as well as the growing illicit drug epidemic, inspired this topic to be reviewed.

The researcher located numerous research studies that examine the effects of substance

abuse on adolescents. However, as this vulnerable population continues to grow across

the world, there is limited research available that compares the effectiveness of individual

substance abuse treatment to family centered treatment.

Research Design, Search Methods, & Search Outcomes

This particular integrative review examines five research articles that were found

in the EBSCO Discovery Services and PubMed databases, as well as various clinical

journals. The researcher maintained the use of specific search criteria such as articles

that were published with in the past five years (2012 2017), peer reviewed, and not
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labeled as systematic reviews or meta-analyses. Selecting academic journals with full

English text in the options tab also filtered articles in the search engines. Key terms that

were incorporated into the searches include adolescent substance abuse treatment,

individual therapy and family based therapy. EBSCO Discovery services yielded 110

articles and PudMed yielded 420 articles.

These qualifications for article use severely limited the available options for this

literature review. However, five articles were selected; each meeting the designated

standards listed above. Each research article shares the common design method of a

quantitative study. An additional similarity was identified among three of the articles in

that they are randomized clinical trials, while two articles are non-randomized clinical

trials.

Findings/Results

The results and findings of the research clearly recognize family based therapy as

a more therapeutic modality when compared to individual therapy for adolescents

suffering from substance abuse. When parents participate in services offered by the

treatment facility, the rehabilitation facility can assist in rebuilding a trusting relationship

between family members. It also helps both parties recognize a need for change and this

desire can be put into action through a common grand (Bertrand et al., 2013). A

summary of the research articles is located in Appendix 1. This literature review of the

selected articles is structured according the following categories: psychosocial family

functioning in the child-parent relationship and relapse rates following completion of

family-based therapy.
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Psychosocial Functioning in the Child-Parent Relationship:

A common similarity noticed throughout three of the studies is the impact of

parental inclusion in an adolescents substance abuse therapy and how psychosocial

behaviors change in the parent-child relationship once treatment is complete (Pugatch,

Knight, McGuiness, Sherritt, & Levy, 2014). Each of these studies utilized the

phenomenological approach to gain valuable data pertaining to this area of concern. In

the quantitative study conducted by Bertrand et al. (2013), 147 adolescents and 69

mothers were recruited from two substance abuse programs in Quebec, Canada: an

outpatient program and a residential program. Data on maternal psychological distress

and parenting practices was collected from each child and parent participant at treatment

admission (T0) and at the six-month follow-up (T2). Parenting practices were also

assessed through the adolescent and parent versions of Stattin and Kerrs questionnaire.

This study utilized data that was specific to the parents reflection on their adolescents

self-disclosure, while the adolescents submitted data about their perception of parental

warmth. Both sample groups completed the questionnaires at treatment entry (T0) and

the six-month follow up (T2). The differences between the two scores measured the

change in parenting practices. Both of these major variables were analyzed and tested

using MPlus software, through a variable path diagram via structural equation modelling

(SEM) (Bertrand et al., 2013). The study demonstrated a significant improvement in

maternal health after adolescent substance abuse treatment. Successful completion of the

treatment program was also positively associated with parental warmth. This can be

concluded from self-disclosure reports of the participating adolescent. These two

changes in parental behaviors influenced a greater reduction in adolescent drug use as

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well. The relationship between maternal mental health and adolescent substance use is

indirect though. Parental warmth must be implemented first before improvements in the

adolescent are noticed. This finding is supported through the treatment facilities

conclusion that psychological distress of the mother must stabilized before addressing the

parental practices.

In the experimental study conducted by Pugatch et al. (2014), 42 adolescents and

72 parents received weekly evaluations containing five questions with forced responses

and two open-ended questions that asked about knowledge, satisfaction, and high-risk

behaviors. Each adolescent evaluations included three additional questions regarding

frequency of alcohol, opioid, marijuana, and other drug use; needle use; and driving risk.

The parents evaluations also asked about their Perception of their childs high-risk

behaviors and frequency of alcohol, marijuana, and other drug use. A final evaluation of

the information discussed in class and changes in their childs status of psychosocial

domains of functioning was offered to parents that maintained consistent attendance

throughout the childs treatment regimen. For adolescents that completed ten or more

group sessions a final evaluation was offered about information discussed in class and

changes in their psychosocial domains of functioning. De-identified data from the

evaluations was entered and analyzed into an SPSS Version 19. Simple frequencies were

calculated in regards to the weekly evaluation submissions. Scores from the final

evaluations were also calculated as simple frequencies and collapsed into dichotomous

variables to determine the proportion of participants who reported any improvement in

knowledge of the various domains of functioning. Researchers received final evaluation

submissions from a majority of the adolescents. This is a significant finding because

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previous research suggests that rates of completion are correlated with an adolescent

outcomes following treatment for substance abuse disorders. Weekly reports of

substance use from adolescents also showed to be in a very high agreement with their

parents perception of the childs usage. Previous research has found that parents often

underestimate their childs illicit drug usage. However, this finding is important because

it suggests that communication improvements may have developed between the

participating adolescent and parent, as a result of information taught throughout the

curriculum.

Research by Slesnick, Guo, & Feng (2013) evaluated the effect of three

empirically supported psychotherapy treatments on parent and child-reported

internalizing and externalizing behaviors among substance abusing adolescents. The

study consisted of 179 children along with their parent. Urn randomization was used to

assign each adolescent to one of the following therapies (1) Motivational Interviewing

(MI), (2) the Community Reinforcement Approach (CRA), or (3) Ecologically-Based

Family Therapy. Adolescents were given The Youth Self-Report of the Child Behavior

Checklist to quickly elicit reports of childrens behaviors across a wide range of

problems such as delinquency, aggression or schizoid behavior. The accompanying

parent completed the Child Behavior Checklist. This questionnaire assessed their

perception of the adolescents problem behaviors. Subscale scores were calculated based

on the YSR/CBCL manual and these raw scores were used for data. In order to compare

the differences between CBCL and YSR reports of internalizing and externalizing

behaviors at baseline and 24 months, a series of paired-sample t tests were used. Results

indicated that during the short term follow up assessments; the three treatments were
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similar in their ability to reduce internalizing and externalizing behaviors. EBFT did not

cause an increase in external and internal behaviors, which supports the goal of this

therapy; enhancing family interaction patterns to eliminate conflicting internalizing and

externalizing behaviors.

Relapse Rates Following Family Based Therapy

Two of the three studies examined the long-term effects; particularly relapse rates,

after participating in family based therapy during adolescent substance abuse treatment.

Horigan et al. (2015) conducted a cross sectional assessment consisting of 261

adolescents. Each participant was randomly assigned to the Brief Strategic Family

Therapy (BSFT) or the treatment as usual (TAU) group. Of the 12 16 sessions held for

each intervention, participants had to attend eight or more. Once the therapy sessions

were complete, participants were contacted following a 3-7 year time span. The data

collected for this major variable was analyzed using SAS 9.3 software. Results indicated

that successful attending 8 or more sessions during the original study was associated with

lower levels of drug use during the follow up sessions for both therapeutic groups.

However, 76% of the participants reported they used drugs in the 90 days preceding the

follow up assessment. This significant finding supports previous research that encourage

continued treatment, as it is shown to reduce the risk of relapse and consistently reinforce

the rehabilitation goals. Consequently, only 5% of the original study group was still

receiving follow up treatment.

An open label study conducted by Wang et al. (2016) in Taiwan also assessed

relapse rates following family based therapy for adolescents in substance abuse therapy.

The sample size was 121 adolescents, each being assigned to either Motivational
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enhancement psychotherapy (MEP), beginning in July 2011 December 2012; MEP

combined with parenting skills training (PST) beginning in January 2013 August 2014;

or standard supervision by the court (control group) beginning in July 2011 August

2014. The adolescents were required to attend one session a week for 10 week to

complete the MEP and MEP+PST program. After treatment was complete, each

participant was urine tested on a monthly basis for the presence of illicit drugs. These

follow up assessments continued through December 2015 or a maximum of two years.

Relapse was noticed in each therapeutic group. However, those in the MEP+PST

program had the least amount of relapsed individuals. The data analyzed by the

statistical software package Statistical Package for the Social Sciences version 16.0

suggested that the probability of adolescents relapsing in the MEP+PST group was only

slightly lower when compared to the control group. Similar findings resulted in the

adjusted Cox proportional hazard model, located on page 702 of the article.

Discussion/Implications

The findings of the integrative review address the outcomes of family based

therapy versus individual therapy in adolescents receiving substance abuse treatment.

While each study related to the proposed topic, only four out of the five articles support

the researchers PICO question. The findings do not suggest elimination of individual

therapy for adolescents though. It only encourages a stronger presence of family based

therapy during treatment. Further studies will need to be conducted to determine

therapeutic balance when incorporating both rehabilitation programs. Each of the articles

address the findings that suggest family functioning to be an influential factor in an

adolescents choice to use illicit drugs. Parental participation in services offered by the
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adolescent substance abuse treatment facility assists in addressing this unsteady family

functioning to decrease the risk of relapse occurring (Wang et al., 2016). It also helps

both parties to recognize a need for change and implement this desire through a common

ground (Bertrand et al., 2013).

The implications of the findings suggest the positive influence that family based

therapy has in assisting participants to rebuild functioning family relationship that is build

off trust, sincerity, and encourages open communication. The researcher recommends

organizing additional research studies that address this horrific global epidemic so, nurses

and other health professionals can provide the proper, therapeutic care to this vulnerable

population.

Limitations

The researcher has acknowledged various limitations that have impacted this

integrative review. As previously stated in the review, there were a minimal number of

articles that referred to the specific criteria of the PICO question. Additional, the

researcher is a full-time undergraduate nursing student that is completed without

additional assistance from peers or mentors. These factors also negatively impact the

amount of time the researcher has available to search, conduct, and review research

relating to this assignment. As a first time author of an integrative literature review, the

material provided along with the incorporated word choice may be reflective of a novice

writing style. Lastly, the researcher was instructed to only incorporate five research

articles that met specific search criteria. The databases available at the researchers

collegiate library were the only search engines that were utilized as well.
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Conclusion

The researchers conclusions of the integrative review strongly encourage the use

of family based therapy during adolescent substance abuse treatment. Influential findings

from the review are derived from several articles that recognize the benefits of this

interventional method. Examples include enhanced family functioning and increased

parental warmth. Addressing both of these areas during family based therapy create a

therapeutic healing environment for both the child and parent to modify their

inappropriate behaviors. In turn, these changes will decrease the use of illicit drugs by

the adolescent while also rebuilding a trusting family relationship. Each of the articles

identified under this category support the researchers conclusions. The other two

articles provide sufficient reason to suggest that individuals suffering from substance

abuse disorders should continue to seek treatment. Maintaining this interventional

modality may decrease the likelihood of relapse. The researcher suggests conducting

additional studies to determine if family based therapy should still be utilized as a long-

term treatment option or if individual therapy will be beneficial once sufficient time has

passed since completion of the rehabilitation program. These findings would support the

additional knowledge health professionals need to address this issue in a therapeutic

manner.
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References

Bertrand, K., Richer, I., Brunelle, N., Beaudoin, I., Lemieux, A., & Mnard, J. (2013).

Substance Abuse Treatment for Adolescents: How are Family Factors Related to

Substance Use Change? Journal of Psychoactive Drugs, 45(1), 28-38.

doi:10.1080/02791072.2013.763560

Horigian, V. E., Feaster, D. J., Robbins, M. S., Brincks, A. M., Ucha, J., Rohrbaugh, M.

J., . . . Szapocznik, J. (2015). A cross-sectional assessment of the long term effects

of brief strategic family therapy for adolescent substance use. The American

Journal on Addictions, 24(7), 637-645. doi:10.1111/ajad.12278

Pugatch, M., Knight, J. R., Mcguiness, P., Sherritt, L., & Levy, S. (2014). A Group

Therapy Program for Opioid-Dependent Adolescents and Their Parents.

Substance Abuse, 35(4), 435-441. doi:10.1080/08897077.2014.958208

Slesnick, N., Guo, X., & Feng, X. (2013). Change in Parent- and Child-Reported

Internalizing and Externalizing Behaviors Among Substance Abusing Runaways:

The Effects of Family and Individual Treatments. Journal of Youth and

Adolescence, 42(7), 980-993. doi:10.1007/s10964-012-9826-z

Wang, L., Lu, S., Chong, M., Chou, W., Hsieh, Y., Tsai, T., . . . Lee, Y. (2016). A

family-oriented therapy program for youths with substance abuse: long-term outcomes

related to relapse and academic or social status. Neuropsychiatric Disease and Treatment,

12, 699-706. doi:10.2147/ndt.s105199