MST and Drug Court. Family Services Research Center Medical University of South Carolina Funded by NIDA and NIAAA

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1 MST and Drug Court Family Services Research Center Medical University of South Carolina Funded by NIDA and NIAAA

2 Project Staff Scott Henggeler Jeff Randall Phillippe Cunningham Colleen Halliday-Boykins Michael Alexander PI Coordinator Supervisor Research Psychiatrist

3 DETERMINANTS OF ADOLESCENT DRUG ABUSE Individual (e.g., favorable attitudes) Family difficulties (e.g., poor monitoring) Caregiver (e.g., substance abuse, dep) Association with substance using peers Poor school performance Neighborhood conducive to substance use

4 Multisystemic Therapy (MST) Addresses multidetermined nature of substance abuse and co-occurring problems (e.g., individual, family, peer, school factors) Integrates evidence-based intervention models Caregiver viewed as key to long term outcomes Program accountability for family engagement and outcomes Home based services Therapists available 24/7, low caseloads

5 MST DRUG STUDIES 1. Missouri Delinquency Project: MST group had fewer drug related arrests than Individual Counseling group 2. Family and Neighborhood Services Project: MST group reported less soft drug use than Usual Services group

6 MST DRUG STUDIES (Cont) 3. NIDA Project 1 MST with Substance Abusing Youth MST group reported less soft drug use at posttreatment than Usual Services group Almost no treatment dropout MST group had greater school attendance MST group had reduced Cost

7 MST DRUG STUDIES (Cont) NIDA Study Limitations Results were not maintained at follow-up Low treatment fidelity MST as currently specified, not sufficient

8 LOW TREATMENT FIDELITY Supervision more than once week Continued Adherence Measures Session tapes coded by MST expert Feedback given to supervisors Correction made immediately Supervisory protocol and ratings

9 COMMUNITY REINFORCEMENT APPROACH (CRA) Budney & Higgins Excellent outcomes with adult cocaine abusers Intensive tracking of substance use with contingencies applied Functional analysis of substance use triggers Cognitive behavioral interventions aimed at substance use Conceptually and clinically compatible with MST

10 Drug Court Positive Features Collaborating with family Collaborating with treatment professionals Frequent monitoring of substance use Consistent sanctions for substance use Consistent rewards for substance abstinence

11 Drug Court Limitations Does not address determinants of adolescent drug use comprehensively Does not use empirically-based treatments

12 RANDOMIZED CLINICAL TRIAL Funded by NIAAA and NIDA 177 substance abusing/dependent juvenile offenders Random assignment to treatment conditions 4 Assessments: Pretreatment, 4 months, 12 months, and 18 months

13 Four Treatment Conditions Family court and community substance abuse services (FC/CS) Drug court and community substance abuse services (DC/CS) Drug court and MST (MST) Drug court and MST with CRA (MST/CRA)

14 KEY RESEARCH QUESTIONS Does drug court improve outcome over family court Does MST improve drug court outcomes over drug court with traditional services Does CRA enhance MST outcomes

15 CASE EXAMPLE: MST AND DC MST and DC: Case of Marvin 17 yr-old male arrested for marijuana possession Smoked marijuana laced with coke daily Sold illicit drugs Hx of fights at school Expelled from school

16 CASE EXAMPLE (cont) Favorable attitude toward drug use Unlimited free time Neighborhood lacking prosocial outlets Mother didn t assign responsibilities Poor monitoring and discipline Triggers: boredom and seeing neg peers

17 CASE EXAMPLE (cont) Mom to increase monitor and discipline CRA and response cost system Dirty screens for several weeks DC sanctions Address mother s barriers Numerous practical needs

18 CASE EXAMPLE (cont) Intervention: prosocial peers and activities Drug avoidance skills Job at a local restaurant GED program Clean screens for past year

19 Outcomes: T1-T3 (N=85) Combined MST vs. combined CS: 65% fewer positive drug screens (p=.01) 81% fewer days in juvenile justice placements (p=.007) 60% fewer self-reported days of alcohol use (p=.04) 74% fewer self-reported days of cannabis use (p=.006)

20 Conclusions Existing services are not particularly effective for adolescent offending and substance use For services to make a positive impact on youth outcomes, empirically-based treatments for youth need to be used

21 Evidenced-Based Treatment in Juvenile Drug Court Family Services Research Center Medical University of South Carolina Funded by CSAT

22 Evidenced-Based Treatment in Juvenile Drug Court Funded by CSAT 120 substance abusing/dependent juvenile offenders (20 currently) 3 Assessments: Pretreatment, 6 months, and 12 months

23 Aims of CSAT Study Compare key outcomes from CSAT study to our randomized drug court study outcomes. Drug court study outcomes will serve as benchmarks Document treatment and drug court process and fidelity and examine the associations between these variables and youth outcomes.

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