Brief Strategic Family Therapy (BSFT) for Young People in Treatment for Non‐Opioid Drug Use: A Systematic Review
This publication is a Campbell Systematic Review of the effect of the family therapy approach Brief Strategic Family Therapy (BSFT) for treatment for non‐opioid drug use (cannabis, amphetamines, ecstasy or cocaine) among young people aged 11‐21 years. The misuse of prescription drugs and the use of ketamine, nitrous oxide and inhalants such as glue and petrol are not considered in this review. Recent reports describe an alarming trend of drug use by young people and a lack of available treatment for those who require it. BSFT is a manual‐based family therapy approach that seeks to reduce drug use among young people and to correct the problem behavior that often accompanies drug use by addressing the mediating family risk factors. This approach is based on the assumption that the family exerts a profound influence on child and youth development. It is also assumed that interventions needs to be well planned, problem‐focused, and tailored to the unique characteristics of the individual family. BSFT initially targets those patterns of interactions that most directly influence the youth's behavior. After a rigorous search for all relevant studies conducted to date, we identified three studies with 806 participants that met the inclusion criteria. The effectiveness of BSFT on reducing drug usage, family functioning, and treatment retention was explored though meta‐analysis. The findings are as follows: On drug usage: There is no evidence that BSFT has an effect on reducing the frequency of drug use compared to community treatment programs, group treatment, and minimum contact comparisons On family functioning: There is no evidence that BSFT has an effect on family functioning compared to community treatment programs, group treatment, and minimum contact comparisons On treatment retention: BSFT may improve treatment retention in young drug users compared to community treatment programs, group treatment, and minimum contact comparisons. The evidence found was limited. Only three studies were included in the data analysis, which provides very low statistical power to detect an effect of BSFT. The evidence is also limited in terms of outcomes reported on education, risk behavior and other adverse effects, and is therefore insufficient to allow any firm conclusions to be drawn regarding the effectiveness of the treatment. The review found that the methodological rigor and the adequacy of reporting in the included studies were generally insufficient to allow confident assessment of the effects of BSFT for young drug users. Two of the three included studies provided insufficient information on core issues to allow us to assess the risk of bias (e.g. methods of sequence generation, allocation concealment and completeness of outcome data). This methodological weakness makes us question the validity of these two studies. Overall, BSFT for treating young people's drug use has not been evaluated with sufficient rigor to allow its effectiveness to be determined. Well designed, randomized controlled trials within this population are needed. Key messages PLAIN LANGUAGE SUMMARY This publication is a Campbell Systematic Review of the effect of the family therapy approach Brief Strategic Family Therapy (BSFT) for treatment for non‐opioid drug use (cannabis, amphetamines, ecstasy or cocaine) among young people aged 11‐21 years. The misuse of prescription drugs and the use of ketamine, nitrous oxide and inhalants such as glue and petrol are not considered in this review. Recent reports describe an alarming trend of drug use by young people and a lack of available treatment for those who require it. BSFT is a manual‐based family therapy approach that seeks to reduce drug use among young people and to correct the problem behavior that often accompanies drug use by addressing the mediating family risk factors. This approach is based on the assumption that the family exerts a profound influence on child and youth development. It is also assumed that interventions needs to be well planned, problem‐focused, and tailored to the unique characteristics of the individual family. BSFT initially targets those patterns of interactions that most directly influence the youth's behavior. After a rigorous search for all relevant studies conducted to date, we identified three studies with 806 participants that met the inclusion criteria. The effectiveness of BSFT on reducing drug usage, family functioning, and treatment retention was explored though meta‐analysis. The findings are as follows: ‐ On drug usage: There is no evidence that BSFT has an effect on reducing the frequency of drug use compared to community treatment programs, group treatment, and minimum contact comparisons 1 . ‐ On family functioning: There is no evidence that BSFT has an effect on family functioning compared to community treatment programs, group treatment, and minimum contact comparisons 1 . ‐ On treatment retention: BSFT may improve treatment retention in young drug users compared to community treatment programs, group treatment, and minimum contact comparisons 1 . The evidence found was limited. Only three studies were included in the data analysis, which provides very low statistical power to detect an effect of BSFT. The evidence is also limited in terms of outcomes reported on education, risk behavior and other adverse effects, and is therefore insufficient to allow any firm conclusions to be drawn regarding the effectiveness of the treatment. The review found that the methodological rigor and the adequacy of reporting in the included studies were generally insufficient to allow confident assessment of the effects of BSFT for young drug users. Two of the three included studies provided insufficient information on core issues to allow us to assess the risk of bias (e.g. methods of sequence generation, allocation concealment and completeness of outcome data). This methodological weakness makes us question the validity of these two studies. Overall, Brief Strategic Family Therapy for treating young people's drug use has not been evaluated with sufficient rigor to allow its effectiveness to be determined. Well‐designed, randomized controlled trials within this population are needed. Executive summary/Abstract BACKGROUND Youth drug use is a severe problem worldwide. This review focuses on a treatment for non‐opioid drugs 2 such as cannabis, amphetamines, ecstasy and cocaine, which are strongly associated with a range of health and social problems. Brief Strategic Family Therapy (BSFT) is a manual‐based family therapy approach concerned with identifying and ameliorating patterns of interaction in the family system that are presumed to be directly related to the youth's drug usage. BSFT relies primarily on structural family theory (i.e. how the structure of the family influences the youth's behavior) and strategic family theory (i.e. treatment methods are problem‐focused and pragmatic). OBJECTIVES The main objectives of this review are to evaluate the current evidence on the effects of BSFT on drug use reduction for young people in treatment for non‐opioid drug use and, if possible, to examine moderators of drug use reduction effects to determine whether BSFT works better for particular types of participants. SEARCH STRATEGY An extensive search strategy was used to identify qualifying studies. A wide range of electronic bibliographic databases were searched in June 2011, along with government and policy databanks, grey literature databases, and citations in other reviews. We additionally searched the reference lists of primary studies, hand‐searched relevant journals, and searched the Internet using Google. We also maintained a correspondence with researchers within in the field of BSFT. Neither language nor date restrictions were applied to the searches. SELECTION CRITERIA Studies were required to meet several criteria to be eligible for inclusion. Studies must: have involved a manual‐based outpatient BSFT treatment for young people aged 11‐21 years enrolled for non‐opioid drug use. have used experimental, quasi‐randomized or non‐randomized controlled designs. have reported on at least one of the following eligible outcome variables: drug use frequency, family functioning, education or vocational involvement, treatment retention, risk behavior or any other adverse effect. not have focused exclusively on treating mental disorders. have had BSFT as the primary intervention. DATA COLLECTION AND ANALYSIS The literature search yielded a total of 2100 references, of which 58 studies were deemed potentially relevant and retrieved for eligibility determination. Six papers were data‐extracted, two of which were subsequently excluded for not
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