Overview of INCANT (INternational CAnnabis Need of Treatment) Study:

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1 International Research Initiatives to Implement and Test Multidimensional Family Therapy at the Center for Treatment Research on Adolescent Drug Abuse (CTRADA; Summary: This report offers an overview of CTRADA s two major international research initiatives to implement and test Multidimensional Family Therapy (MDFT). It also explains our online training program that supports international dissemination, and gives a listing of all international presentations. INCANT (INternational CAnnabis Need of Treatment) a 5-country randomized clinical trial of MDFT in Europe (France, Belgium, Germany, the Netherlands, and Switzerland) Training Youth Addiction Workers in Scotland in Empirically Based family Therapy a 4-site implementation study in Glasgow, Scotland to train Youth Addiction workers in MDFT. MDFT Online Training Program to support International Dissemination Projects List of international presentations/trainings Background: Multidimensional Family Therapy (MDFT; Liddle, 2002) is recognized internationally as among the most effective practices for adolescent substance abuse and delinquency (CSAT, 1999; Drug Strategies, 2002; NIDA, 1999, 2006; Williams & Chang, 2000). This flexible treatment system has been the focus of consistent empirical development and refinement since 1985 and continues to be tested in important federal research initiatives. MDFT has been highlighted by NIDA in its Principles of Drug Addiction Treatment (1999) and more recent publication on interventions for Criminal Justice Populations (2006) as among the few empirically supported drug treatments for adolescent drug abuse and delinquency. Additionally, MDFT is included in the CSAP/Office of Juvenile Justice and Delinquency Prevention Strengthening Families--Exemplary Programs Initiative and is one of only 8 featured interventions included in the Drug Strategies publication highlighting exemplary, empirically supported adolescent treatment models (Drug Strategies, 2002). One of its central features is its flexibility and adaptability within a range of contexts, making it community friendly and transportable (Liddle et al., 2002, 2006). In three current projects, MDFT developers have successfully implemented MDFT engagement strategies and other interventions within the Miami-Dade Juvenile Drug Court program, detention facilities in Miami-Dade County and Pinellas County, and Miami-Dade Dependency Drug Court, demonstrating its ability to be adapted for different treatment settings. As a therapy of multiple, interconnected systems, this treatment approach is consistent with technology transfer models focused on systems-level changes (Goodman, 2000). 1

2 Overview of INCANT (INternational CAnnabis Need of Treatment) Study: INCANT (International Cannabis Need of Treatment is a multi-country collaborative treatment study funded under Europe s Cannabis Research Action Plan. The Cannabis Research Action Plan is a joint initiative of Belgium, France, Germany, the Netherlands and Switzerland designed to answer important research questions in order to further develop an effective health-based cannabis policy. Aims of the projects funded under the Cannabis Research Action Plan include: 1) improving the primary and secondary prevention of cannabis consumption; 2) improving the treatment of people who experience problems with cannabis; and 3) developing practical tools to assist national and local policy makers and authorities in implementing and monitoring effective and efficient policies. INCANT has been designated as a top priority study by the Scientific and Steering Committees of the Cannabis Research Action Plan. The INCANT pilot study and the randomized control trial are designed to address the urgent need for more effective treatment for cannabis dependent youth in the 5 participating countries. The pilot study phase was successfully completed between September, 2004 and March, 2005, in all of the five countries: Belgium (Cannabis Clinic and Rimbaud Centre, both from the Centre Hospitalier Universitaire Brugmann); France (Centre Emergence and Institut Mutualiste Montsouris); Germany (Therapieladen); Netherlands (Parnassia Verslavingszorg, Palmhuis [De Jutters], and Parnassia Research Centre [PARC]); and Switzerland (Jugendberatung der Stadt Zürich and Institut für Suchtforschung [ISF/ARI, Zurich]). The INCANT Pilot project team is led by H. Rigter (Principal Investigator), Erasmus University Rotterdam, in partnership with H. Liddle and C. Rowe, University of Miami. The major aims of the pilot study were to: 1) assess the feasibility of training European therapists from a range of backgrounds in Multidimensional Family Therapy (MDFT), an empirically supported treatment developed and validated in the United States (Liddle, 2002); 2) assess whether European therapists can deliver MDFT with adequate levels of adherence; and 3) to develop study procedures and a proposal for the randomized control trial, which include identifying an appropriate comparison treatment and developing adequate methods of screening, recruitment, and assessment of adolescents with cannabis abuse or dependence. In the INCANT pilot study, therapists from the five Western-European countries appeared to be trainable in MDFT. Moreover, the data from this investigation suggest that MDFT can be implemented in European practice, though not without effort or change of routine. We are currently conducting a multinational randomized trial comparing MDFT with a treatment as usual condition as defined by each country. The objective is to evaluate if MDFT is more effective than treatment as usual in treating cannabis abuse or dependence among adolescents across the 5 participating European countries. Sixty cases will be recruited for each condition across countries. Outcome measures target substance use, symptoms of substance use disorders, mental health, family functioning, school performance and delinquency. Youth will be followed up to 18 months beyond treatment. 2

3 Overview of Training Youth Addiction Workers in Scotland in Empirically Based family Therapy Study This research expands the scope of a recently funded NIDA study that aims to develop a theory-based, multicomponent community therapist training system (CTTS) to teach and foster competence among community drug treatment providers in Multidimensional Family Therapy (MDFT; Liddle, 2002a). In this supplemental study, collaborative research teams in Miami, Florida (University of Miami Center for Treatment Research on Adolescent Drug Abuse, CTRADA, H. Liddle, Director) and Glasgow, Scotland (University of Glasgow Centre for Drug Misuse Research, CDMR, N. McKeganey, Director) will pilot test the feasibility, acceptability and effectiveness of the CTTS in changing clinician practices and clinical outcomes in Glasgow s Young People s Community-Based Alcohol and Drug Services. The proposed study significantly broadens the impact of the parent study by examining the feasibility and impact of the CTTS with youth addiction workers in Scotland, and locating the training system within a national drug treatment professional training program (CDMR s Scottish Training on Drug and Alcohol, STRADA). The Scottish Executive s Effective Interventions Unit, whose mission is to identify and disseminate effective practice to support the implementation of the national drug misuse strategy, is also a full partner in the research and funds the bulk of the local research activities to be conducted by the CDMR. The aims of this project are to investigate the feasibility of training youth addiction workers and their supervisors in Glasgow, Scotland, and to examine the impact of the training on treatment outcomes. In the current study, 4 Community Addiction Teams will participate as sites for the MDFT training and implementation (West Glasgow Addiction Team: 1 supervisor, 1 youth addiction worker; South Glasgow Addiction Team: 1 supervisor; East Glasgow Addiction Team: 1 supervisor, 2 youth addiction workers; and Greater Pollock Addiction Team: 1 supervisor, 1 youth addiction worker). The study is conducted in three phases. Phase I (1 year) involved start up activities (6 months) and collection of baseline data (6 months). 34 youth served in the CATs were recruited during the baseline phase and assessed at intake, 3 months, and 6 months after the start of treatment (28 out of 34 were assessed at 3 month, 6 month data is currently being collected). In addition, interviews with the youth addiction workers were also completed during the baseline phase. Phase II is currently being implemented with the youth addiction workers and supervisors (6 months). During this phase, staff will receive extensive training in MDFT. By Phase III (6 months), training will be complete and the practice patterns of the clinicians will be tracked to evaluate the durability of training effects. The implications of the study include the potential to create an effective training module for an effective family-based treatment for drug abusing adolescents and their families that can be implemented across other cultural and practice settings. In broader terms, this work sets the stage of a larger scale study in which MDFT training and implementation could be examined on a national level throughout Scotland. 3

4 MDFT Online Training Program to support International Dissemination Projects: Therapists and supervisors in our international studies have the added benefit of learning tools at their fingertips. In keeping with our commitment to provide the highest quality training experience for MDFT therapists and supervisors a training experience that produces results - we have launched our own work in this new frontier of education. Using cutting-edge web technologies to promote interactivity and make learning stimulating, with NIDA funding, we developed this MDFT Online Learning Program in colloboration with the Dr. Barry Issenberg from the Michael S. Gordon Center for Research in Medical Education ( Our program is delivered through the premier course delivery platform, Angel. This platform creates a dynamic virtual classroom experience that provides MDFT therapists with an eight-unit learning course covering adolescent development, substance abuse, parenting, general clinical skills, the MDFT approach, and supplemental units (e.g., HIV/STD prevention training and cultural competency). Below are some of the features of the MDFT online learning program: Audiovisual presentations from MDFT developer Dr. Howard Liddle and other recognized MDFT experts MDFT clinical case video vignettes Animated graphics illustrating core MDFT theories and concepts Full-length instructional videos on key extrafamilial topics including sexual health An extensive reference library with MDFT protocols, key clinical and research articles and reports, and resources for working in the extrafamilial realm Easy to use course calendar, discussion boards, course , chat, roster of the MDFT community, helpful links/web resources National and international users of the MDFT Online Learning Program have provided positive feedback thus far. These MDFT therapists in the U.S. and abroad are reporting that the program has improved their MDFT clinical work. Specifically, (1) the therapists report that they have an improved conceptualization of adolescent substance abuse and related problem behaviors; (2) they have learned how to successfully apply clinically proven MDFT techniques and modalities to reach and treat their population; and (3) they expanded their knowledge base of the MDFT approach and adolescent substance abuse by accessing our compendium of key clinical and research articles and reports. The program is accessible to the MDFT Clinic therapists to constantly reinforce learning. 4

5 List of international presentations/trainings (chronologically-ordered): Phan, Olivier. (2008, December). European Conference on Scientific Experts. Liddle, H. A., & Dakof, G. A. (2008, June) MDFT training in Gatchina, Russia. Liddle, H. A. (2008, May). MDFT Live at Crisol. Presented at the Crisol Conference. Mexico City, Mexico. Liddle, H. A. (2008,May). Effective family-based intervention for young people who engage in substance misuse. Presented at the Alcohol and Drug Use in Young People A World of Solutions Conference. Dublin, Ireland. Rowe, CL and Liddle, HA (2008, March). An Introduction to Multidimensional Family Therapy for Adolescent Drug Abuse and Delinquency. Invited workshop to the Singapore Ministry of Community Development, Youth, and Sports and the Singapore Prisons System. Singapore. Rowe, CL, HA Liddle, and GA Dakof (2008, March). Multidimensional Family Therapy: Empirically Supported Family-Based Treatment for Adolescent Problem Behaviors. Invited seminar to the National University of Singapore Department of Social Work. Singapore. Liddle, H. A. (2007, November). An eco-systemic approach to adolescent substance misuse: Risk and protective factors. Presented at the Masters Class in Adolescent Substance Misuse, London, England Liddle, H. A. (2007, November). A critical review of family/systemic therapy in adolescent substance misuse. Presented at the 3rd International Conference on the Evidence Base for Family Therapy, London, England Liddle, H. A. (2007, November). Scientific status of family based therapies for adolescent drug Abuse & Family therapy for substance misuse across the life span: From cutting edge of research to coal-face reality of clinical practice. Presented at the 3rd International Conference on the Evidence Base for Family Therapy, Kings College, London, England Liddle, H. A. (2007, June). Enactment made simple. Presented at the Multidimensional Family Therapy Booster (MDFT) conference, Baden-Baden, Germany. Liddle, H. A., & Rowe, C. (2007, June). Individual work with the adolescent. Presented at the Multidimensional Family Therapy (MDFT) Booster conference, Baden-Baden, Germany. Liddle, H. (2007, June). MDFT 101 & beyond. Presented at the Multidimensional Family Therapy (MDFT) Booster conference, Baden-Baden, Germany. Rowe, C. L., Liddle, H. A., Bryce, G., & Barnard, M. (2007, June). Implementing Multidimensional Family Therapy in Youth Addiction Teams in Glasgow, Scotland: Promising preliminary findings of a collaborative training effort. Invited panel presentation at Drugs and Alcohol Today Scotland national conference, Glasgow, Scotland. Liddle, H. A. (2007, March). Multidimensional Family Therapy for adolescent drug abuse: Keys to clinical and research outcomes. Presented at the Milano Workshop, Milan, Italy. Liddle, H. A. (2007, March). Multidimensional Family Therapy for adolescent drug abuse: Keys to clinical and research outcome. Presented at the 2007 National Family and Marital Congress, Istanbul, Turkey. Liddle, H. A. (2007, March). Multidimensional therapy means multidimensional supervision.presented at the 2007 National Family and Marital Congress, Istanbul, Turkey. Liddle, H. A. (2005, February). Multidimensional Family Therapy (MDFT): An empirically-supported treatment for adolescent drug abuse. Presented at the Hong Kong Workshop, Hong Kong, China. Liddle, H. A. (2005, February). Multidimensional Family Therapy (MDFT) for adolescent drug abuse. Presented at the International Conference on Tackling Drug Abuse, Hong Kong, China. 5

6 Liddle, H. A. (2004, October). Clinical demonstration of Multidimensional Family Therapy (MDFT): An empirically-supported treatment for adolescent drug abuse. Workshop conducted at the European Family Therapy Association (EFTA) Conference, Berlin, Germany. Liddle, H. A. (2004, September). Outcome research: Findings of the effectiveness of systemic therapy. Symposium conducted at the European Family Therapy Association (EFTA) Conference, Berlin, Germany. Liddle, H. A., Dakof, G. A., Rowe, C., Henderson, C. (2004, September) Multidimensional Family Therapy for adolescent drug abuse: Findings from four recent studies. Poster presented at the European Family Therapy Association (EFTA) Conference, Berlin, Germany. (winner of best poster) Liddle, H. A., Rowe, C. L., & Kanzki, E. C. (2004, June). Multidimensional Family Therapy and the INCANT study. Invited talk to the INCANT sites, Parnassia Psycho-medical Center & De Jutters Youth Care Institute, the Hague, the Netherlands; Addiction Research Institute & Wetzlikon Treatment Center, Zurich, Switzerland; Therapieladen, Berlin, Germany; Centre Emergence/Institut Mutualiste Montsouris, Paris, France; Cannabis Clinic at the Centre Hospitalier Brugmann, Brussels, Belgium. Henderson, C. E., Greenbaum, P., Dakof, G. A., Rowe, C. L., & Liddle, H. A. (2004, May). Latent growth mixture modeling with intervention trials: An example from a randomized controlled trial of adolescent substance abuse treatment. In D. Feaster (Chair), Advanced applications of general growth mixture modeling. Symposium conducted at the Annual Meeting of the Society for Prevention Research, Quebec City, Canada. Liddle, H. A. (2004, March). A family-based approach to adolescent substance abuse treatment: Research and clinical aspects. Keynote Speaker, Northern Ireland Youth Justice Conference Children in Trouble with the Law: What Works?. Newcastle, Northern Ireland. Liddle, H. A. (2004, March). Multidimensional Family Therapy: Summarizing 20 years of treatment development and research. Invited Lecture at St. George s Medical School. London, England. Liddle, H. A., Rowe, C. L., McKeganey, N., & Barnard, M. (2004, February). Training Youth Addiction Workers in an Empirically Based Family Therapy: A Collaborative International Research Proposal. Invited talk to the Scottish Executive Effective Interventions Unit, Edinburgh, Scotland, UK. Liddle, H. A. & Rowe, C.L. (2004, February). Multidimensional Family Therapy for Adolescent Substance Abuse: Evidence Base and Clinical Features. Invited talk to the Addiction Research Institute Scientific Committee, Zurich, Switzerland. Rowe, C. L. (2003, October). Adapting and Testing an Empirically Developed Family-Based Treatment for Scottish Young People and their Families. Invited talk to the Centre for Drug Misuse Research and Scottish Executive Effective Interventions Unit, Glasgow University, Glasgow, Scotland, UK. Liddle, H. A. (2003, September). Multidimensional Family Therapy for adolescent substance abuse: evidence base and clinical features. Invited talk at the Conference on "Best Practices" in Adolescent Mental Health. Vancouver, British Columbia. Liddle, H. A. (2003, August). Empirical and clinical update of Multidimensional Family Therapy. Invited workshop, American Psychological Association Convention, Toronto, Canada. Shelef, K., Diamond, G. M., Diamond, G. S., & Liddle, H. A. (2003, June). The reliability and validity of observer-rated alliance among adolescents in multidimensional family therapy. Presented at the Society for Psychotherapy Research. Weimar, Germany. 6

7 Rowe, C. L. (2003, May). Multidimensional Family Therapy for Adolescent Drug Abuse. Invited talk to the Lanarkshire Alcohol and Drug Action Team, Lanarkshire Primary Care Trust, National Health Service, Lanarkshire, Scotland, UK. Rowe, C. L. (2003, May). Multidimensional Family Therapy for Adolescent Drug Abuse. Invited talk to the Department of Health Sciences, University of York, York, England, UK. Rowe, C. L. (2003, May). Adapting and Testing an Empirically Developed Family-Based Treatment in the UK. Invited talk to the Academic Addiction Psychiatry Unit, Keele University, Stokeon-Trent, England, UK. Rowe, C. L. (2003, May). Adapting and Testing an Empirically Developed Family-Based Treatment in the UK. Invited talk to the Institute of Psychiatry, National Addiction Centre/ Child and Adolescent Psychiatry Department, King s College London, London, England, UK. Liddle, H. A. (2003, February). Multidimensional family therapy for adolescent substance abuse. Series of invited presentations given at various institutions in the United Kingdom, including Distinguished Lecturer Series, Queens University, Belfast, Northern Ireland, Grand Rounds, Institute of Psychiatry, Kings College, London, England & Bridging the Gaps Lecture Series, Stirling University, Stirling, Scotland. Rowe, C. L., Henderson, C., Dakof, G. A., & Liddle, H. A. (2002, June). Differential predictors of drug use among comorbid youth. Poster session presented at the Annual Conference of the College on Problems of Drug Dependence, Quebec City, Quebec, Canada. Rowe, C. L., Henderson, C. E., Liddle, H. A., & Dakof, G. A. (2002, June). Differential predictors of substance use among clinically referred comorbid youth. Poster presented at the annual conference of the College on Problems of Drug Dependence. Quebec City, Quebec, Canada. Liddle, H. A., Dakof, G. A., & Henderson, C. E. (2002, June). Controlled trial of a family-based alternative to residential drug treatment for co-morbid adolescent substance abusers: Preliminary findings. Poster session presented at the annual conference of the College on Problems of Drug Dependence, Quebec City, Quebec, Canada. Liddle, H. A., & Dakof, G. A. (2002, June). A Family-Based, Intensive Outpatient Alternative to Residential Drug Treatment for Co-Morbid Adolescent Substance Abusers: Preliminary Findings of a Controlled Trial. Poster presented at the annual conference of the College on Problems of Drug Dependence. Quebec City, Quebec, Canada. Tejeda, M., Newman, F. L., Coatsworth, D., Dakof, G. A., Santisteban, D., and Szapocznik, J. (1997, June). A possible solution to a measurement puzzle for family therapy: How to develop a measurement model from multidimensional-multi-observer measures of family functioning. Paper presented at the Society for Psychotherapy Research Annual Meeting, Geilo, Norway. Liddle, H. A. (1996, October). Behavioral therapies initiative, Principal Investigators' Meeting. NIDA Stage 1, NIDA Treatment Research Branch, Washington, D.C. Liddle, H. A. (1996, October). Invited talk on clinical supervision. Master Lecture Series. AAMFT Meeting, Toronto, Canada. Liddle, H. A. (1996, October). Increasing the participation of minority researchers in drug abuse research. Invited presentation at the NIDA Research Meeting, APA Annual Conference, Toronto, Canada. Liddle, H. A. (1996, August). Workshop on adolescent drug abuse treatment strategies, talk on Clinical implications and findings from a therapy development study on multidimensional family therapy, and invited Presidential sponsored by Division 43 on "Summarizing a decade of research on Family-based treatment models for adolescent drug abuse". NIDA / APA Science Directorate Conference on Drug Abuse, Toronto, Canada. 7

8 Liddle, H. A. (1996, August). Discussant to Symposium on drug abuse among ethnic minority youths. APA Annual Conference, Toronto, Canada. Liddle, H. A. (1996, August). Family-based treatment for adolescent drug abuse. Invited presentation to APA Annual Meeting, Toronto, Canada. Liddle, H. A. (1994, July). The adolescents and families project: Results of a randomized clinical trial. Invited Plenary Address to the Society for Psychotherapy Integration International Meeting, Buenos Aires, Argentina. Liddle, H. A. (1993, June). Adolescent drug abusers and family therapy. Addiction Research Foundation Course on Drug Abuse, Toronto, Canada. Liddle, H. A. (1992, April). Adolescent drug abuse. Addiction Research Foundation Course on Drug Abuse, Toronto, Canada. 8