When the Surgeon General asserted that teen drinking remained one of the nation's most serious public health problems, he called on parents, guardians and experts in teen interventions to treat the matter with urgency.
That was in 2007, when Cynthia "Cindy" Rowe, Ph.D., associate professor of epidemiology and public health, was marking her eleventh year at the Miller School. Working with mentors who were international experts in child psychology and adolescent drug abuse, she had become well-versed in Multidimensional Family Therapy (MDFT), an internationally accepted treatment for adolescent substance abuse that may also help curtail teen drinking.
Pioneered by Rowe's mentor, Howard Liddle, Ed.D., Multidimensional Family Therapy is practiced through training agreements with institutions in several U.S. states and European countries. Liddle, professor of epidemiology and public health, and director of the Miller School-based Center for Treatment Research on Adolescent Drug Abuse, developed the family-based intervention 25 years ago.
Like other members of the MDFT team, Rowe has helped train other counselors locally and abroad to use MDFT for substance abuse intervention. She says knowing she has helped "build stronger families during some of the most difficult times" has brought a sense of personal satisfaction.
Now, armed with a five-year, $3,275,536 grant from the National Institutes of Health/ National Institute on Alcohol Abuse and Alcoholism, Rowe and her team are answering the Surgeon General's call and will conduct a randomized trial to test MDFT and another family intervention for adolescent alcohol problems.
"Research was showing that, in addition to well-known problems with drugs, many kids were engaging in binge drinking, getting very drunk, getting into fights or accidents -- life-threatening behaviors,'' says Rowe, who won the grant based on the results of a promising pilot study. "So for many years we wanted to do a study that focused on helping kids who have trouble with drinking. Family-based treatments have proven very effective for adolescent drug abuse, but they have not been studied extensively with kids who are primarily drinking.
"It's sort of an odd thing,'' she continues. "You wouldn't think there would be such a disconnect in studying teens with drug problems and teens with drinking problems, but in the research field there is actually quite a disconnect. Part of the problem is that finding the teens who are primarily alcohol abusers has been difficult."
Rowe resolved that problem in her pilot study by identifying alcohol-abusing teens and their families in the emergency room. The location, she says, proved productive because teen drinkers often wind up at the hospital after a fight, car accident, or other brush with danger. The setting also created an ideal opportunity to engage kids and parents in MDFT because traumatic episodes are scary, motivating family members to ensure the adolescent seeks help.
The new study will recruit 250 adolescents, ages 12 to 18, and their families from the ER at Jackson Memorial Hospital and Miami Children's Hospital. Expanding on the pilot study, adolescents identified with risk for alcohol abuse will be randomly assigned to one of three different interventions: standard care, Family Motivational Interviewing Intervention (FMII), or the more intensive MDFT.
Both MDFT and FMII aim to enhance the influence of the family to motivate and help youth change, but rely on different theoretical foundations and clinical techniques. Both will provide two initial engagement sessions in the homes of participants within 72 hours of the ER visit. Thereafter, MDFT participants will be enrolled in a three-month course of this family-centered treatment, while FMII participants will undergo three months of standard group treatment.
In the standard-care intervention, teens will be referred to the same group treatment as the FMII group, but will not receive engagement or family sessions. Results will be compared after three, six, nine, 12 and 18 months to garner retention rates, clinical outcomes and cost-effectiveness.
"Usually, for substance abuse, the most cost-effective and efficient approach is to identify the kids young enough who are the highest risk, and intervene with models that work,'' Rowe says. "Treatments such as MDFT work with the family to strengthen parenting, to help the parents who are often overburdened with their own stress, and deal with other issues, such as problems in school, that often go hand-in-hand with teen substance abuse. When families are provided these resources and skills, we begin to see the power of the family. Rather than blaming each other, family members begin working together to deal with their problems."
And it's the evidence that shows teens can change in incredible ways when families come together that has made MDFT internationally accepted, and has cemented Rowe's commitment to this clinical research program. A student of this form of therapy since her graduate school days at Temple University - home of the Liddle team before it moved to the Miller School in 1996 - Rowe completed her Ph.D. under Liddle and Gayle Dakof, Ph.D., research associate professor in epidemiology and public health. She went on to a one-year clinical psychology internship at Jackson Memorial Hospital.
"Drs. Liddle and Dakof are not only great researchers, they are also great clinicians," Rowe notes. "This is very rare. Their combination of skills and experience brings such balance to our team, and that's one of the reasons our team stands out in this area of research."
It's also why, as their study abstract says, Rowe and her team now have the potential to guide providers and policy makers to implement the most effective and cost-beneficial alcohol intervention for youth, and to halt the progression of alcohol problems in susceptible adolescents.
