Lisdexamfetamine: a prodrug stimulant for ADHD

This article reviews the unique prodrug stimulant lisdexamfetamine dimesylate (LDX, Vyvanse), an approved treatment for attention-deficit/hyperactivity disorder. LDX is an inactive prodrug in which l-lysine is chemically bonded to d-amphetamine. Although its efficacy is not significantly different from that of other stimulants, LDX may be different with respect to potential toxicity and abuse liability. In this article, I will review the short-term controlled studies that were the basis for LDX's approval for both children and adults; the lack of and need for more long-term studies; two double-blind, placebo-controlled, crossover studies that examined LDX's abuse liability; and clinical uses for the drug. The clinical implications stemming from LDX's unique characteristics are also discussed.     

Professional vs. personal factors related to physicians' attitudes toward drug testing

Questionnaires concerning attitudes toward alcohol and drug testing in the workplace, personal experiences with these substances, professional experiences in treating abuses, religious and political ideology and other personal and professional characteristics were completed by 303 internists, family physicians, gastroenterologists and psychiatrists. Drug testing was most favored by those who more strongly believed in the efficacy of treatment for abusers, the seriousness of the drug problem, the illegality of drug abuse and that marijuana use should not be permissible. Many other personal but almost no professional characteristics were correlated with attitudes toward drug testing. Physicians' opinions about drug testing strongly reflected personal ideologies rather than medical training or clinical experience.     

WHERE ARE ALL THE FAMILY THERAPISTS? ABUSE AND VIOLENCE WITHIN FAMILIES AND FAMILY THERAPY'S RESPONSE

This paper draws on a wide range of research from different fields to document the epidemic proportions of physical violence and sexual abuse in North American families. It delineates the gender dimensions of this problem, with men being the predominant perpetrators of sexual abuse of both boys and girls, and the major physical abusers in couple relationships. Family therapy's lack of response to the problem, and its conceptual inadequacies in doing so, are challenged. A feminist perspective for thinking about abuse is presented and guidelines for working with it are suggested. A course on treating violence and abuse in families is recommended as a required part of family therapy training.     

Towards an Integrated Approach to a Family Intervention for Co‐occurring Substance Abuse and Schizophrenia

Comorbid substance abuse and schizophrenia is a major cause for concern from clinical, economic and health care systems perspectives. Existing treatment strategies are frequently inadequate, partly due to a lack of research into the unique problems facing this dually diagnosed population. These individuals commonly place a disproportionate burden on the mental health delivery system. In addition, their families are left with the onerous task of caring for them. This paper reviews the literature on family interventions for both substance abuse and schizophrenia and postulates that a composite model of family therapy might be appropriate.     

THE EFFICACY OF MARITAL AND FAMILY THERAPY: AN EMPIRICAL OVERVIEW, CONCLUSIONS, AND RECOMMENDATIONS

Based primarily on the contributions to this Special Issue of JMFT, this article provides an overview of the empirical research on the efficacy of marital and family therapy for the following disorders and problems: schizophrenia; affective (mood) disorders; slected externalizing, internalizing, and pervasive developmental disorders of childhood; adolescent conduct disorder; marital distress and the prevention of divorce; alcoholism; adult and adolescent drug abuse; and various chronic adult, adolescent, and childhood physical disorders. Convincing scientific evidence supports the efficacy of broadly defined marital and family therapy for the treatment of many disorders, as well as its superiority to standard and individual treatments for certain disorders and populations. We conclude with recommendations for future research as well as for collaborative initiatives between marital/family therapists and other professionals working in the marriage and family field.     

Family therapy for drug abuse: review and updates 2003-2010

Just 15 years ago, Liddle and Dakof (Journal of Marital and Family Therapy, 1995; 21, 511) concluded, based on the available evidence, that family therapy represented a "promising, but not definitive" approach for the treatment of drug problems among adolescents and adults. Seven years later, Rowe and Liddle (2003) review described considerable progress in this specialty with encouraging findings on adolescent-focused models based on rigorous methodology, as well as advances with adult-focused family-based treatments. The current review brings the field up to date with highlights from research conducted in the intervening 7 years, cross-cutting issues, recommendations for new research, and practice implications of these findings. Adolescent-focused family-based models that attend to the ecology of the teen and family show the most consistent and strongest findings in recent studies. Adult-focused models based on behavioral and systems theories of change also show strong effects with drug abusers and their families. The overarching conclusion is that family-based models are not only a viable treatment alternative for the treatment of drug abuse, but are now consistently recognized among the most effective approaches for treating both adults and adolescents with drug problems.     

Psychological treatment of adolescent substance abusers:: A review

Alcohol and drug abuse among youth has become a major national concern. Psychological treatment strategies reported in the literature that have been used with adolescent substance abusers include five approaches: (a) behavior therapy, (b) skills training, (c) reality therapy, (d) psychodynamic therapy, and (e) family therapy. A limited number of studies have evaluated these treatments. Behavior therapy, skills training, and family therapy approaches show some evidence of effectiveness. However, most studies had methodological flaws.     

A Family Perspective for Substance Abuse: Implications from the Literature

SUMMARY

This paper calls for researchers and treatment providers to increase their recognition of the role that family and family functioning has for understanding the incidence and impact of substance abuse. Substance abuse is identified as a family problem by exploring its occurrence within families as well as its impact on marital relationship, family violence, and child abuse and neglect. The impact of substance abuse on the roles of spouses and parents are examined, as is the impact of substance abuse on children at various developmental stages. The role of the family as participant in active substance abuse as well as a valuable treatment resource is also explored. Finally, the authors present recommendations for increasing the focus on family in substance abuse research.     

Out of the Darkness: Three Waves of Family Research and the Emergence of Family Therapy for Lesbian and Gay People

Like family relationships themselves, the history and treatment of lesbian and gay people and their families is complicated. For this paper, three waves of research on the families of gay and lesbian individuals are described. During the first wave, gay and lesbian sexual orientation was seen as a disease and family dynamics were blamed for its genesis. Subsequently in the second wave it was believed that, fearing rejection many gay and lesbian people either distanced or were rejected from their own families and established friendship networks that have been described as families of choice. More recently, in the third wave, the family has been identified as a resource for lesbian and gay youth whereby open relationships with parents can help protect them from mental illness, substance abuse, and HIV risk. Furthermore, an increasing number of same-sex couples are choosing to become parents, overcoming biological and social obstacles. In this article these shifting views of the role of family in the lives of lesbian and gay people will be described along with case material that illustrates the historic influences, current developments and future directions of family treatment for this population. To be maximally effective with gay and lesbian people and their families, clinical social workers and other mental health professionals must understand how family therapy has been influenced by a progression of ideas that continue to evolve. In this paper, research examining the role of the family in the lives of lesbian and gay people will be described in three waves; as a source of blame, to an impediment to gay and lesbian happiness and ultimately a resource that can enhance lesbian and gay well-being. The influences of research on family therapy with this population will be described and case examples will demonstrate how to harness the strengths of family relationships identified in the most recent wave.     

Review of outcome research on marital and family therapy in treatment for alcoholism

This review of controlled studies of marital and family therapy (MFT) in alcoholism treatment updates the earlier review by O'Farrell and Fals-Stewart (2003). We conclude that, when the alcoholic is unwilling to seek help, MFT is effective in helping the family cope better and motivating alcoholics to enter treatment. Specifically, both Al-Anon facilitation and referral and spouse coping skills training (based on new findings) help family members cope better, and CRAFT promotes treatment entry and was successfully transported to a community clinic in a new study. Once the alcoholic enters treatment, MFT, particularly behavioral couples therapy (BCT), is clearly more effective than individual treatment at increasing abstinence and improving relationship functioning. New BCT studies showed efficacy with women alcoholics and with gay and lesbian alcoholics, and BCT was successfully transported to a community clinic, a brief BCT version was tested, and BCT was adapted for family members other than spouses. Future studies should evaluate the following: MFT with couples where both members have a current alcohol problem and with minority patients, mechanisms of change, transportability of evidence-based MFT approaches to clinical practice settings, and replication of MFT outcomes of reduced partner violence and improved child functioning.     

TREATING ADOLESCENT DRUG ABUSE: A COMPARISON OF FAMILY SYSTEMS THERAPY, GROUP THERAPY, AND FAMILY DRUG EDUCATION

The differential effectiveness of three models of adolescent drug abuse treatment was assessed in a controlled outcome study. Family Systems Therapy (FST) was compared to Adolescent Group Therapy (AGT) and Family drug Educations (FDE). FST appeared to be more effective in stopping adolescent drug abuse than AGT or FDE, registering twice as many apparently drug-free clients than FDE and three times as many as AGT. However, a number of possible confounds make this conclusion tentative. No tretment approach was superior in altering patterns of family functioning although all three conditions improved perceived intergenerational communication.     

Substance Abusing Mothers with a History of Childhood Abuse and Their Children's Depressive Symptoms: The Efficacy of Family Therapy

This study examined the associations among maternal history of childhood abuse, substance use, and depressive symptoms and the change in children's depressive symptoms in therapy. Mothers (N = 183) were randomly assigned into either a family or an individual treatment condition. Mothers were assessed for their childhood abuse retrospectively, baseline depressive symptoms, and substance use, whereas their children's depressive symptoms were measured five times during 1.5 years. Maternal childhood abuse was associated with a slower decline in child depressive symptoms through elevated maternal depressive symptoms, only in individual treatment. Maternal substance use further moderated this mediation pathway. This study supports the efficacy of family therapy in protecting children of mothers with a substance use disorder and a history of childhood abuse.     

Alcohol Use and Prior Substance Abuse Treatment in Relation to Gambling Problem Severity and Gambling Treatment Outcome

Recent research has made it clear that problematic gambling is often accompanied by problematic alcohol use. Unfortunately, little is known about the nature of this association, especially as it relates to gambling treatment outcome. The purpose of this study is to explore the effect of current alcohol use level and previous substance abuse treatment on the symptoms of a large cohort of pathological gamblers as well as on their response to treatment for pathological gambling. The sample included 464 men and 301 women recruited at six gambling treatment programs in Minnesota. Gambling treatment patients were assessed on a number of gambling problem severity and related clinical variables using the Gambling Treatment Outcome Monitoring System (GAMTOMS). Patients with frequent alcohol use had greater gambling involvement at baseline than infrequent alcohol users. Patients with a previous history of substance abuse treatment had more severe psychosocial problems, ostensibly resulting from their gambling behavior, than patients without past substance abuse treatment. A MANOVA with repeated measures showed that neither pretreatment alcohol use, nor past substance abuse treatment exerted significant effects on gambling treatment outcome. While the level of pretreatment alcohol use and a history of substance abuse treatment are markers for greater gambling problem severity, treatment outcome for pathological gambling was not adversely impacted by these variables.     

Addressing substance abuse treatment needs of parents involved with the child welfare system

The goal of this paper is to synthesize available data to help guide policy and programmatic initiatives for families with substance abuse problems who are involved with the child welfare system, and identify gaps in the research base preventing further refinement of practices in this area. To date, Family Treatment Drug Court and newly developed home-based substance abuse treatment interventions appear the most effective at improving substance abuse treatment initiation and completion in child welfare populations. Research is needed to compare the efficacy of these two approaches, and examine cost and child well-being indicators in addition to substance abuse treatment and child welfare outcomes.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

The Community Context of Family Structure and Adolescent Drug Use

Using data from the National Educational Longitudinal Study (NELS), this article investigates a number of hypotheses used to explain the relationship between family structure and adolescent drug use. In particular, using linked community‐level data, an explicit examination of hypotheses drawn from a community‐context model is conducted. These hypotheses posit that the impact of family structure on adolescent behavior is, in part, explained by the different types of communities within which families reside and that community characteristics moderate the impact of family structure on drug use. The results of multilevel regression models fail to support these hypotheses; adolescents who reside in single‐parent or stepparent families are at heightened risk of drug use irrespective of community context. Moreover, adolescents who reside in single father families are at risk of both higher levels of use and increasing use over time. A significant community‐level effect involves jobless men: Adolescents are at increased risk of drug use if they reside in communities with a higher proportion of unemployed and out‐of‐workforce men.     

Cocaine Abusing Women Who Report Sexual Abuse: Implications for Treatment

ABSTRACT

Four hundred seventy-three substance-abusing women were assessed for histories of sexual abuse. The results of bivariate analysis indicated that Sexual Abuse Survivors (SAS) had higher levels of depression, anxiety, and psychological distress. A greater number of SAS reported histories of emotional and physical abuse. They also had greater severity on ASI scales of alcohol, drug, medical, and family/social difficulty. Logistic regression analysis indicated that women who were survivors of sexual abuse were more likely to have histories of emotional and physical abuse, higher levels of addiction severity, and more family members who used drugs. Implications for research and treatment are discussed.     

Comparison of Family Therapy Outcome With Alcohol-Abusing, Runaway Adolescents

Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents ( N  =   119) and their primary caretakers from two runaway shelters and assigned them to (a) home-based ecologically based family therapy (EBFT), (b) office-based functional family therapy (FFT), or (c) service as usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared with SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome.