Overview of Multidimensional Family Therapy (MDFT)

Multidimensional Family Therapy ([MDFT] Liddle, 2002a) has been developed and refined over the past 20 years as an outpatient family - based treatment system for adolescent substance abuse and related problems.  It has been recognized in numerous scholarly reviews and independent sources including international and United States government funding agencies, private foundations, and media outlets as among the best approaches for treating adolescent substance abuse.

Multidimensional Family Therapy is an Effective and Flexible Clinical Approach

  • Superior outcomes in comparison to several state-of-the-art, widely used treatments
  • Engages teens and families in treatment and motivates them to complete the program
  • Lower cost than standard outpatient or residential treatment
  • Research demonstrated success in treating a range of teens and families (e.g., different ethnicities, genders, ages, severity of problems)
  • Extensive empirically based knowledge about how MDFT works
  • Flexibly adapts to existing program factors and providers’ resources and needs
  • Success in improving client, therapist, and program outcomes in community-based “transportation” studies

Treatment Engagement and Retention

  • MDFT clients stay in treatment longer than clients in outpatient and residential comparison treatments (Dakof et al., 2003):
  • 95% of clients in intensive outpatient MDFT stayed in treatment for 90 days as compared to 59% in residential
  • 88% of clients in intensive outpatient MDFT completed treatment (180 days) as compared to 24% in residential
  • 96% of young teens in MDFT completed treatment (120 days), as compared to 78% of youth in group therapy
  • Recent U.S. national figures indicate that 58% of adolescent drug abusers stay in standard residential for 90 days and 27% stay in standard outpatient for 90 days (Hser et al. 2001)

Consistent Clinical Outcomes in Controlled Studies

  • MDFT has demonstrated more favorable outcomes than several other state-of-the-art treatments, including family group therapy, peer group treatment, individual cognitive-behavioral therapy (CBT), and comprehensive residential treatment (Liddle et al. 2001; Liddle, 2002b; Liddle & Dakof, 2002; Liddle, Rowe, Dakof, Ungaro & Henderson, 2004; Rowe, Liddle, Dakof & Henderson, 2004).
  • MDFT studies have included samples of teens with serious drug abuse and delinquency -- typically heavy marijuana users, with alcohol, cocaine, and other drug use; mainly referred from juvenile or drug court.

In addition to successfully treating adolescents who are heavy drug users, MDFT has worked effectively as a community-based prevention program (Faw, et al.

  • 2005; Hogue, Liddle et al. 2002) and has successfully treated younger adolescents who are initiating drug use (Liddle et al. 2004; Rowe, et al. 2004a).
  • Substance use is significantly reduced in MDFT to a greater extent than all comparison treatments investigated in 5 controlled clinical trials (between 41% and 82% reduction from intake to discharge) (Liddle et al. 2001; Liddle, 2002b; Liddle et al. 2004a; Liddle et al., 2004b; Rowe et al., 2004a; Rowe, Liddle et al. 2004).
  • Substance related problems are significantly reduced in MDFT to a greater extent than comparison treatments (Liddle, 2002b; Rowe et al., 2004a).
  • Treatment gains are enhanced in MDFT after treatment discharge; MDFT clients continue to decrease substance use after discharge up to 12 month follow-up (58% reduction of marijuana use at 12 months; 56% abstinent of all substances and 64% abstinent or using only once per month; Liddle, 2002b; Liddle & Dakof, 2002; Rowe et al., 2004).
  • Youth receiving MDFT often abstain from drug use; MDFT studies (Liddle, 2002b; Rowe et al., 2004a) have indicated high proportions of youth receiving MDFT report abstinence from all illegal substances at 12 months post intake (64% and 93% respectively).  Participants receiving comparison treatments report lower abstinence rates (44% for CBT and 67% for peer group treatment).
  • Psychiatric symptoms show greater reductions during treatment in MDFT (range of 35% to 80% within treatment reduction) than comparison treatments – MDFT clients also continue to improve following discharge while teens in CBT show relapse of emotional and behavioral problems after treatment (Liddle et al. 2004; Rowe et al., 2004a; Rowe et al., 2004b).
  • School functioning improves more dramatically in MDFT than comparison treatments – For instance, MDFT clients return to school and receive passing grades at higher rates (43% in MDFT vs. 17% in family group therapy and 7% in peer group therapy) (Liddle et al. 2001; Rowe et al., 2004a).
  • Family functioning improves to a greater extent in MDFT than family group therapy or peer group therapy using observational measures and these improvements are maintained up to 12 month follow-up (Liddle et al., 2001; Liddle et al. 2004a).
  • Delinquent behavior and association with delinquent peers decreases to a greater extent in MDFT than peer group treatment; these changes are maintained through a 12-month follow-up. MDFT transportation studies have also shown that association with delinquent peers decreases more rapidly after therapists have received training in MDFT (Liddle et al., 2004a; Rowe et al., 2004a; Rowe et al., 2004b).
  • Arrests, convictions, and probation placements are less likely to occur during 12 month follow-up for youth receiving MDFT than youth receiving peer group treatment (Rowe et al., 2004a).
  • Out of home placements occur less frequently in MDFT transportation studies after therapists have received training in MDFT (Rowe et al., 2004b).

Cost Savings of Multidimensional Family Therapy

  • Average weekly costs of treatment are significantly less for MDFT ($164) than community-based outpatient treatment ($365) (French et al., 2003). 
  • An intensive version of MDFT designed as an alternative to residential treatment provides superior clinical outcomes at 1/3 the cost (average weekly costs of $384 vs. $1,068) (Liddle & Dakof, 2002; Zavala et al., 2005).

Diverse Client Populations Targeted

  • Inner-city minority (African-American and Hispanic) youth and families with few resources and serious and pervasive problems
  • Urban and rural Caucasian drug abusing teens and families
  • Young adolescents at high risk for drug abuse problems
  • Adolescent drug abusers with co-morbid psychiatric disorders
  • Adolescent drug abusing and delinquent females

Research Developed Knowledge about Mechanisms of Change in Multidimensional Family Therapy. MDFT studies

  • Have specified the within-treatment process of improving family interactions (Diamond & Liddle 1996; Diamond, Liddle et al. 1999)
  • Have demonstrated how therapists successfully build therapeutic relationships with teens and parents (Diamond, Liddle et al. 1999; Shelef, Diamond, Diamond, & Liddle, 2005), and that MDFT therapeutic alliances are linked to and predict treatment completion (Robbins, Liddle et al., 2006).
  • Have demonstrated that adolescents are more likely to complete treatment when therapists have stronger relationships with their parents and that stronger therapeutic relationships with adolescents are related to greater decreases in their drug use (Shelef et al., 2005).
  • Have shown that parents’ skills and practices are improved during therapy and that these changes are linked to reductions in adolescents’ symptoms (Schmidt, Liddle, & Dakof, 1996)
  • Have demonstrated a connection between systematically addressing important cultural themes and increasing teens’ participation in treatment (Jackson-Gilfort, Liddle, Tejeda, & Dakof, 2001).
  • Have adapted the model to the needs and issues of adolescent girls (Dakof, 2000)
  • Have shown that MDFT produces superior outcomes than individual therapy for more seriously impaired youth (Henderson et al., 2004)
  • Have shown that in MDFT interventions focused on changing the family produced changes in drug use, emotional, and behavioral problems (Hogue, Liddle, Dauber, & Samuolis, 2004).

Flexibility in Adapting to Program and Provider Needs

  • MDFT is a “treatment system” rather than a “one size fits all” approach. Different versions of MDFT have been developed and tested according to study aims, client needs, and treatment setting characteristics.
  • MDFT developers see “transportation” as a collaborative adaptation process in which MDFT experts and program staff and administrators develop a multifaceted strategy that can address the needs of each stakeholder and barriers to implementation
  • MDFT developers are experienced at working with complex organizations and systems to assess providers’ resources and needs, train providers with different levels of expertise, adapt and adjust the model for use within existing programs, and field-test and correct the approach as necessary
  • MDFT training materials and manuals are well developed and have been used extensively in training community-based therapists in U.S. and European projects
  • The MDFT treatment system is amenable to a variety of treatment settings (e.g., intensive outpatient, outpatient, day treatment, prevention) and can be adapted to accommodate the complexities of these agencies
  • MDFT is being adapted and implemented for new studies in juvenile drug court and juvenile detention settings, and a brief therapy version of MDFT is being tested at present as well

Success in Improving Client and Provider Outcomes in “Transporting” Studies

  • MDFT researchers successfully transported MDFT into a representative hospital-based day treatment program for adolescent drug abusers (Liddle, Rowe, et al. 2002)
  • Clients’ outcomes were significantly better after staff were trained in MDFT – clients showed a 25% decrease in drug use during treatment prior to MDFT training, compared to an average 50% improvement in reduction following the MDFT training and similar improvements in behavioral problems, placement in controlled environments, and affiliation with delinquent peers (Liddle, Rowe, et al. 2002; Rowe et al., 2004b)
  • Treatment gains were sustained; following withdrawal of all MDFT clinical and research staff, clients improved at similar rates to those achieved while therapists were closely monitored by MDFT trainers (Rowe et al., 2004b)
  • Therapists successfully delivered the MDFT according to protocol following training, with a 36% increase in the number of weekly individual therapy sessions, a 150% increase in the number of weekly family sessions, a 390% increase in contact with juvenile probation officers, and a 1,400% increase in school contacts following training (Liddle, Rowe, et al. 2002; Rowe et al., 2004b)
  • Therapists broadened their treatment focus, addressing more MDFT content themes and focusing more on the adolescents’ thoughts and feelings about themselves and important extrafamilial systems (Rowe et al., 2004b)
  • In an MDFT transportation study, after training in MDFT and withdrawal of all MDFT clinical and research staff, therapists continued to deliver MDFT according to protocol.  For example, the number of weekly individual therapy sessions increased an additional 12%, and the number of school contacts increased an additional 34% (Rowe et al., 2004b)
  • Program factors improved dramatically following the transportation of MDFT into the program, including adolescents’ perceptions of increased program organization and clarity in program expectations.  These changes remained following withdrawal of MDFT clinical and research staff.
  • Both improvements in client and program factors were linked to providers’ adherence in delivering MDFT

New International Research Initiatives to Implement and Test MDFT

  • MDFT is recognized internationally as among the most effective treatments for adolescent substance misuse (e.g., Brannigan, Schackman, Falco, & Millman, 2004; DrugScope/ Drug and Alcohol Findings, 2002; Rigter et al, 2005)
  • Research funding received from NIDA, and generated in the U.K. and Europe to implement and test MDFT
    • 5-country randomized clinical trial of MDFT effectiveness in Europe (France, Belgium, Germany, the Netherlands, and Switzerland)
    • 2-site implementation study in Glasgow, Scotland with funding from NIDA and the Scottish Executive
Dr. Howard Liddle, developer of MDFT, is Professor in the departments of Epidemiology & Public Health, Psychology, and Counseling Psychology, and Director, Center for Treatment Research on Adolescent Drug Abuse at the University of Miami School of Medicine. Dr. Liddle has been recognized with achievement awards from the American Association for Marriage and Family Therapy, the American Family Therapy Academy, the American Psychological Association, the Florida Association for Marriage and Family Therapy, and most recently by the Hazelden Foundation in Minnesota for the 2003 Dan Anderson Research Award (http://www.hazelden.org/servlet/hazelden/cms/ptt/hazl_7030_shade.html?sf=t&sh=t&page_id=27468)

For more information about Multidimensional Family Therapy

  • Center for Treatment Research on Adolescent Drug Abuse (CTRADA)
    University of Miami Miller School of Medicine; P.O. Box 019132
    Miami, FL 33101
  • Direct MDFT training inquiries to Dr. Gayle Dakof 305-243-3656 or gdakof@med.miami.edu
For background on the MDFT research program and MDFT studies

Click here for References.