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Poor scientific basis for the effects of BSFT

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There is no solid body of research to ascertain whether the American treatment method Brief Strategic Family Therapy (BSFT) has a greater effect on young people's drug use than treatment as usual. While it seems that the family-based treatment can retain youth longer into the treatment program, this is not a convincing argument for choosing BSFT over other methods as a new Campbell systematic review has shown.

Youth drug use is a severe problem worldwide. The habitual use of drugs can make it hard for young people to complete their education, and can have far-reaching implications, both socially and for health. Problematic drug use can also create difficulties for the society of which young people are a part, which is why it is crucial to find effective approaches to help young people out of their habitual drug use.

Brief Strategic Family Therapy (BSFT) is a problem-oriented family therapy approach that attempts to reduce or minimize a young person’s drug use by influencing both the challenges and coping patterns in the family through a therapy that involves all family members.

In an effort to find effective tools in the fight against young people's drug use, [SFI’s] researchers have studied whether BSFT is more or less effective than other approaches when compared with, for example, individual therapy, group therapy or parent training programs. It is worth noting that the researchers only studied young people's use of non-opioid substances such as cannabis, amphetamines, ecstasy and cocaine and not, for example, heroin and morphine.

A tailored approach

The theory behind BSFT is -- as with many other family treatment programs -- that the family is a crucial structural factor in a young person's life, and that a treatment encompassing the entire family can influence the youth's drug use. In practice, the treatment consists of a series of family meetings, where a treatment plan is drawn up collaboratively by, for example, changing thought patterns or promoting better conflict resolution.

One special feature of BSFT is that the approach is tailored precisely to the individual, making it possible to apply it in many different contexts and with different ethnic groups.

FACTS ON THE SYSTEMATIC REVIEW

The researchers studied the effectiveness of the approach on young people aged 11-21 years who use non-opioid substances such as cannabis, amphetamines, ecstasy and cocaine.

Effectiveness was studied by comparing BSFT with a number of other treatment methods (more precisely: individual and group therapy, parent training groups, non-manualized family therapy, case management, participatory learning group intervention, minimum contact group and 12-step program).

Three studies were included, with a combined total of 806 participants. All three studies were conducted in the USA.

The included studies were all randomized controlled trials where BSFT treatment was compared with traditional/alternative treatments; meta-analysis was conducted in attempt to gain a more complete picture of the effectiveness of the approach.

The three included studies provided insufficient information for a reliable conclusion on effectiveness to be made.

No difference when compared to other treatments

Researchers identified only three randomized controlled trials which met required standards. These included a combined total of 806 participants. On the basis of these three studies, the researchers had to acknowledge that BSFT did not apparently lead to better family functioning, or help young people out of their drug use, more than other comparable approaches. This does not mean that the approach cannot benefit the young people or their families, however: the researchers were simply not able, using the relatively meager amount of data available, to find any difference between BSFT and other treatments. The study cannot therefore be used to highlight BSFT as a particularly effective treatment for youth drug use.

On the other hand, it appears that BSFT tends to be better at retaining young people in a treatment program than alternative programs. Nevertheless, as it is unclear whether the approach is effective, it is hard to use the improved retention rate as an argument for the introduction of BSFT. More high-quality effectiveness studies of the approach are needed.

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