Scalable family therapy training materials for adolescents with substance use disorder (UNFT)

Background: Adolescence is a critical period for the onset of substance/drug use disorders (S/DUDs), and the family can be both a protective and risk factor. In LMICs, adolescents with DUDs and their families are facing grave challenges without access to effective treatment and rehabilitation services. Family therapy (FT) has strong evidence for treating adolescent conduct problems and S/DUDs, however, there remain substantial barriers to scale-up of this approach in community settings under the public domain.

FT/family-based interventions are recommended in the UNODC-WHO International Standards for the Treatment of Drug Use Disorders (2016). UNODC, in collaboration with WHO and leading FT experts, with funding support from Japan, developed a science-informed, skills-based and scalable treatment training package with elements of FT for adolescents with DUDs, including those in contact with the criminal justice system (UNFT: UNODC family-based treatment for adolescents with DUDs).

Methods: After an initial literature review to identify evidence-based FT programmes for adolescent S/DUD treatment, UNODC brought together a group of experts including many developers of such programmes to develop the outline of the training materials. The draft training materials were enhanced through a remote peer review process. The materials were piloted in 2018 in 3 trainings in Asia. The final materials considered lessons learnt from the pilot experience.

Results: UNODC, in collaboration with WHO, convened a technical consultation meeting in June 2018 in Vienna, bringing 25 experts from 13 countries to identify key elements of effective approaches and develop the training outline. The draft package enhanced through a peer review process was further tailored through 3 regional pilots in Asia to meet the needs and cultural contexts: project countries included Indonesia, Philippines, Vietnam, Cambodia, Lao PDR, Thailand (Southeast Asia); Sri Lanka, India, Bangladesh, Maldives (South Asia); Uzbekistan, Tajikistan, Kyrgyzstan, Kazakhstan, Turkmenistan, Armenia (Central Asia). The contents include: 1)Theoretical foundations/core assumptions of FT, 2)Cultural issues, 3)Treatment phases, interventions and assessment methods (positive reframing and relational reframing, perspective taking and relational questions, going with resistance, etc.), 4)Problem solving, etc, with FT skill video clips, provided from the Centre on Addiction, on a voluntary basis. The results of focus group discussions in the pilots indicated the usefulness of the information and techniques; the most popular contents were the genogram, positive reframing, self-care and role play; expected implementation barriers included lack of human and financial resources and supervision, etc.

Conclusions: UNODC has, in collaboration with WHO and FT experts, developed the UNFT training package. Its feasibility studies are scheduled to take place in Indonesia, Sri Lanka and Bangladesh in 2019. UNODC is currently seeking funding for a feasibility and outcome study to further disseminate and evaluate the UNFT.