PROTOCOL: Functional Family Therapy (FFT) for young people in treatment for non‐opioid drug abuse

Youth drug abuse1 of the kind that persists beyond the experimentation phase is a severe problem worldwide (United Nations Office on Drugs and Crime (UNODC), 2010). Abuse of non-opioid drugs such as cannabis, amphetamine and cocaine is strongly associated with a broad range of negative health implications such as traffic accidents, sexually transmitted diseases, mental problems and suicide as well as social problems including poor academic achievement, delinquency and violent behavior (Deas & Thomas, 2001; Essau, 2006; Rowe & Liddle, 2006; ONDCP, 2000; Shelton, Taylor, Bonner & van den Bree, 2009; Nordstrom & Levin, 2007; Lynskey & Hall, 2000). While cannabis, amphetamine, cocaine and other non-opioid drugs remain illegal in most countries, surveys indicate widespread prevalence. In the US, 25.5 percent of 12th-grade students report having used an illicit drug (any kind) within the last month (Johnston, O'Malley, Miech, Bachman & Schulenberg, 2014). In Canada, 21 percent of 15–24 year olds report having used of some kind of illicit drugs within the last year (Health Canada, 2011). In Australia, seven percent 12–17 year olds report using some kind of drug within the last month (White & Smith, 2009). The European Monitoring Centre for Drugs and Drug Addiction has found that that within Europe prevalence differs significantly from country to country but that overall around a quarter of Europeans report having used some kind of illicit drug in their lifetime (European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), 2013). The prevalence of specific kinds of illicit drug abuse varies significantly, with cannabis generally being the most commonly used drug. In the US, 22.7 percent of 12th-grade students report having used marijuana/hashish (types of cannabis), 4.1 percent amphetamine, and 1.1 percent cocaine during the last 30 days before the National Survey on Drug Use conducted in 2013 (Johnston et al., 2014). The European Drug Report of 2013 indicates that 11.7 percent of the 15 to 34 year-olds in Europe have used cannabis, 1.3 percent amphetamine, and 1.9 percent used cocaine during the last year (EMCDDA, 2013). Although not all young drug users progress to severe dependence, some do and may therefore require treatment (see e.g. Crowley, Macdonald, Whitmore & Mikulich, 1998). Research draws attention to the significant gap between the number of young people classified as in need of treatment and the number of young people who actually receive such treatment (SAMHSA, 2010; National Survey on Drug Use and Health (NSDUH), 2007). In the US, for example, 7.2 million people aged 12 or older are classified as needing treatment for illicit drug abuse, but only 1.4 million of these young people actually receive treatment at a specialty facility for an illicit drug abuse problem (SAMHSA, 2011). The treatment usually provided to young people is delivered in outpatient settings. Accordingly, 90 percent of the 89,521 clients under age 18 registered in substance abuse treatment in 2012 by SAMHSA were in outpatient treatment, which is the same proportion as the total treatment population (SAMHSA, 2013). Equal proportions of the clients under age 18 were enrolled in facilities with a primary focus on substance abuse treatment and in facilities whose primary focus were provision of a mix of mental health and substance abuse treatment services; this differs from the total treatment population as youth tend to be treated in dual focus facilities more often than adults (SAMHSA, 2013). Cognitive-behavioral therapy and motivational interviewing are specific therapeutic approaches that are used at least sometimes by most (respectively 91 and 87 percent) treatment facilities (SAMHSA, 2013). There is growing public concern about the effectiveness and high costs of available treatments for young people, and the high rates of treatment dropout and post-treatment relapse to drug abuse (Austin, Macgowan & Wagner, 2005; Najavits & Weiss, 1994; Stanton & Shadish, 1997). While relapse must be acknowledged as an expected part of any treatment process targeting individual drug use, efforts should be made to make treatment as attractive, accessible and relevant as possible for young people in order to minimize the risk of unwarranted dropout and continuous relapse (Simmons et al., 2008; National Institute on Drug Abuse (NIDA), 2009). Furthermore, the services provided should be empirically supported to increase the likelihood that (a) treatment will be successful, and (b) public spending supports the interventions that are the most effective. Researchers point to the fact that many research projects have empirically validated different types of treatment approaches as effective for young drug users (e.g. Rowe & Liddle, 2006; Waldron, Turner & Ozechowski, 2006; Williams, Chang & Addiction Centre Adolescent Research Group, 2000; Austin et al., 2005). The effectiveness, however, depends upon the interplay between a specific intervention and individual factors such as gender, ethnicity, family composition, co-morbidity and history of drug abuse (Brannigan, Schackman, Falco & Millman, 2004; Hawkins 2009; Horsfall, Cleary, Hunt & Walter 2009). For example, research that treatment of a specific such as may for different Ozechowski, Waldron, & Waldron, & 2011). 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