Comparison of Three Evidence-Based Practices to Reduce Substance Use

Image of three different circles overlapping each other.

In a recent article in our Primary Sources column, we looked at a study of three therapies that have been used for years by mental health professionals to help people with drug abuse problems. In the study, all three therapies helped runaway and homeless youth and their families communicate better and improved their mental health. But there are differences in how they are delivered and what outcomes they target. We put together a comparison to help runaway and homeless youth workers decide if one or more of these approaches might be right for their programs:

Motivational Interviewing

What it is: A therapist tries to create conditions that will motivate patients and help them become committed to changing their lives. A shorter version, called brief motivational interviewing, has been found to be just as effective as the original. Some people think the brief version is a better fit for highly mobile homeless youth.

Goal: Less drinking and drug use and more follow-through in treatment.

How it works: Therapists using this approach are supposed to

  • Express empathy
  • Develop discrepancy between clients’ actual and desired behavior
  • Roll with resistance
  • Support clients’ belief in their abilities to achieve their goals

Who it's for: 18- to 25- year-olds.

How long it lasts: Motivational interviewing varies in length. The brief version can last one to five sessions.

Pros: This highly replicable treatment has a lot of research behind it and can be done in a brief period of time.

Cons: Motivational interviewing may work best when therapists have professional training in it. In addition, this approach only addresses the young person’s self-motivation, and not family or community problems that may compound their addictions.

Ecologically-Based Family Therapy

What it is: This type of therapy helps runaway teens with drug problems and their families communicate better. Together, the therapist, youth and family address immediate needs, resolve the crisis of running away and try to reconnect emotionally.

Goal: Less drinking and drug use; better family relationships and reunification; prevention of HIV.

How it works: The therapy takes into account the individual, interpersonal, and environmental context as well as the strengths and needs of the family and its members. Techniques include:

  • Reframing
  • Relabeling
  • Relational re-interpretations
  • Communication skills training
  • Conflict resolution
  • Therapeutic case management

Who it’s for: 12- to 17-year-olds.

How long it lasts: Includes 12 family therapy sessions at home or in an office, and two to four individual HIV-prevention sessions, lasting 50 minutes each, over a period of three to six months (including follow-up after youth return home).

Pros: This therapy was designed for working with runaway youth.

Cons: The length of this program may make it better for long-term programs than for, say, emergency shelters. Providers need excellent skills in managing family crisis and youths’ risks. And while the therapy targets family, it doesn’t directly address a youth’s behavior and motivation.

Community Reinforcement Approach

What it is: The community reinforcement approach aims to replace drug and alcohol use with healthy behaviors. The version for teens, called adolescent community reinforcement, was adapted for a drop-in center for street youth.

Goal: Less drinking and drug use

How it works: For the adolescent version of this approach, therapists choose from 19 procedures that address, for example:

  • Problem-solving skills to cope with day-to-day stressors
  • Communication and relapse prevention skills through role-playing
  • Active participation in positive activities

Who it’s for: 13- to 25-year-olds

How long it lasts: Varies.

Pros: This therapy was adapted for drop-in centers for street youth.

Cons: This therapy works best when participants have the means and motivation to complete homework assignments, and when the organization is able to help youth remove themselves from negative environments.

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