Multidimensional Family Therapy (MDFT) for Young People in Treatment for Non-opioid Drug Abuse: An Updated Systematic Review
Trine Filges, Malene Wallach Kildemoes, Elizabeth BengtsenBackground
Youth drug abuse is a severe problem worldwide, and the use of cannabis, amphetamine, ecstasy and cocaine (referred to here as non-opioid drugs) is strongly associated with a range of health and social problems. This review focuses on drug abuse that is severe enough to warrant treatment. The population is young people who are receiving MDFT specifically for non-opioid drug abuse. MDFT is a manual-based family therapy approach that focuses on individual characteristics of the young person, the parents, and other key individuals in the young person’s life, as well as on the relational patterns contributing to the drug abuse and other problem behaviors. A variety of therapeutic techniques are used to improve the young person and the family’s behaviors, attitudes, and functioning across the variety of domains. MDFT aims to reorient the young person and his/her family towards a more functional developmental trajectory.
Objectives
The main objectives of this review are to evaluate the current evidence on the effects of MDFT on drug abuse reduction for young people (aged 11-21 years) in treatment for non-opioid drug abuse, and if possible, to examine moderators of drug abuse reduction effects, specifically analyzing whether MDFT works better for particular types of participants.
Search Methods
An extensive search strategy was used to identify qualifying studies. Searches were run up to July 2025. A wide range of electronic bibliographic databases were searched along with government and policy databanks, grey literature databases, citations in other reviews and the included primary studies, hand searching in relevant journals, and Internet searches using Google. We also maintained correspondence with researchers in the field of MDFT. No language or date restrictions were applied to the searches.
Selection Criteria
The intervention was manual-based outpatient MDFT drug treatment for young people aged 11-21 years enrolled for non-opioid drug abuse. The outcomes of interest were abstinence, reduction of drug abuse, family functioning, education or vocational involvement, retention, risk behavior or any other adverse effect. Controlled trials, randomized or non-randomized, were eligible, whereas retrospective and qualitative approaches were not.
Data Collection and Analysis
The number of potentially relevant studies was 14,919. Twenty-one studies, reported on a total of seven trials, met the inclusion criteria. Meta-analyses were conducted on each outcome and each time point separately. All analyses were inverse variance weighted using random effects statistical models. The effect size used was standardized mean difference (SMD) for continuous outcomes and odds ratios (OR) for dichotomous outcomes. It was not possible to assess moderators of effects.
Main Results
Not all the studies provided data that enabled the calculation of effect sizes (ESs) on the different outcomes. Two studies had two different control groups, and we performed separate analyses including the different control groups where these two studies provided relevant outcome measures. The most conservative effects for the different outcomes are reported in the following. All outcomes are measured as decreases; hence a negative ES favors MDFT. Meta-analysis of six ESs showed a small effect of MDFT for reduction in youth drug abuse problem severity at 6 months post-intake (SMD = −0.23 95% CI −0.43 to −0.03 compared to Cognitive Behavioral Therapy (CBT), peer group, multifamily educational therapy (MEI) and Adolescent Community Reinforcement Approach (ACRA)). At 12 months post-intake meta-analysis (seven ESs) showed a small effect of MDFT for reduction in youth drug abuse problem severity (SMD = = −0.18 95% CI −0.30 to −0.06 compared to CBT, peer group, adolescent group therapy (AGT) and ACRA). At 18 months post-intake (four ESs) the effect was small and no longer statistically significant (SMD = −0.21 95% CI −0.43 to 0.01 compared to CBT and AGT). Pooled results of the six studies providing data on drug abuse frequency reduction favored MDFT. The effect of MDFT for youth drug abuse frequency reduction was small at 6 months post-intake (SMD = −0.24 95% CI −0.38 to −0.10 compared to CBT, peer group, and MET/CBT5). It was not statistically significant at 12 months post-intake (SMD = −0.13 95% CI −0.32 to 0.06 compared to CBT, peer group, and MET/CBT5/ACRA) or at 18 months post-intake (SMD = −0.07 95% CI −0.28 to 0.14 compared to CBT). All seven studies provided retention data. Meta-analysis favored MDFT for retention of participants (OR = 0.34 95% CI 0.16 to 0.74 compared to CBT, peer group, AGT and MET/CBT5). At most three studies contributed data on the remaining secondary outcomes and none of the meta-analyses showed a statistically significant result.
Authors’ Conclusions
The available data support the hypothesis that, compared with certain other active treatments, MDFT may reduce the severity of drug abuse among youth compared to other active treatments at least up to 12 months post-intake. Furthermore, MDFT may reduce the frequency of drug abuse when treating young people with drug abuse with MDFT compared to other active treatments at least up to 6 months post-intake. The number of studies providing data for drug abuse reduction was limited, however, and this should be considered when interpreting these results. The conclusions that can be drawn about MDFT as an effective treatment for young people with drug abuse compared to other treatments would be more convincing if more studies were available. The pooled effect sizes are small and confidence intervals are often close to zero. The statistically significance of the pooled results on severity of drug abuse among youth 6 months post-intake is sensitive to the removal of studies with methodological weaknesses. The results also indicate that retention may be positively affected by structured MDFT treatment compared to other less-structured control conditions. However, the results must be interpreted with caution as the estimated between study variation is relatively large. The main conclusion of this review is that there is insufficient firm evidence of the effectiveness of MDFT, especially with regard to moderators of drug abuse reduction effects, and whether MDFT works better for particular types of participants. While additional research is needed, the review does, however, offer support that MDFT treatment to young people with non-opioid drug abuse may reduce their drug abuse somewhat more than other less structured control conditions. There is evidence to indicate that MDFT may reduce drug abuse in young people in treatment for non-opioid drug abuse.