Family-based Programs for Substance Abusing Teen Girls

How can we stem the growing trend of substance abuse in girls?

Posted Nov 04, 2015

​Joseph Nowinski, Ph.D. and Abigail Jeffries

There is no question that substance abuse is increasingly a threat to adolescent health nationwide, indeed worldwide. But within that vulnerable age group, substance abuse in girls has been increasing the most rapidly. Among youth ages 12-17, girls’ nonmedical use of prescription painkillers, alcohol, methamphetamine, and most other illicit drugs matches or exceeds that of boys (www.samhsa.gov).

Dr. Karol Kumpfer recommends family-based prevention programs to combat this problem, which has been occurring for the last two decades. [Kumpfer, K. L. Family-based interventions for the prevention of substance abuse and other impulse control disorders in girls. ISRN Addict. 2014 Mar 3;2014:308789. doi: 10.1155/2014/308789. eCollection 2014.]

Risk factors for girls

Girls may be using more because they have greater access to alcohol and illicit drugs, and because social roles for women in society have been changing. But there is another contributing factor that family-based prevention programs seek to address: the quality of the home environment.

Stress within the home due to chronic conflict, depression, and/or substance abuse by parents contributes to adolescent substance abuse. Research shows this is especially true for girls, because they are more sensitive than boys to their family environment.

Ineffective and inconsistent parenting can also contribute to chaos at home and social isolation, and can prevent adolescents from bonding with a parent or significant adult. Other risk factors that make girls particularly vulnerable to substance abuse include peer pressure and the ever-present desire for thinness.

Family genetics can also be a risk factor for girls, although it is more so for boys. Recent studies suggest that a nurturing home environment may grant some protection from genetic diseases by reducing levels of the stress hormone cortisol, which can activate inherited genes.

Even families that seem functional on the surface should take note. Kumpfer cites research that shows “even simple things such as the diminishing number of family meals eaten together have been found to have a negative impact on later adolescent's risk for substance use and negative youth development.”

The most effective approach

Instead of focusing just on the adolescent who may be at risk for substance abuse, family-based intervention programs address the whole family as a system, teaching appropriate parenting and family management skills. These programs are the most effective way of preventing or treating adolescent substance abuse and delinquency, according to Kumpfer, and because they target the overall family environment, they are especially recommended for preventing substance abuse in girls.

Through family-based programs, adults learn to:

  • Increase love and bonding through a positive parent/child relationship
  • Communicate effectively
  • Monitor adolescent behavior
  • Discipline consistently
  • Set family values and expectations for nondrug use

Girls who feel close to pro-social, nurturing parents who are not substance abusers are less likely to associate with drug-using friends. This is especially important because the peer group’s influence is so strong when it comes to illicit drug use. In addition, Kumpfer notes that most youth substance abuse occurs in homes, which can be prevented by family monitoring, supervision, and attention

What it looks like

An example of a family-based program in wide use today is the Strengthening Families Program (SFP) developed by Kumpfer at the University of Utah.

The whole family attends each week. For the first hour, children and parents attend their own classes. Children are trained in social and emotion-regulation skills, peer resistance skills, problem solving, and effective communication. The parents’ class focuses on attention and rewards, clear communication, effective discipline, substance use education, problem solving, and limit setting.

In the second hour, children and parents practice what they have learned about the importance of setting aside time to have fun as a family, how to communicate with each other, and how to use family meetings to plan activities and reduce stress and conflict.

The program is tailored to be sensitive to the culture of the participants, and support is offered in the form of transportation, dinner, babysitting, incentives for completing homework, and graduation parties.

SFP has been used successfully in a wide variety of community settings, including schools, youth centers, churches, public housing complexes, prisons and hospitals. Families can also get a 10-session SFP 7–17 Years DVD for home use.

Tools for a lifetime

Although they tend to cost more than other types of prevention programs to administer, family-based programs are thought to be cost-effective in the long run. The familiar proverb about teaching a person to fish applies. Participants learn skills that not only help to prevent or reduce current substance abuse, but by strengthening their family unit they gain long-term, substantive benefits and tools to help their children grow and develop.

Family-based programs, which are typically offered under the direction of a trained professional, may cost around $100 per family per session. But given the high cost impact of substance abuse on our health care system and the ability of these highly effective programs to impact all members of a family group over a sustained period of time, the up-front program investment can be an excellent value.

Programs available on DVD or the Web can cost far less. Although the benefit of a live facilitator is lost with a DVD, some teens get more out of the program if they are not trying to learn the concepts in a group of potentially distracting, high-risk youth.

Kumpfer cites follow-up studies of randomized school students whose families completed an African American cultural adaptation of SFP 10–14 Years, called Strong African American Families. Years later, there were 50% reductions in substance abuse, delinquency, depression, anxiety, and HIV risk even in genetically at risk youth. Another study of the program found that at 22 years of age, lifetime diagnosed mental health problems were reduced by 230% to 300% even 10 years after participation in SFP.

What to look for in a program

Although she is partial to SFP, Kumpfer points out that there is no one best program. The most effective programs are the ones that bring positive changes to the ongoing family dynamics and home environment.

When considering a program, make sure it focuses on developing the participants’ parenting and family management skills – not merely the dangers of substance abuse – and targets youth social and emotional regulation skills.

Look for a program that offers a nonthreatening environment and a sensitive, well-trained staff that has weekly clinical supervision. Programs are more successful when they involve fathers, are adapted to the specific needs and culture of the family, offer between 11 and 18 sessions, include family practice sessions and homework, and are age and developmentally appropriate

These specific programs meet a high level of evidence of effectiveness:

  • Helping the Noncompliant Child (the basis of FAST Track project)
  • Strengthening Families Program
  • Functional Family Therapy
  • Multisystemic Family Therapy
  • Preparing for the Drug Free Years (now called Guiding Good Choices)
  • Treatment Foster Care

Food for thought

A breakdown of the home environment may be a critical factor in the rise of substance abuse in girls. Research shows that family-based prevention programs are effective at addressing this threat and providing long-lasting protective benefits.

Joseph Nowinski, Ph.D. is the author of Almost Alcoholic: Is My (Or My Loved One's) Drinking a Problem?

​Abigail Jeffries is a freelance writer with a special interest in health and mental health issues. abigailjeffries@comcast.net

Abigail Jeffries
Source: Abigail Jeffries