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Multidimensional Family Therapy (MDFT)

Substance Use Disorders: Treatment for Youth
Benefit-cost methods last updated December 2019.  Literature review updated May 2015.
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Multidimensional Family Therapy (MDFT) is an integrative, family-based, multiple systems treatment for youth with drug abuse and related behavior problems. The therapy consists of four domains: (1) engage adolescent in treatment, (2) increase parental involvement with youth and improve limit-setting, (3) decrease family-interaction conflict, and (4) collaborate with extra-familial social systems. Youth are generally aged 11 to 16 and have been clinically referred to outpatient treatment. For this meta-analysis, two studies measured the effects of MDFT on delinquency and ten measured the effects on subsequent substance use. All 12 studies included youth who were referred from the juvenile justice system as well as schools, child welfare agencies, health and mental health agencies, and parents.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2018). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $1,776 Benefits minus costs ($5,918)
Participants $136 Benefit to cost ratio $0.29
Others $3,842 Chance the program will produce
Indirect ($3,307) benefits greater than the costs 28 %
Total benefits $2,448
Net program cost ($8,365)
Benefits minus cost ($5,918)
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Crime $1,431 $0 $3,565 $716 $5,713
K-12 special education $51 $0 $0 $25 $76
Labor market earnings associated with cannabis abuse or dependence $26 $61 $0 $0 $86
Health care associated with externalizing behavior symptoms $268 $76 $277 $134 $755
Adjustment for deadweight cost of program $0 $0 $0 ($4,183) ($4,183)
Totals $1,776 $136 $3,842 ($3,307) $2,448
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $6,168 2001 Present value of net program costs (in 2018 dollars) ($8,365)
Comparison costs $0 2001 Cost range (+ or -) 10 %
This program is typically administered over a three-month period. Per-participant costs from Zavala, S. K., French, M. T., Henderson, C. E., Alberga, L., Rowe, C., & Liddle, H.A. (2005). Guidelines and challenges for estimating the economic costs and benefits of adolescent substance abuse treatments. Journal of Substance Abuse Treatment, 29(3), 191-205.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

^WSIPP’s benefit-cost model does not monetize this outcome.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Cannabis use disorder 14 6 251 -0.308 0.128 17 0.000 0.187 20 -0.308 0.016
Crime 14 3 151 -0.215 0.157 17 -0.215 0.157 27 -0.215 0.169
Externalizing behavior symptoms 14 4 346 -0.145 0.084 17 -0.080 0.061 20 -0.145 0.085
Grade point average^ 14 1 40 0.168 0.301 17 n/a n/a n/a 0.168 0.577
Internalizing symptoms 14 3 290 -0.049 0.132 17 -0.049 0.132 19 -0.049 0.710
Substance use disorder^ 14 7 354 -0.406 0.102 17 n/a n/a n/a -0.406 0.001

Citations Used in the Meta-Analysis

Henderson, C.E., Dakof, G.A., Liddle, H.A., & Greenbaum, P.E. (2010). Effectiveness of multidimensional family therapy with higher severity substance-abusing adolescents: Report from two randomized controlled trials. Journal of Consulting and Clinical Psychology, 78(6), 885-897.

Hendriks, V., van, . S.E., & Blanken, P. (2011). Treatment of adolescents with a cannabis use disorder: Main findings of a randomized controlled trial comparing multidimensional family therapy and cognitive behavioral therapy in The Netherlands. Drug and Alcohol Dependence, 119, 64-71.

Liddle, H.A., Dakof, G.A., Parker, K., Diamond, G.S., Barrett, K., & Tejeda, M. (2001) Multidimensional family therapy for adolescent drug abuse: Results of a randomized clinical trial. American Journal of Drug Abuse, 27(4), 651-688.

Liddle, H.A., Rowe, C.L., Dakof, G.A., Henderson, C.E., & Greenbaum, P.E. (2009). Multidimensional Family Therapy for young adolescent substance abuse: Twelve-month outcomes of a randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(1), 12-25.

Liddle, H.A., Dakof, G.A., Turner, R.M., Henderson, C.E., & Greenbaum, P.E. (2008). Treating adolescent drug abuse: A randomized trial comparing multidimensional family therapy and cognitive behavior therapy. Addiction, 103(10), 1660-1670.

Rigter, H., Henderson, C.E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., Schaub, M., ... Rowe, C.L. (2013). Multidimensional family therapy lowers the rate of cannabis dependence in adolescents: a randomised controlled trial in Western European outpatient settings. Drug and Alcohol Dependence, 130, 1-3.