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Multidimensional Family Therapy (MDFT)

Substance Use Disorders: Treatment for Youth
Benefit-cost methods last updated December 2023.  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.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). 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 $2,026 Benefits minus costs ($6,726)
Participants $152 Benefit to cost ratio $0.29
Others $4,353 Chance the program will produce
Indirect ($3,753) benefits greater than the costs 30%
Total benefits $2,778
Net program cost ($9,504)
Benefits minus cost ($6,726)

^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. See Estimating Program Effects Using Effect Sizes for additional information.

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
14 3 151 -0.215 0.157 17 -0.215 0.157 27 -0.215 0.169
14 7 354 -0.406 0.102 17 n/a n/a n/a -0.406 0.001
14 6 251 -0.308 0.128 17 0.000 0.187 20 -0.308 0.016
14 1 40 0.168 0.301 17 n/a n/a n/a 0.168 0.577
14 4 346 -0.145 0.084 17 -0.080 0.061 20 -0.145 0.085
14 3 290 -0.049 0.132 17 -0.049 0.132 19 -0.049 0.710
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
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system $1,625 $0 $4,049 $813 $6,486
Cannabis use disorder Labor market earnings associated with cannabis abuse or dependence $29 $68 $0 $0 $97
Externalizing behavior symptoms K-12 special education $77 $0 $0 $39 $116
Health care associated with externalizing behavior symptoms $295 $83 $304 $147 $830
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($4,752) ($4,752)
Totals $2,026 $152 $4,353 ($3,753) $2,778
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Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $6,168 2001 Present value of net program costs (in 2022 dollars) ($9,504)
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.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative 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 discounted dollars. 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.

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.