Solution-Focused Brief Therapy with Substance Using Individuals: A Randomized Controlled Trial Study

Background:  Substance use is identified or suspected in 66% of all substantiated child protective cases and 79% of cases where children are removed from their homes. Substance abusing parents are more likely to neglect their children by providing inadequate shelter, neglecting a child’s personal care, and having less economic stability. Studies also report that 30%-80% of individuals with substance use problems experienced some traumatic event in their lifetime. Unfortunately providing effective treatment to address substance use and trauma continues to be a challenge for clinicians. This study evaluates the effectiveness of Solution-Focused Brief Therapy (SFBT) for child welfare involved parents receiving outpatient substance abuse treatment. The two hypotheses examined are:

1. Do parents who receive SFBT counseling decrease their substance use related problems as compared to those parents who receive treatment-as-usual counseling?
2. Do parents who receive SFBT counseling decrease their trauma related problems as compared to those parents who receive treatment-as-usual counseling?

Methods:  A randomized controlled trial design was used with half the counselors at two Midwestern substance abuse counseling agencies trained in SFBT while the others continued treatment-as-usual, which consisted of various evidence-based interventions. Substance using parents who have had their children removed from their custody and have a case plan goal of family reunification were recruited for participation. Substance use and trauma symptomology were examined with the Addiction Severity Index (ASI) and Trauma Symptom Checklist-40 (TSC). Mixed linear models were used to test within and between-group changes using intent-to-treat analysis (N=64). Hedges’s g effect sizes were calculated to examine magnitude of treatment effects.

Results: Follow-up main effects for the ASI were all negative, indicating participants exhibited lower levels at posttest irrespective of study condition. The SFBT group within group effect sizes for ASI ranged from small (0.14) to medium (0.62) while control group within-group effect sizes for ASI ranged from negative improvement where clients reported doing worse (-0.20) to large (0.74). Follow-up main effects were all negative, indicating that participants exhibited lower levels on the TSC outcomes at posttest irrespective of which treatment condition they were in. The SFBT group within group effect sizes on the TSC ranged from small (0.40) to large (0.87) while control group within-group effect sizes on the TSC ranged from small (0.41) to large (0.73).

Implications:  This study demonstrates SFBT can be effective in helping clients address substance use and trauma related problems and in fact may be slightly better than current evidence-based approaches, based on within-group effect size results. Currently, most treatment rely on identifying and modifying cognitive thinking and beliefs and changing maladaptive behaviors through rationalization. Unfortunately, clients may become defensive to this more confrontational approach, especially when addressing trauma. Clients may not want to explore past or current traumatic events in an effort to reprocess them as a criterion for moving forward in counseling treatment. SFBT provides an alternative approach to help clients manage their substance use and trauma-related problems without having to spend a great deal of time talking about their problems or traumatic events.