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Multisystemic Therapy

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What is Multisystemic Therapy (MST) for Youth Alcohol Recovery?

Multisystemic therapy (MST) is an intervention designed for juvenile offenders who abuse drugs or alcohol.

The goal of MST is to uncover and analyze the roots of the adolescent’s behavioral problems. It also aims to teach their families how to foster their success in recovery.

MST is intended to stop juvenile offenders from developing into career criminals. Often, it treats them within the same environment that is at the root of their issues.

The program delivers around 60 hours of personalized alcohol addiction treatment for each participating youth. Sessions usually occur at least twice a week and happen in a natural environment the youth feels comfortable in (usually their home).

MST teams work closely with the youth's family to plan strategies to encourage and monitor their success.


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How Does an MST Program Work? 

Multisystemic therapy primarily addresses youth offenders between the ages of 12 and 17 who abuse drugs or alcohol.

Other issues addressed include delinquent or antisocial behavior, violence, or other forms of criminal activity.

MST therapists often work with four to six families at a time, working as a team. Due to MST services' intense nature, therapists mustn’t work with too many groups.

Team members may include:

  • One supervisor
  • Four MST therapists
  • One data clerk
  • One intake clinician or research assistant

The MST team is available to families 24 hours a day, 7 days a week via an on-call rotation.

An MST program usually lasts between three to five months. However, there is no definite length of service. 

MST teams typically provide services at times that are convenient to the family.

Home placement sessions may occur daily or once a week, depending on the family's requirements and the stage in the program.

Preventing Alcohol Abuse

MST uses the following strategies to reduce alcohol abuse among youth offenders:

  • ABC assessments in which the antecedents (prior causes), behaviors, and consequences an instance of alcohol abuse are analyzed.
  • Family and drug management plans in which therapists and family members develop a plan to help the youth avoid drinking.
  • Drug refusal skills in which the youth and family practice how to avoid using alcohol through extensive role-playing.
  • Random urine tests to check for alcohol consumption
  • Vouchers and prizes to incentivize meeting treatment metrics (e.g., clean urine tests, participating in sessions, etc.)

Benefits of Multisystemic Therapy 

There are many benefits of multisystemic therapy.

Benefits include:

  • Reduced criminal activity or chance of prison
  • Decreasing rates of out-of-home placements
  • Reduced delinquent behavior problems
  • Reduced substance use
  • Decreased antisocial behavior
  • Improved family functioning 
  • Improved mental health 
  • Reduced suicide 
  • Reduced foster care use 
  • Improved mental health outcomes
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Is Multisystemic Therapy Evidence-Based?

Structural family therapy is also proven to lessen delinquent and antisocial behavior and alcohol and drug use among young people.6

Likewise, studies show that MST can improve participating members functioning at school, work, and home. MST services can also improve family functioning and reduce out-of-home placement.2

MST treatment programs may also reduce the likelihood of arrest and incarceration, especially for gang-related youths. 6

A 25-year follow-up analysis of MST shows lower criminal activity among MST youth members than non-MST therapy participants.7 Arrest and imprisonment rates are also lower for siblings and caregivers of MST adolescents after treatment.7

Research also shows that MST for abused and neglected children improves their and their parent's mental health.8 It also reduces the chances that the caregivers and parents will neglect or hurt their children.8

Finally, MST family therapy for youths with mental health issues, or disturbed children, may reduce antisocial behavior and suicide attempts while improving family functioning.2

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How Much Does MST Cost?

The cost of intensive family MST varies. Most of the price reflects the salaries of dedicated MST staff members. Other factors include region, length of treatment, and provider.

Generally, the cost of structural family therapy ranges between $10,000 to $20,000 per youth.

While this may sound expensive, compare this to the cost of out-of-home placement for a young person - $25,000 per year for placement and up to $258,000 to secure a bed.

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Updated on March 29, 2022
10 sources cited
  1. Multisystemic Therapy (MST).
  2. Tan, Jia Xuan, and Maria Lourdes Restrepo Fajardo. "Efficacy of multisystemic therapy in youths aged 10-17 with severe antisocial behaviour and emotional disorders: systematic review." London journal of primary care vol. 9,6 95-103. 9 Aug. 2017.
  3. Antisocial Behavior in Adolescents Aged 10–17 Years. Adolescent Res Rev 3, 67–93, 2018.
  4. Fain, Terry, Sarah Michal Greathouse, Susan Turner, and H. Dawn Weinberg. "Is Multisystemic Therapy (MST) Effective for Hispanic Youth?" An Evaluation of Outcomes for Juvenile Offenders in Los Angeles County. Santa Monica, CA: RAND Corporation, 2014.
  5. Multisystemic Therapy Frequently Asked Questions, MST Services.
  6. Zajac, Kristyn et al. ‘Multisystemic Therapy for Externalizing Youth.’ Child and adolescent psychiatric clinics of North America vol. 24,3 : 601-16.
  7. Wagner, David V et al. “Long-term prevention of criminality in siblings of serious and violent juvenile offenders: a 25-year follow-up to a randomized clinical trial of multisystemic therapy.” Journal of consulting and clinical psychology vol. 82,3 : 492-9.
  8. Vidal, Sarah et al. ‘Placement and Delinquency Outcomes Among System-Involved Youth Referred to Multisystemic Therapy: A Propensity Score Matching Analysis.’ Administration and policy in mental health vol. 44,6 : 853-866.
  9. Letourneau, Elizabeth J et al. ‘Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial.’ Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) vol. 23,1 2009.
  10. Letourneau, Elizabeth J et al. ‘Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend.’ Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43) vol. 27,6 : 978-85.

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