International research

The International Cannabis Need for Treatment (INCANT) Study

In 2003, representatives of the national governments of Belgium, France, Germany, the Netherlands, and Switzerland agreed there was a need in Europe for a treatment program for adolescents with cannabis use disorders and other behavioral problems. Based on a literature review of evidence-based treatments and an international experts meeting, Multidimensional Family Therapy (MDFT) was selected for a pilot study first, and then for a joint, cross-national randomized controlled trial designated INCANT (International Cannabis Need for Treatment).

Dr. Henk Rigter of Erasmus and Leiden Universities in the Netherlands led this transnational effort, a unique study in the field. MDFT supervisors and teams were trained in Brussels (Brugmann Hospital), Berlin (Therapieladen), Paris (Centre Emergence and CEDATs), The Hague (Parnassia Brijder and De Jutters), and Geneva (Phénix).

Several outcomes are noteworthy:

  • MDFT strongly boosted treatment retention in INCANT, as in earlier American trials. Treatment retention in TAU was lower.
  • MDFT reduced the number of days of cannabis use (TLFB) more than the individual psychotherapy. When adolescents were divided in a "low-severity" and a "high-severity" group based on the TLFB, MDFT was as effective as TAU in the low-severity group, but markedly more so in the high-severity group (effect size was moderate to large).
  • MDFT decreased psychological problems associated with substance use more than the individual treatment. MDFT reduced the number of externalizing symptoms more clearly than the individual treatment.
  • A major conclusion: when cannabis use is heavy and cannabis dependence is severe or (to be reported) associated with mental co-morbidity or family dysfunction, MDFT would appear to be the treatment of choice.


 

 International replication of MDFT

Van der Pol, T. M., Henderson, C. E., Hendriks, V., Schaub, M. P., & Rigter, H. (2017). Multidimensional Family Therapy reduces self-reported criminality among adolescents with a cannabis use disorder. International Journal of Offender Therapy and Comparative Criminology. Advance online publication. doi: 10.1177/0306624X16687536

Schaub, M. P., Henderson, C. E., Pelc, I., Tossmann, P., Phan, O., Hendriks, V., ... & Rigter, H. (2014). Multidimensional Family Therapy decreases the rate of externalising behavioural disorder symptoms in cannabis abusing adolescents: Outcomes of the INCANT trial. BMC Psychiatry, 14(1), 26.

Rowe, C. L., Rigter, H., Gantner, A., Mos, K., Nielsen, P., Phan, O., & Henderson, C. (2013). Implementation fidelity of Multidimensional Family Therapy in an international trial. Journal of Substance Abuse Treatment. 

Rigter, H., Henderson, C., 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 randomized controlled trial in Western European outpatient settings. Drug and Alcohol Dependence.

Phan, O., Henderson, C.E., Angelidis, T., Weil, P., van Toorn, M., Rigter, R., Soria, C., & Rigter, H. (2011) European youth care sites serve different populations of adolescents with cannabis use disorder. Baseline and referral data from the INCANT trialBMC Psychiatry, 11(110).

Rigter, H., Pelc, I., Tossman, P., Phan, O., Grichting, E., Hendriks, V., & Rowe, C. (2010). INCANT: A transnational randomized trial of Multidimensional Family versus treatment as usual for adolescents with cannabis use disorderBMC Psychiatry, 10(28).



 

Publications by Western European researchers and clinicians about MDFT and transnational MDFT randomized trial INCANT

*INCANT publications
Between brackets: D = Dutch, E = English, F = French, G = German

Bonnaire, C., & Phan, O. (2017). Relationships between parental attitudes, family functioning and Internet gaming disorder in adolescents attending school. Psychiatry Research, 255, 104-110. doi: 10.1016/j.psychres.2017.05.030

*Lascaux M, Ionescu S, Phan O. Effectiveness of formalised therapy for adolescents with cannabis dependence: a randomised trial. Drugs: education, Prevention and Policy 2016; 23: 404-409.

Nielsen, P., Rigter, H., Croquette Krokar, M. (2016). La thérapie familiale multidimensionelle (MDFT). In N. Favez & J. Darwiche (Eds.) Thérapies de couple et de famille (pp. 105-122). Brussels: Mardaga. [F]

Phan, O., Obradovic, I., Har, A. Abus et dépendance au cannabis à l’adolescence: diagnostic. Archives de pédiatrie. 2016. [F]

Nielsen, P., Rigter, H., Croquette-Krokar, M. (2016). La Thérapie familiale multi-Dimensionnelle (MDFT). In Nicolas Favez and Joëlle Darwiche (Eds.), Les thérapies de couple et de famille: Modèles empiriquement validés et applications cliniques. Brussels: Mardaga. [F]

*Lascaux M, Phan O. Comparaison des thérapies habituellement proposées aux adolescents présentant une addiction au cannabis au sein de cinq pays européens – dans le contexte de la recherche INCANT (International Cannabis Need of Treatment). L'Encephale 2015; 41 Suppl 1: S21-S28. [F]

Vullings, H. Multidimensionele familietherapie. Systeemtherapie. Jaargang 26, nr. 2 Juni 2014 [D]

Bonnaire, C., Bastard, N., Couteron, J. P., Har, A., Phan, O. [Multidimensional Family Therapy: Which influences, which specificities?]. L'encephale. 2013. [F]

*Har, A. & Bonnaire, C. (2013). The end of INCANT: The transition from research to clinical work. Thérapie Familiale 34(4), 529-541. doi:10.3917/tf.134.0529

*Hendriks VM, van der Schee E, Blanken P. Multidimensionele gezinstherapie en cognitieve gedragstherapie bij adolescenten met een stoornis in het gebruik van cannabis; een gerandomiseerd onderzoek. Tijdschrift voor Psychiatrie 2013; 55: 747-759. [D]

Rigter, H. (2013). Multidimensionele familietherapie in West-Europa voor jongeren met cannabisproblemVerslaving, 9(3), 3-16. [D]

Spapen, P., Angelidis, T., Antoniali, V., Van Gerwen, K., Pelc, I., & Verbanck, P. Evaluation d'une thérapie systémique á partir de l'étude INCANT. Thérapie Familiale; 34(2): 195-214. [F]

K. Mos en H. Rigter (2012): Gezinsgericht werken in justitiële jeugdinrichtingen; inzichten uit Multidimensionele familietherapie. Tijdschrift Kind en Adolescent praktijk. Jaargang 11, nr. 3 september 2012 [D]

Tossmann, P., Jonas, B., Rigter, H., & Gantner, A. (2012) Multidimensionale Familientherapie (MDFT) bei cannabisbenogenen Storungen. SUCHT-Zeitschrift fur Wissenschaft und Praxis/Journal of Addiction Research and Practice, 51(3), 157-166. [G]

Gantner A. Multidimensionale Familientherapie. In: Müller M, Bräutigam B (Eds.). Hilfe,sie kommen! Systemische Arbeitsweisen im aufsuchenden Kontext. Heidelberg: Carl-Auer-Verlag, 2011. [G]

Gantner A. Multidimensionale Familientherapie. In: Batra A, Bilke-Hentsch O (Eds.). Praxisbuch Sucht. Therapie der Suchterkrankungen im Jugend- und Erwachsenenalter. Stuttgart: Thieme Verlag, 2011. [G]

*Gantner A. Therapeutische Frühintervention: MDFT in der Jugendsuchthilfe. SuchtMagazin 2011; 5: 18-21. [G]

*Grichting E, Haug S, Nielsen P, Schaub M. INCANT Hauptstudie. Nationaler Schlussbericht. Zurich: Institut für Sucht- und Gesundheitsforschung, 2011. [G]

*Hendriks V, van der Schee E, Blanken P. Treatment of adolescents with cannabis use disorder: main findings of a randomized controlled trial comparing multidimensional family therapy and cognitive behavioural therapy in the Netherlands. Drug and Alcohol Dependence 2011; 119: 64-71. [E]

Mos K, Jong J, Eltink E, Rigter H. Wegwijzer voor toepassing van MDFT in justitiële jeugdinrichtingen en aansluitende ambulante zorg. Leiden: MDFT Academie, 2011. [D]

Nielsen P, Beytrison P, Coroquette Krokar M. Les thérapies ordonnées par la justice pour les adolescents surconsummateurs de substances psychoactives : réflexions et expériences dans un débat d’actualité. Cahiers critiques 2011 ; 46 : 85-95. [F]

Phan O, Couteron JP, Bastard N, Bonnaire C. Aspect mutidimentionnel de la consommation problématique de drogue à l’adolescence. Alcoologie, addictologie 2011; 33. [F]

*Phan O. Étude de comparaison de l’efficacité de la MDFT (Multidimensional Family Therapy) versus la TAU (Treatment As Usual) dans le traitement de l’abus et de la dépendance au cannabis. Paris : MD/PhD thesis, Université Pierre et Marie Curie, 2011. [F]

*Phan O, Henderson CE, Angelidis, Weil P, van Toorn M, Rigter R, Soria C, Rigter H. European youth care sites serve different populations of adolescents with cannabis use disorder. Baseline and referral data from the INCANT trial. BMC Psychiatry 2011; 11: 110. [E]

Rigter H, Erftemeyer L, Mos K. Wegwijzer voor toepassing van MDFT in jeugdzorgplus en residentiële jeugdzorg. Leiden: MDFT Academie, 2011. [D]

Rigter H, Mos K. Die Einführung Multidimensionaler Familientherapie (MDFT) in Europa: Das Beispiel der Niederlande. In: Müller M, Bräutigam B (Eds.). Hilfe,sie kommen! Systemische Arbeitsweisen im aufsuchenden Kontext. Heidelberg: Carl-Auer-Verlag, 2011. [G]

*Schaub M, Haug S. INCANT Schweiz. SuchtMagazin 2011; 5. [G]

Spohr B, Gantner A, Bobbink J, Liddle H. Multidimensionale Familientherapie. Jugendliche bei Drogenmissbrauch und Verhaltensproblemen wirksam behandeln. Göttingen: Vandenhoeck & Ruprecht, 2011. [G].

*Gantner A, Spohr B. Multidimensionale Familientherapie (MDFT) in der Praxis: Therapeutische Erfahrungen mit jugendlichen Cannabisabhängigen und ihren Familien. SUCHT. Zeitschrift für Wissenschaft und Praxis 2010; 56: 71-6. [G]

*Jouanne C, Phan O, Corcos M. Comparaison de l’efficacité de la MultiDimensional Family Therapy (MDFT) versus la Treatment As Usual Explicité (TAUE) dans le traitement de l’abus et de la dépendance au cannabis chez l’adolescent : présentation du protocole INCANT (Treatment efficacy comparaison study with cannabis users or dependents adolescents: MultiDimensional Family Therapy (MDFT) versus Treatment As Usual Explicité (TAUE)) Annales Médico-psychologiques, revue psychiatrique 2010; 7: 487-94. [F]

*Lascaux M, Bastard N, Bonnaire C, Couteron JP, Phan O. INCANT. Une comparaison de deux modéles thérapeutiques formalisé. Alcoologie, Addictologie 2010 ; 3. [F]

Nielsen P, Croquette Krokar M. Phénix – la prise en charge d’adolescents surconsommateurs de cannabis : la thérapie familiale multidimensionelle (MDFT). In : Al Curdi C, Carrasco K, Savary JF (Eds.). Intervention précode. GREA : Yverdon-les-Bains, 2010. [F]

*Phan O, Jouanne C, Monge S. Un essai clinique randomisé sur la psychothérapie des adolescents dépendants au cannabis [A random clinical trial concerning the psychotherapy of adolescents addicted to cannabis]. Annales Médico-Psychologiques 2010; 168 : 145-51. [F]

*Rigter H, Pelc I, Tossmann P, Phan O, Grichting E, Hendriks V, Rowe C. INCANT: a transnational randomized trial of multidimensional family therapy versus treatment as usual for adolescents with cannabis use disorder. BMC Psychiatry 2010;10: 28. [E]

Spapen P, Angelidis A, Antoniali V, van Gerwen K, Pelc I, Verbanck P. La thérapie familiale multidimensionelle des adolescent(e)s dépendents du cannabis. Thérapie familiale 2010 ; 31 : 117-32. [F]

Spohr B, Gantner A. Multidimensionale Familientherapie. Eine Verbindung von Familien- und Suchttherapie für Jugendliche mit Substanzstörungen und Verhaltensauffälligkeiten. Psychotherapie im Dialog 2010; 11: 254-57. [G]

*Verbanck P, Pelc I, Glaesener M, Gladsteen Y, Spapen P, van Gerwen K, Antoniali V, Angelidis T. INCANT: eindactiviteitenverslag. Periode: november 2006 – april 2010 [INCANT final report. Period: November 2006 – April 2010]. Brussels: CHU Brugmann, Instelling voor Psychiatrie en Medische Psychologie, 2010 (also available in French). [D+F]

Mos K, Kaptijn E. Multidimensionele familietherapie. Een evidence based intensieve gezinsmethodiek voor gezinnen van jongeren met meervoudig complexe problematiek. In : Hermanns J, van Montfoort A (Eds.). Gezinsinterventies, aan de slag met problematische opvoedingskwesties. Amsterdam: Uitgeverij SWP, 2008. [D]

*Phan O, Bonnaire C, Bastard N, Jouanne C. Le projet INCANT. Psychotropes 2008 ; 14(3-4) : 137-56. [F]

Gantner A, Spohr B, Bobbink J, Becker H. Pendeldiplomatie im Quadrat. Multidimensionale Familientherapie (MDFT): ein systemischer Therapieansatz für Jugendliche mit Drogenproblemen und Verhaltensauffälligkeiten, deren Eltern und Bezugspersonen. Wiener Zeitschrift für Suchtforschung 2007(4); 13-26. [G]

Rigter H. Problematisch gebruik van cannabis en alcohol. In: Verheij F, Verhulst FC, Ferdinand RF (Eds.). Kinder- en jeugdpsychiatrie. Behandeling en begeleiding. Assen: Van Gorcum, 2007. [D]

Gantner A. Multidimensionale Familientherapie für cannabisabhängige Jugendliche. Praxis der Kinderpsychologie und Kinderpsychiatrie 2006: 55: 520-32. [G]

Rigter H. Cannabis. Preventie en behandeling bij jongeren. Utrecht: Trimbos-instituut, 2006 (chapter 11). [D]

*Rigter H. Report on the INCANT pilot study. The feasibility of Multidimensional Family Therapy in European context as a treatment for troubled adolescents misusing cannabis and possibly other substances. Rotterdam: Erasmus MC, Department of Public Health, 2005 (www.incant.eu). [E]

*Rigter H: Treating cannabis dependence in adolescents: a European initiative based on current scientific insights. In Jugendkult Cannabis Risiken und Hilfe. Berlin: Die Drogenbeauftragte der Bundesregierung; 2005: 117-24. [E]

*Rigter H, Pelc I, Phan O, et al. Report on the INCANT Study Multidimensional Family Therapy in Europe as a treatment for adolescents with cannabis use disorder and other problem behaviours. Rotterdam: Erasmus MC, Department of Public Health, 2005 (www.incant.eu). [E]

Rigter H, van Gageldonk A, Ketelaars T, van Laar M. Hulp bij probleemgebruik van drugs. Actualisering van de NDM achtergrondstudie uit 2004. Utrecht: Trimbos-instituut/NDM, 2006. [D]