Family Behavior Therapy (FBT) owes its theoretical underpinnings to the Community Reinforcement Approach (CRA) to alcohol abuse, which was pioneered by Nate Azrin and his colleagues in the 1970s. In this approach, substance abuse is conceptualized to occur because of its strong inherent reinforcing properties. Therefore, CRA interventions are designed to reinforce the addicted individual for behaviors that are incompatible with drug use. Now one of the most widely utilized treatments for the addictions, CRA was unique to existing treatments when it was developed. For instance, it was the first approach to incorporate multiple significant others of the substance abuser into the treatment plan (including employers). CRA was particularly innovative because it included many behavioral intervention components that were capable of handling a variety of problems, such as escape routes to assist women and their children from getting abused, job interviewing skills training to assist in gainful employment, and communication skills training to enhance the general tone of the relationship.
In the late 1980s, Dr. Azrin received funding from the National Institute on Drug Abuse (NIDA) to develop one of the first behavioral treatments for adolescent substance abuse. This also was the first controlled trial to employ both significant other and self-reports of adolescent substance use in addition to objective urinanalysis testing as measures of treatment outcome. Due to initial difficulties in the recruitment of adolescents, adults were enrolled in the initial clinical trails. This fortuitous event resulted in a robust and developmentally sensitive family-based intervention capable of treating the addictions across the life-span.
More than 3 decades after the development of CRA, federal funding from the NIDA and the National Institutes of Mental Health (NIMH) has permitted FBT for substance abuse to evolve into one of the premier evidence-based treatment programs in the world, incorporating standardized treatment plans that are consumer-driven, treatment manuals with accompanying step-by-step protocol checklists that may be utilized during sessions to guide treatment implementation and measure program fidelity. Measures of treatment outcome are also now more sophisticated, and include standardized methods of conceptualizing assessment results family members.