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MST-Substance Abuse

MST-Substance Abuse (MST-SA, also known as MST-CM for MST enhanced with Contingency Management protocols) treats youth who are abusing drugs and alcohol. In addition to standard MST, MST-SA is the only other adaptation that has proven to be effective with this population.

While its foundation is MST in which therapists work with only a few families at a time to give parents and caregivers guidance, MST-SA is highly focused on drug and alcohol use.

At every session, the therapist determines whether the adolescent is currently using drugs and drinking alcohol. If the answer is yes, the underlying reasons for the substance abuse (peer pressure and boredom, for example) are sought, and an intervention is built. If the answer is no, the factors that led to the youth stopping are leveraged to influence future behavior.

MST-SA teams develop, with the caregivers, a specific written plan for the offender that the caregivers enforce. The plan is designed to keep the youth from doing drugs and consuming alcohol excessively.

Every juvenile must take specialized training in drug-refusal skills, which includes extensive role-playing so that the youth can see effective ways of “just saying no.” The offender is also schooled in how to exit from a situation where drugs or alcohol are being offered.

An important part of the program is random drug testing at a frequency depending on the drug of choice. For instance, marijuana stays in the system, so weekly testing is sufficient. Cocaine, on the other hand, is fast acting, necessitating daily testing. Caregivers are taught how to spot and track drug and alcohol consumption. Consequences are linked to the negative results.

Rewarding positive behavior is an integral part of MST-SA. These incentives (and consequences) are specified in a written contract.

Substance Abuse Graph


Case study: What MST-SA did for one offender.

Marvin was 17 and living in the nation’s capital. He had a long list of offences—selling drugs, smoking coke-laced marijuana daily, getting into fights at school that resulted in expulsion.

The MST-SA team identified factors that led to his criminal behavior.

  • To Marvin, drug use was okay.
  • He had unlimited free time, which gave him too much time to get into trouble.
  • His neighborhood didn’t have places where he could use his energy in constructive ways.
  • His mother didn’t give him responsibilities such as chores.
  • Nor did she monitor his activities or discipline him.

Marvin’s team determined that boredom and hanging out with friends, involved in similar illegal activities, triggered his delinquency. With this knowledge, MST-SA therapists showed Marvin’s mother how she could increase supervision and better discipline her son. As part of the intervention, Marvin was introduced to friends who didn’t get into trouble and got him involved in positive activities. He also received instruction on how to avoid using drugs.

For the first several weeks of the intervention, Marvin had positive drug tests. Then things turned around. He got a job in a local restaurant and enrolled in a General Educational Development (GED) program to get the equivalent of a high-school diploma. AND his drug screens were clean.

MST-SA is rated as an effective program by the Office of Justice Programs' CrimeSolutions.gov website that uses rigorous research to determine what works in criminal justice, juvenile justice, and crime victim services.