Improving family outcomes with families affected by substance abuse

INTRODUCTION

Each year, an estimated 500,000-656,000 children are born with prenatal drug and alcohol exposure. This translates to a cumulative 12 million of the 73 million children ages 0-17 being affected by intrauterine drug exposure (1,2). This results in 1 in 4 children residing with a parent with a parent with an alcohol or drug problem. Research has shown that the addiction components of intoxication, craving, dependency, and impulsivity adversely interfere with self-awareness, the ability to delay gratification, and the ability to appreciate adverse consequences (3). Thus, behaviors associated with drug use may lead to poor parenting practices.

Studies on the special needs of female substance abusers began over thirty years ago (4,5). Female substance abusers are more likely than males to report more dysfunction in their family of origin, such as parental death, childhood abandonment, family discord, and divorce (4,6). Female substance abusers are also more likely than their male counterparts to be the sole provider of at least one dependent child, and express concern about parenting issues when they enter treatment (7,5). The home environment of children of mothers with substance abuse is often described as unstable and transitory, with children receiving inconsistent and varying levels of affection, discipline, and developmentally appropriate support (8).

Research has found that approximately half of all mothers with drug dependence have had contact with the child welfare system, and on average, fewer than half are living with their children at the time of treatment admission, and up to one-third have lost all parental rights as a result of their drug use (9, 10). However, mothers with substance abuse report no less feeling of love and concern for their children than non-abusing mothers (11).

Societal views of female addicts as those with “dysfunctional personalities and incapable of mothering” serve as barriers to treatment for many mothers with co-morbid substance abuse and mental illness (11). Furthermore, despite the parenting and family concerns often cited among mothers with substance abuse, comprehensive treatment services that are equipped to effectively address the complex issues associated with maternal substance abuse are rare, resulting in women having to gain access to multiple services that are often unconnected and ill-equipped to provide comprehensive, integrated care (12, 13).

The Strengthening Families Program (SFP) (14) is an evidence-based intervention that was developed after it was recognized that alcoholism and drug abuse is a family disease and children of substance abuser's (COSA's) were at high risk for adverse emotional, behavioral and cognitive outcomes. Researchers developed the SFP, an intervention to foster the family environment and improve the parent's ability to nurture and provide learning opportunities for their children. This program has been used with ethically and racially diverse populations.

The purpose of the present study was to address parenting and family issues faced in a population of mothers with a history of substance abuse in a residential treatment setting. This study will extend the literature by examining a population of women living in a residential treatment facility with their children. The hypotheses for the present study were as follows: (a) SFP will improve family functioning; (b) SFP will improve parenting; and (c) SFP will improve positive child behavior.

METHODS

Sixty-five mothers enrolled at a Baltimore residential treatment facility, from 2005-2007, participated in the twelve week SFP. This family-based prevention intervention has three separate 14-week classes: (a) A Parent Skills Training session, (b) Children's Training session, and (c) Family Skill Training session. The parent skills training session is exclusively for the parents and parent participation has been associated with fewer problems handling school aged children and has also demonstrated increased knowledge of child behavior management principles, which have direct impact on the behaviors of children (14). The pre and post test battery recommended to evaluate the effectiveness of the SFP included the Alabama Parenting Questionnaire (15), Strengthening Families Program Knowledge Questions and Child Behavior Questions Aggressive, Depression, and Delinquent Behavior subscales) (16), Family Environment Scale (17), and Parent Observation of Children's Activities (POCA) (18). Wilcoxon signed-rank tests were used to analyze the change in pre and post-test scores. Significance level was set at 0.05.

RESULTS

Participants showed statistically significant total improvements in parenting knowledge (z = 2.0, p<0.05), positive parenting (z = 2.5, p<0.01) and parental involvement (z = 3.6, p<0.01). There were also significant improvements in parenting skills (z = 3.1, p<0.01), family organization (z = 4.4, p<0.01), family cohesion (z = 2.9, p<0.01), communication (z = 3.8, p<0.01), parent supervision (z =4.8, p<0.01), and parenting efficacy (z = 2.6, p<0.01). There was a significant decrease in reported parent alcohol/ drug use (z = 2.3, p<0.05). Statistically significant improvements were found in child concentration problems (z = 2.2, p<0.05). However, no significant results were found on the POCA subscales of overt aggression, covert aggression, criminal behavior, depression, hyperactivity, impulsivity, or shy behavior.

CONCLUSION

These findings support previous research that document improvements in parent, child, and family outcomes following participation in the SFP (14, 19). The proposed primary and secondary hypotheses of this study were supported by the data. The tertiary hypothesis was partially supported. Improvements were noted in child concentration. It should be noted that parents did not perceive their children to have significant behavioral problems. Overall, the study findings add to the current knowledge on the effectiveness of the SFP by demonstrating improvements in family and parenting skills in an urban-based, residential treatment facility.

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