The Complex Nature of Parental Substance Use: Examining Past Year and Prior Use Behaviors as Correlates of Child Maltreatment Frequency

Background: Child maltreatment studies predominantly have operationalized parental substance use as dichotomous variables for any use, any harmful/risky use, or any substance use disorder (SUD). This limits our understanding about how a range of use behaviors may contribute to child maltreatment. Objective: Build upon prior studies by incorporating a multi-faceted approach to operationalizing parental substance use. Methods: Cross-sectional, secondary data analyses were conducted using the National Survey of Child and Adolescent Well-being (NSCAW I). The study used weighted negative binomial regression to examine relationships between annual child maltreatment frequency and different ways of operationalizing substance use among 2,100 parents. Results: Several, inter-related behaviors (i.e., heavy drinking, illicit drug use, polysubstance use, SUD, and prior SUD < 4 years) appeared to be relevant for understanding differences in child maltreatment frequencies. A gradient effect was detected across five substance use behavior patterns: (1) lowest estimated counts were observed for nonusers, light-to-moderate drinkers, and parents with a prior (but not past year) SUD (? < 7.0), (2) slightly higher estimated count was observed for heavy drinkers and/or illicit drug users (? = 9.3), and (3) highest estimated count was observed for parents with past year SUD (? = 17.6). Conclusions/Importance: SUD is a critical screening criteria for potential child harm. Parents reporting risky substance use behaviors may benefit from prevention or brief intervention services related to both their substance use and parenting behaviors. Administrative systems also could benefit from detailed tracking of substance use behaviors for future program evaluation and development.     

‘Good enough’ parenting: Negotiating standards and stigma

BackgroundPolicy concern with families has led to the framing of ‘good parenting’ as a skill set that parents must acquire while ‘poor parenting’ is linked to a raft of social problems, including child maltreatment. A range of professionals are responsible for monitoring parents for evidence of ‘poor parenting’, and for reporting those parents to statutory child protection authorities. Little is known about how parents in vulnerable circumstances negotiate these dual pressures of ‘good parenting’ and surveillance.MethodsEight parents who use drugs were interviewed about raising children well. The data is drawn from a project that used a positive deviance approach to understand the practices and norms that contribute to positive child outcomes in communities where positive outcomes are unexpected or statistically anomalous.ResultsParents use a range of strategies to minimise risk of harm from drug use. Participants resist negative stereotypes that portray their parenting primarily in terms of risk; and in contrast to previous research, describe feelings of guilt but not shame. Systemic barriers to safe environments include the nature of illicit drug markets and the surveillance and policing responsibilities of service agencies.ConclusionThe findings contribute to an understanding of safe and competent parenting by parents who use drugs and highlight how drug laws and fear of intervention can work against the creation of safe family environments.     

Sobriety Treatment and Recovery Teams: Implementation Fidelity and Related Outcomes

Background: Although integrated programs between child welfare and substance abuse treatment are recommended for families with co-occurring child maltreatment and substance use disorders, implementing integrated service delivery strategies with fidelity is a challenging process. Objective: This study of the first five years of the Sobriety Treatment and Recovery Team (START) program examines implementation fidelity using a model proposed by Carroll et al. (2007). The study describes the process of strengthening moderators of implementation fidelity, trends in adherence to START service delivery standards, and trends in parent and child outcomes. Methods: Qualitative and quantitative measures were used to prospectively study three START sites serving 341 families with 550 parents and 717 children. Results: To achieve implementation fidelity to service delivery standards required a pre-service year and two full years of operation, persistent leadership, and facilitative actions that challenged the existing paradigm. Over four years of service delivery, the time from the child protective services report to completion of five drug treatment sessions was reduced by an average of 75 days. This trend was associated with an increase in parent retention, parental sobriety, and parent retention of child custody. Conclusions/Importance: Understanding the implementation processes necessary to establish complex integrated programs may support realistic allocation of resources. Although implementation fidelity is a moderator of program outcome, complex inter-agency interventions may benefit from innovative measures of fidelity that promote improvement without extensive cost and data collection burden. The implementation framework applied in this study was useful in examining implementation processes, fidelity, and related outcomes.     

Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?

Background: In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied.

Objectives: To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement.

Methods: Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program.

Results: Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk.

Conclusion/Importance: The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.     

Methamphetamine Use in German Families: Parental Substance Use,Parent–Child Interaction and Risks for Children Involved

Background: With an immense increase in methamphetamine use in Germany in the past decade, large sections of the drug-using community have been identified as parents of young children. Objective: With the fast-emerging issue of psychosocial and familial consequences of methamphetamine use, this study focused on gaining an insight into substance use, parenthood, and parenting by German methamphetamine users, with special emphasis on the psychological outcomes for the children involved. Methods: We conducted 24 qualitative interviews with parents (16 mothers and eight fathers), who were in outpatient treatment for their Crystal Meth use and were currently abstinent from using drugs. Personal information on parenting, drug use, and effects on the children was supplemented by standardized parents’ reports on the children’s behavioral patterns. Results: Parenting was described as challenging and often emotionally neglectful, impulsive, and inconsistent. The interview results further indicated an inter-relatedness of substance use and the parental role. Overall, children of methamphetamine users appeared to be at an increased risk of pre-and postnatal substance exposure and great psychosocial distress, especially evident in externalizing behavior such as hyperactivity and behavioral problems. Conclusion: Results demonstrate the complex problems of methamphetamine-involved parents and suggest the need for a close cooperation between addiction treatment and child welfare services in providing appropriate psychological and educational support for parents and children.     

Life-Time Risk for Substance Use Among Offspring of Abusive Family Environment From the Community

The current study examined the cumulative risk, age of initiation, and functional impairments among adults with substance use problems (N = 1748) by child abuse status. Child abuse was associated with earlier initiation of marijuana, cocaine, and heroin use, and had greater risks for all the drugs studied (hazard ratios, 1.7–3.2). Furthermore, child abuse was associated with increased medical and functional impairments, including ER visits, health problems, drug dealing, drug dependence, and drug cravings. Provision of social services and parenting education during the perinatal period may prevent the long-term impact of child abuse on substance use and related impairments. The study's limitations are noted.     

Parent Drag Use and Bonding to Parents as Predictors of Substance Use in Children of Substance Abusers

ABSTRACT

The social development model (Catalano and Hawkins 1996) hypothesizes that strong bonds to prosocial others and institutions contribute to prosocial behavior, while strong bonds to antisocial others and institutions contribute to antisocial behavior. Consistent with this perspective, previous research indicates that bonding to parents and child substance use are negatively associated for children of non-substance abusers but are negligibly or positively associated for children of substance abusers. This paper examines the interactive relationship between parent drag use, bonding to parents, and child substance use in a longitudinal study of families headed by substance abusers in methadone treatment for opiate addiction. Bonding to parents and child substance use are moderately negatively correlated in children whose parents ceased using drugs but are weakly positively correlated in children whose parents continued using drugs. These results support the social development model and suggest that family interventions for preventing substance use in children of substance abusers should focus on reducing parent drag use and promote bonding to parents who are abstinent.     

Trauma in the childhood stories of people who have injected drugs

Aim: To document childhood trauma in the life stories of people who have injected drugs. Method: Fifty-five participants (38 m, 17 f) recruited via Scottish recovery networks, who had injected drugs in the previous five years, were interviewed by peer researchers using the Life Story method. Results: Remembered childhood trauma included persistent violence, repeated sexual abuse, neglect and traumatic bereavements. Many traumas were related to adult alcohol use. Few participants told of no trauma, some of severe trauma contributing to subsequent drug problems, some recounted stories including traumatic events, but not linked to later drug problems. A few told of initial severe behavioural problems leading to trauma for the child and to drug problems. Drug problems followed trauma by various routes, without straightforward cause and effect: direct use of drugs as avoidant coping; juvenile heavy recreational use that escalated; forming relationships in mid to late teens with criminals. For men, this involved enmeshment in drug dealing, crime and prison. Some women formed relationships with men who injected drugs, who often introduced them to drugs, and some of whom were violently abusive. Heroin injecting was an effective means of blotting out distressing thoughts and feelings. Although, childhood stories also contained positive memories, factors that might have promoted resilience were rarely mentioned. Conclusions: Severe childhood trauma was common and gravitated people towards problem drug use via various pathways. Participants had often normalised the problems and did not remember adult help. Parental alcohol use contributed to trauma. Addiction services need to be more trauma minded.     

Experience with Family Drug Courts in Three Cities

Abstract

The purpose of the study was to describe the following components of specialized Family Drug Courts: (1) children under court supervision; (2) parent(s) named in the petition; (3) services provided and court actions taken; and (4) relapse rates. Data were collected from the court records of 65 families in three courts in Florida, Kansas, and New York. Courts differed in type of clients, sanctions used, and length of time required between drug testing. Drug testing frequency varied depending on the parent's recovery and cooperation. Test results indicated a decline in drug use in the first four months and an increased risk for relapse between the 15th and 19th weeks. Specialized Family Drug Courts show promise for an improved way to address child abuse and neglect involving parental substance use. They can also provide a unique clinical training experience for health professionals.     

Washington State Recreational Marijuana Legalization: Parent and Adolescent Perceptions,Knowledge, and Discussions in a Sample of Low-Income Families

Background: In November 2012, Washington State and Colorado became the first states in the United States to legalize recreational marijuana use for adults, and Uruguay became the first country to allow the cultivation, distribution, possession, and use of marijuana. One possible consequence of these changes is increased adolescent marijuana use. Parents may mitigate this adverse consequence; however, whether parents and adolescents have accurate knowledge about the laws and are discussing marijuana use in light of the law changes is unknown. Objective: We examine perceptions, knowledge, and parent–child discussions about Washington State's recreational marijuana law in a sample of low-income families. Methods: Participants were a subset of families (n = 115) in an ongoing study that originally recruited parents and adolescents from middle schools in Tacoma, Washington. In summer 2013, when students were entering the 11^th grade, students and their parents were asked questions about the recreational marijuana law. Results: Participants perceived that their marijuana-related attitudes and behaviors changed little as a result of the law, and displayed uncertainty about what is legal and illegal. Most parents reported discussing the new law with their children but only occasionally, and conversations emphasized household rules, particularly among parent lifetime marijuana users compared to non-users. Conclusions/Importance: Results suggest that there should be a public health campaign focused on families that provides clear information about the recreational marijuana laws.     

Hidden Harms and the Number of Children Whose Parents Misuse Substances: A Stepwise Methodological Framework for Estimating Prevalence

Background: Globally, the problem of hidden harms to children of parents who use drugs and alcohol has been recognized. However, it is at a community level that resources must be allocated. Objective: The aim of this research was to provide a methodological framework for estimating the prevalence of children with potential hidden harms, in a community setting. Methodology: Benchmark–multiplier methods were used. Alcohol dependency was measured using the Rapid Alcohol Problem Screen tool. A retrospective audit of records combined with a multisource enumeration to remove duplicates was used to derive a minimum benchmark and a multiplier for the number of children to known adults. Further benchmarks were derived from the localized data of a general population survey. Community services were consulted for estimate validation, needs, and recommendations. The setting was an Irish urban disadvantaged region in 2016. Results: From the audit and multisource enumeration, a ratio of 0.88 children to every one client known to local treatment services was estimated. This provided a minimum estimate of 3.7% of children at risk of being impacted by illicit drug use where parents were known to services. From the general population survey and the local multiplier, an estimate of 15–24% of children potentially impacted by illicit drug use was derived. Finally, from the alcohol dependency data, an estimate of 14–37% of children possibly impacted by parental alcohol dependency was derived. Conclusions: Estimates were accepted as realistic by service providers who highlighted the need to improve interagency and interdisciplinary communication between drug and family services.     

Factors Associated with Parents' Belief in the Appropriateness of Providing Alcohol to their Child

Background: Parental provision of alcohol to their underage child has been associated with risky adolescent drinking. While parents' belief in the appropriateness of providing their child with alcohol may influence their provision behaviors, research into the factors associated with this belief is lacking. Objectives: This study sought to identify the factors associated with parents' belief in the appropriateness of providing alcohol to their underage child. Methods: Western Australian parents of 12–17 year olds (n = 443) completed an online survey assessing their drinking habits, alcohol provision behaviors, alcohol-related beliefs and attitudes, their child's alcohol consumption, and demographics. Results: Nearly half (44%) the parents surveyed reported providing their underage child with alcohol. Parents of older children and parents who (i) did not believe in the harms and recommendations associated with alcohol use in youth, (ii) agreed with youth-related drinking myths, and (iii) reported more occasions of alcohol consumption by their child were more likely to believe that it was appropriate to provide alcohol to their underage child. Those who believed providing alcohol to their underage child was appropriate were in turn more likely to provide alcohol. Conclusions: Interventions aiming to reduce parental provision of alcohol to children should focus on changing parents' beliefs that this is an appropriate harm minimization behavior. Belief change may be facilitated by the implementation of public education campaigns that increase parents' belief in the alcohol-related harms associated with youth drinking and debunk youth-related drinking myths.     

Characteristics of Students and Services in New York State Student Assistance and Prevention Counseling Programs

This article reports on a review of selected New York State school prevention program student case records. Methods: Data were extracted from Office of Alcoholism and Substance Abuse Services (OASAS) standardized Prevention Activity Summary forms. A total of 407 records from 12 high schools throughout New York State were reviewed. Results: The age range of students in this sample was 12 to 18 years old with a mean age of 15.5 years in an approximately normal distribution. Students in this sample were typically referred to services by school sources or were self-referred. The most frequently cited reasons for admission were personal problems, family problems, and alcohol or substance use or abuse. The majority of students are referred to individual sessions. Counselors rated services as producing positive change in all problem areas, with the largest change for adolescents whose parents used alcohol or other substances. Conclusions: Findings suggest positive outcomes for prevention counseling. Severity of alcohol and drug use decreased and severity of risk factors for alcohol and drug use likewise decreased.     

Adolescent Drug Misuse Treatment and Use of Medical Care Services

Research on adults has documented that use of medical services decreases after initiation of treatment for alcohol problems, but little is known about this relationship among adolescents. We studied utilization and costs of care following participation in the Adolescent Chemical Health Program (ACHP) of Kaiser Permanente, Northwest Region, in 1986-88. Three groups of adolescents (and their parents) were identified: adolescents who were assessed and initiated treatment in ACHP (n = 561), adolescents who were assessed and recommended for treatment but did not return for treatment (n = 278), and adolescents with no known substance use problems (n = 381). Medical records were reviewed for 1 year pre-and 1.5 years postassessment. After adjusting for preassessment medical visits, severity of alcohol and drug use, gender, and age, analyses suggested that substance user treatment was not associated with reduced use of medical services or costs by either adolescents or parents.     

The parents' experience: coping with drug use in the family

The families of drug users are often overlooked in the planning and delivery of services. This paper is based on interviews with parents of heroin users and staff from a support agency that worked with families affected by drug use. Findings highlight the devastation parents experienced in learning that their child was using heroin, and the subsequent impact that this had on their lives. Accessing support from a specialist agency provided tangible benefits for parents. These included a reduced sense of isolation, an increased knowledge of drugs and drug-related issues, and greater empathy for their son or daughter. This resulted in an improved support network for the drug user. However, parents faced many obstacles in accessing support, not least a lack of awareness of their needs amongst appropriate agencies. The paper concludes by highlighting the need to develop further tailored interventions to support families affected by drug use, and to improve the knowledge and awareness of the issue among treatment agencies and a range of other relevant organizations.     

LINGUISTIC ACCULTURATION ASSOCIATED WITH HIGHER MARIJUANA AND POLYDRUG USE AMONG HISPANIC ADOLESCENTS

Hispanic sixth and seventh graders in 22 New York City middle schools (mean age: 12.66 years) completed self-report questionnaires with items related to drug use (cigarette smoking, alcohol use, and marijuana) use and linguistic acculturation at two assessments (N= 1299 at baseline; N = 1038 at 1-year follow-up). Adolescents who spoke English with their parents smoked marijuana more frequently than those who spoke Spanish with their parents at both surveys.By the 1-year follow-up, students who spoke English with their parents and bilingual students who spoke English and Spanish with their parents engaged in greater polydrug use than those who spoke Spanish with their parents.     

Parenthood,Child Care,and Heroin Use: Outcomes After Three Years

Background: Internationally there is a lack of measurement on the impact of childcare on people who use drugs. Objectives: The aim of this article was to longitudinally measure drug use, familial and social status and criminal involvement between parents and nonparents who use heroin and have children in their care. Methods: From 2003 to 2006, 404 participants were recruited to the Research Outcome Study in Ireland Evaluating Drug Treatment Effectiveness (ROSIE) as part of a longitudinal cohort study design. Participants completed the Maudsley Addiction Profile and 88% (n = 356) completed interviews at the 3-year period. One way between groups ANOVA with post hoc tests and backward, stepwise multiple regression were employed for analysis. Results: At follow-up, parents who had children in their care used heroin (p = .004), illicit methadone (p ≤ .001) and cocaine (p = .024) on fewer days than those who had no children, or those who had children but did not have children in their care. These differences were not observed at intake. Living with someone at intake who used drugs was found to be significantly associated with increased heroin (p ≤ .001), benzodiazepine (p = .039), and tobacco (p = .030) use at 3 years. Furthermore, a change in childcare status to caring for a child was associated with increased cannabis use (p = .025). Conclusion/Importance: While caring for children was associated with reduced heroin use at 3 years, living with a person who used at intake removed this effect, thus indicating that while individual based addiction theories reflected observed outcomes, social network connectedness was more influential.     

The effect of injecting alone on the use of drug checking services among people who inject drugs

ObjectivesDrug checking services aim to provide people who use drugs with information on the content and purity of their substances as a harm reduction intervention. The objective of this study was to determine the relationship between injecting alone and use of drug checking services in Vancouver, Canada.MethodsData were derived from three prospective cohort studies of people who inject drugs (PWID). We conducted bivariable and multivariable logistic regression analysis to estimate the effect of injecting alone on use of drug checking services.ResultsBetween May 2018 and December 2018, a total of 793 people who inject drugs were included in the study: 579 (73.0%) reported injecting alone and 177 (22.3%) reported use of drug checking services. In a multivariable model adjusted for various confounders (including various sociodemographic variables, drug use patterns, and whether participants had suffered physical attacks/violence), injecting alone was negatively associated with use of drug checking services (Adjusted Odds Ratio = 0.65; 95% Confidence Interval: 0.44–0.97).ConclusionsWe observed a negative association between injecting drugs alone and use of drug checking services, which may be due in part to a number of exogenous factors that prevent people who inject alone from accessing drug checking services (e.g., stigma, location of services). As these individuals are at heightened risk of experiencing overdoses, there is a need to pursue other strategies to reach this group of people who use drugs.