Secondary Effects of Parent Treatment for Drug Abuse on Children

Official Title: “Secondary Effects of Parent Treatment for Drug Abuse on Children”

As they move from preadolescence to adolescence and adulthood, children need nurturing and supportive environments to realize their potential. Unfortunately, many children reside in destructive families that often result in negative short and long-term outcomes. As well-chronicled in the scientific and lay press, an all-too-common example involves parental substance abuse. Indeed, children living with a parent who abuses drugs often have significant emotional, behavioral, and social problems. It has long been recognized that interventions are needed to address the clinical needs of these youth and to help prevent the development of problems that may emerge in early adulthood. To date, the majority of treatments have focused on either treating the children individually, or in the context of family therapy. Although directly involving these youth in treatment may be ideal, the majority of custodial parents who enter treatment for substance abuse are very reluctant to allow their children to engage in individual or family therapy. Thus, interventions for substance-abusing parents that do not directly involve children, but serve to improve the family environment as a whole, may have the greatest potential for reaching the most children and thereby positively influencing their overall adjustment and well-being.

From this vantage, a promising approach is Learning Sobriety Together (LST; the "brand" name of Behavioral Couples Therapy [BCT] for alcoholism and drug abuse), a comprehensive psychosocial intervention for substance abuse that focuses both on reducing addiction severity, improving couple adjustment, reducing interparental conflict and intimate partner violence (IPV), and improving the family environment and psychological functioning. In a series of preliminary studies, the PI found that children whose substance-abusing fathers and nonsubstance-abusing mothers participated in LST displayed higher psychosocial adjustment at posttreatment and during an extended follow-up than youth whose substance-abusing fathers participated in individual-based treatment (IBT) or whose parents participated in a couples-based attention control treatment. These findings indicate that LST may extend beyond the couple to their children and may provide an entry point into the family system from which to improve the adjustment of these youth.

The present randomized clinical trial provides the next important step for this line of research. First, the present study is a far more developed examination of the potential effects of LST on multiple dimensions of youth functioning, taken from multiple perspectives. Second, we do not know "how" LST works. The positive effects of LST on parents (reduced addition severity, improved dyadic adjustment, reduced partner violence, improved parenting, and improved parental psychological adjustment) may have positive "trickle down" effects on youth; however, we have not undertaken an empirical examination of these potential mechanisms of action. If we can understand how it works, we will be able to use that information to refine LST to enhance the mechanisms that benefit youth. Thus, the present study will examine possible curative mechanisms. Third, we have a very limited understanding for "whom" it works. Thus, we will examine whether LST may operate differently for children of different stages of development. If we can understand this moderating effect, we may be able to develop and refine LST to meet the needs of families with children of different ages.

To address these issues, the present study is a randomized clinical trial (RCT) to compare the emotional and behavioral adjustment, beliefs, and behaviors, including serious problem behaviors, of youth ages 8 to 16 (as rated by mothers, fathers, teachers, and the children themselves) whose fathers are randomly assigned to participate in LST with their nondrug using female partners as compared to fathers who are assigned to IBT. We will also focus on potential mechanisms of action that are positively influenced by LST.

The present randomized clinical trial provides the next important step for this line of research. First, the present study is a far more developed examination of the potential effects of LST on multiple dimensions of youth functioning, taken from multiple perspectives. Second, we do not know "how" LST works. The positive effects of LST on parents (reduced addition severity, improved dyadic adjustment, reduced partner violence, improved parenting, and improved parental psychological adjustment) may have positive "trickle down" effects on youth; however, we have not undertaken an empirical examination of these potential mechanisms of action. If we can understand how it works, we will be able to use that information to refine LST to enhance the mechanisms that benefit youth. Thus, the present study will examine possible curative mechanisms. Third, we have a very limited understanding for "whom" it works. Thus, we will examine whether LST may operate differently for children of different stages of development. If we can understand this moderating effect, we may be able to develop and refine LST to meet the needs of families with children of different ages.

To address these issues, the present study is a randomized clinical trial (RCT) to compare the emotional and behavioral adjustment, beliefs, and behaviors, including serious problem behaviors, of youth ages 8 to 16 (as rated by mothers, fathers, teachers, and the children themselves) whose fathers are randomly assigned to participate in LST with their nondrug using female partners as compared to fathers who are assigned to IBT. We will also focus on potential mechanisms of action that are positively influenced by LST.

We intend to use the information collected from the proposed investigation to refine and modify LST to enhance its positive effects on children. This process of (a) examining multiple dimensions of functioning and (b) evaluating theoretically and empirically identified mediators and moderators to inform intervention development and refinement has been used successfully for over a decade with LST, resulting in empirically informed LST variants for alcoholic patients, drug-abusing patients, patients who engage in domestic violence, female substance-abusing patients, and so on. Thus, this project provides the next critical step for LST refinement and interventions for couples entering LST who have custodial children, the latter of whom we may only be able to help by helping their parents.

Intervention(s) in this Clinical Trial

• Behavioral: Individual Drug Abuse Treatment
  • Fathers participate in individual drug abuse treatment for substance abuse.

Arms, Groups and Cohorts in this Clinical Trial

• Experimental: Lifestyle Counseling
  • Couples receive behavioral couples therapy for paternal drug use.
• Active Comparator: Individual Drug Abuse Treatment
  • Fathers participate in individual drug abuse treatment for substance abuse.

Primary Measures

• Effects of Parents' SA Treatment on Youth Behavioral,Emotional and SA Outcomes of Drug Use of Parents
  • Time Frame: up to six months post-treatment
    Safety Issue?: No

Secondary Measures

• Effectiveness of Behavioral Couples Treatment for Drug Use
  • Time Frame: up to six months post-treatment
    Safety Issue?: No

Inclusion Criteria:

• couples must be married or cohabiting in a stable relationship for at least 2 years
• both partners must be at least 18 years of age
• men must be residing in the home for the last 2 years
• men must meet DSM-IV criteria for current opiate or cocaine dependence (DSM-IV 4th ed., American Psychiatric Association, 1994)
• men must have medical clearance to engage in abstinence-oriented outpatient treatment
• men must agree to refrain from the use of alcohol or illicit drugs for the duration of treatment
• men must refrain from seeking additional substance abuse treatment except for self-help meetings (e.g., Narcotics Anonymous) for the duration of treatment unless recommended by his primary individual therapist.
• the randomly selected target child cannot have cognitive or physical limitations that would preclude interview (e.g., mental retardation, blindness).
• children in the study must be fluent in English.

Exclusion Criteria:

• the female parent meets DSM-IV criteria for a psychoactive substance use disorder in the last 6 months
• if either partner has perpetrated severe levels of violence against the other as assessed by the Timeline Followback Spousal Violence or CTS-2
• if either parent meets DSM-IV criteria for an organic mental disorder, schizophrenia, delusional (paranoid) disorder, or other psychotic disorders
• if either partner participates in other substance abuse treatment (except for self-help groups)
• one or both partners are fearful of participating in couples treatment
• one or both partners want to leave the relationship, in whole or in part, due to IPV

Gender Eligibility for this Clinical Trial: Both

Minimum Age for this Clinical Trial: 8 Years

Maximum Age for this Clinical Trial: 65 Years

Are Healthy Volunteers Accepted for this Clinical Trial?: No

Lead Investigator: Old Dominion University Other

Overall Clinical Trial Officials and Contacts

Michelle L Kelley, Ph.D. Principal Investigator Old Dominion University  

Information obtained from ClinicalTrials.gov on February 02, 2012

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT01172587

Study ID Number: 1R01DA024740-01A2

ClinicalTrials.gov Identifier: NCT01172587

Health Authority: United States: Institutional Review Board