Opiate-Addicted Parents in Methadone Treatment: Long-Term Recovery, Health, and Family Relationships (original) (raw)
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Addiction, 2008
Aims-This study examines the efficacy of the Focus on Families project (currently called Families Facing the Future), a preventive intervention to reduce substance use disorders among children in families with a parent in methadone treatment. Design-One hundred and thirty families were randomly assigned to a methadone clinic treatment-as-usual control condition or treatment-as-usual plus the Focus on Families intervention [1] between 1991 and 1993. Setting-Participants were recruited from two methadone clinics in the Pacific Northwest. Participants-This study examines the development of substance use disorders among the 177 children (56.84% male) involved in the program using data from a long-term follow-up in 2005, when these participants ranged in age from 15 to 29 years. Intervention-The intervention was delivered through group parent-training workshops at the methadone clinics and through individualized home-based services. The intervention taught parenting skills and skills for avoiding relapse to drug abuse. Measurements-At long-term follow-up, substance use disorders were measured by the Composite International Diagnostic Interview (CIDI). Survival analyses were used to assess intervention versus control differences in the hazard of developing substance use disorders. Findings-Overall, intervention and control participants did not differ significantly in risk of developing substance use disorders. However, there was evidence of a significant difference in intervention effect by gender. There was a significant reduction in the risk of developing a substance use disorder for intervention group males compared to control group males (Hazard Ratio = .53, p = .03), while intervention versus control differences among girls were nonsignificant and favored the control condition. Conclusions-Results from this study suggest that helping parents in recovery focus on both reducing their drug use and improving their parenting skills may have long-term effects on reducing substance use disorders among their male children. However, the overall long-term benefits of this program are not supported by the results for female children.
Opiate Addicts and Their Parents
Family Process, 1975
A minority of opiate addicts, especially young males, maintain close ties with their parents. These families, referred to here as “addict‐families,” are characterized by: (a) much greater success by the parents in meeting reality demands than by the addicts; (b) apparent congeniality and closeness but an absence of effective communication; (c) unsuccessful attempts by the parents to control the addict's behavior; (d) a tendency for the father to dominate the mother; (e) extreme overindulgence of the addict by one or both parents; (f) absence of parental support for movement toward adult responsibility in the addict; (g) family consensus in perceiving the addict as failing by conventional values. The characteristics seem to perpetuate the addiction, and the addiction appears to maintain the stability of the family.
Child: Care, Health and Development, 2007
High rates of child abuse and neglect occur in many families in which either or both parents abuse illicit drugs. This study reports on the results of a randomized controlled trial with families having a parent on methadone maintenance (N = 64), in which an intensive, home-based intervention, the Parents Under Pressure (PUP) program, was compared to standard care. A second brief intervention control group of families received a two-session parenting education intervention. The PUP intervention draws from the ecological model of child development by targeting multiple domains of family functioning including the psychological functioning of individuals in the family, parent-child relationships, and social contextual factors. Mindfulness skills were included to address parental affect regulation, a significant problem for this group of parents. At 3-and 6-month follow-up, PUP families showed significant reductions in problems across multiple domains of family functioning, including a reduction in child abuse potential, rigid parenting attitudes, and child behavior problems. Families in the brief intervention group showed a modest reduction in child abuse potential but no other changes in family function. There were no improvements found in the standard care group and some significant worsening was observed. Results are discussed in terms of their implications for improved treatment. D
INTERGENERATIONAL FAMILY THERAPY WITH METHADONE MAINTENANCE PATIENTS AND FAMILY MEMBERS
The results of a treatment-outcome study on the effectiveness of brief intergenerational family therapy (IFT) vs. videotaped didactic family classes (DFC) for methadone maintenance patient and their families are presented. There were 41 families randomized to one of two treatments. The ethnic composition of the sample was of 27% Hispanics, 9.0% African Americans, 37% Anglo, with the rest of mixed ethnicity. The results on three levels of outcome (identified patient, family members, and the family systems) were analyzed using a mixed-design (repeated measures with a between group independent variable) MANOVA with treatment (IFT vs DFC) as the between-group independent variable and time of evaluation (pre, post, follow-up) as the repeated measure. Both conditions were effective in reducing drug abuse symptomatology for the identified patient. Family members improved on social supports and psychiatric symptoms for both conditions. For the outcome measures on the family as a system, both conditions showed beneficial effects for Conflict, Control, and Organization in relation to the family of origin. However, IFT was more effective than DFC for some family environment variables (e.g., cohesion and expression), while DFC showed improvement with others (i.e., independence). The clinical and research implications of these findings are discussed.
Parent training skills and methadone maintenance: clinical opportunities and challenges
Drug and Alcohol Dependence, 2000
Children raised in substance abusing families show high rates of behavioural and emotional problems, in particular oppositional, defiant and non-compliant behaviours. While a range of social and individual factors correlate with poor parenting, it is often the quality of the parent-child relationship that mediates the effects of most other risk factors on child development. By addressing this relationship using behavioural family interventions, child behaviour problems have been reduced in multiple problem families. However, there has been little attempt to systematically evaluate such programs in substance abusing families. It is argued that methadone replacement programs provide a window of opportunity to deliver well-validated parent training programs that enhance the quality of parent-child relations. However, it is likely that such programs would need to be medium to long term and address issues beyond parent child relationships. How such interventions may be delivered and evaluated is discussed. 0
Journal of Drug Abuse, 2016
During the past decade, prescription drug abuse has emerged as a major public health concern in the United States. The National Institute on Drug Abuse (NIDA) estimates that 52 million Americans aged 12 and older have used prescription drugs for nonmedical reasons at least once in their lifetime [1]. The Monitoring the Future [MTF] survey similarly found that one in 12 high school seniors abuse Vicodin and one in 20 seniors abuse OxyContin [2]. Vicodin and OxyContin are the most commonly abused drugs in adolescents [2, 3]. The Center for Disease Control [CDC] suggests that opioid abuse is the strongest predictor for developing a heroin addiction. In fact, heroin use has more than doubled among young adults aged 18 to 25 years [3]. White males and females, young adults, and individuals from higher socioeconomic backgrounds reported an increase in heroin use from 2002 to 2013 [3-5]. It appears as if adolescents who use opioid pain relievers such as Vicodin and OxyContin for nonmedical reasons are at greater risk for developing an addiction to heroin in young adulthood [5]. There is a pressing need to develop innovative strategies to encourage young adults to seek and engage in treatment [6]. The Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey on Drug Use and Health estimates that 23.5 million individuals age 12 years or older require treatment for an alcohol or a drug abuse problem [7]. Of these individuals, only 11% of them will receive specialized treatment for an addictive disorder [7, 8]. Treatment research indicates that the number of admissions for heroin and other opioids has increased from 1992 to 2008 [9]. Despite this increase in treatment admissions, the number of drug overdose deaths have doubled in the United States [4]. The majority of overdoses are attributed to prescription drugs with pharmaceutical opioids accounting for most of them [4, 9]. Treatment providers suggest a paradigm shift is required in the delivery of services to promote sustained recovery [10, 11]. Treatment approaches need to shift from an "emergency room model of acute care" to "a model of sustained recovery management" [12]. Addiction researchers similarly suggest that innovative comprehensive treatment approaches be developed to address the opioid drug epidemic in the United States [13-15]. Most treatment research indicates that a family component is necessary for treatment to be effective, particularly with opiate addicts aged 15 to 25 years old [16-20]. Little et al. [21] conducted a randomized pilot study for adolescent drug abusers. Adolescents exposed to family therapy reported less marijuana use compared to those adolescents not exposed to family therapy. Both groups
Participation in a parent training program for methadone clients
Addictive Behaviors, 1995
Programs for drug abusers are plagued by high rates of dropout. Because of the strong relationship between longer treatment and positive outcome, researchers have begun to study individual and program-specific factors that influence premature termination of treatment. For the most part, these studies have focused on dichotomous measures of dropout or number of sessions attended. In this article, we extend this line of research in two ways. First, we develop and measure a number of indicators of treatment participation based on therapist ratings. Second, we develop a model of treatment participation that employs both individual and program-specific factors. The data show that tremendous variation in participation occurred even among those who attended a majority of sessions, which highlights the importance of obtaining more elaborate measures of treatment participation. The model predicting treatment participation suggests that initiation of heroin use later in life, continued use of marijuana, and behavioral indicators of motivation are the strongest predictors of program participation. Research and practical implications of the findings are discussed.
Family Practice, 2000
Keen J, Oliver P, Rowse G and Mathers N. Keeping families of heroin addicts together: results of 13 months' intake for community detoxification and rehabilitation at a family centre for drug users. Family Practice 2000; 17: 484-489. Background. Heroin addiction is a major public health problem affecting both the addicted individuals and their children, who have been shown to have poor social, educational and health status and to be at higher risk of abuse than their peers. Whilst the antenatal effects of parental drug use and the overall poor outcomes for these children have been widely studied, there has been little emphasis on the effectiveness of treatment interventions and even less emphasis on evaluating the effect on children of the standard treatments aimed at their parents' drug use.
Involving significant others in the care of opioid-dependent patients receiving methadone
Journal of Substance Abuse Treatment, 2005
Positive, abstinence-oriented, social support is associated with good substance abuse treatment outcome but few interventions are designed to help patients improve their social supports. This article reports on a behavioral intervention designed to encourage opioiddependent patients receiving methadone to include drug-free family members or friends in treatment and to use these individuals to facilitate development of a supportive, non-drug-using social network. This report uses data from a quality assurance program review of the treatment response of 59 opioid-dependent outpatients who identified a drug-free significant other to participate in their treatment. Fifty-five (93.2%) brought a significant other (most often the patient's mother, 29%) to both the initial evaluation session and at least one joint session. Social support activities were family-(33%), church-(28%), and self-help group-related (30%). Approximately 78% of patients who participated in the social support intervention achieved at least four consecutive weeks of abstinence. Women responded better than men. We conclude that methadone-maintained patients can and will include non-drug-using family members and friends in treatment, and these individuals can be mobilized to help patients improve their recovery. D