Improving the outcomes of children affected by parental substance abuse: a review of randomized controlled trials (original) (raw)
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Outcome Measures of Interventions in the Study of Children of Substance-abusing Parents
Pediatrics, 1999
Children of substance-abusing parents, including children of alcoholics (COAs), are one of the highest risk groups of youth for substance-abuse problems. For both genetic and family environmental reasons, COAs and children of drug abusers are very vulnerable to becoming alcohol or other drug abusers.1,2 With drug use rates increasing in the past 7 years,3 prevention practitioners must work harder to identify and evaluate effective ways to prevent future substance abuse in these at-risk children. Most prevention programs designed specifically for COAs or children of drug abusers have struggled with identifying, attracting, maintaining, and measuring outcomes.This article focuses on general and unique measurement methods and instrument problems in prevention interventions for children of substance-abusing parents. Part I covers the need for improved measurement in research and practice with children of substance-abusing parents and recommended measures for different hypothesized outco...
A realistic review of family-based interventions for children of substance abusing parents
2021
Background Millions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. Family-based intervention programs for children with substance abusing parents can yield positive outcomes. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). The primary objectives were to uncover patterns of contextual factors and mechanisms that generate program outcomes, and advance program theory in this field. Methods Realist review methodology was chosen as the most appropriate method of systematic review because it is a theory-driven approach that seeks to explore mechanisms underlying program effectiveness (or lack thereof). A systematic and comprehensive sea...
Adicciones, 2007
The scientific literature consistently reports that while children of substance abusers may be at biological, psychological, or environmental risk, the effects of these risks can be abbreviated through the use of effective interventions and treatments. Research has consistently demonstrated reductions in family and child dysfunction when effective family intervention programs are consistently utilized. While a number of effective family-based approaches have been developed and evaluated, only a few have been designed specifically for children of substance abusing parents. Just two have been tested in randomized control trials -The Streghtening Families Program and Focus on the Family. The Streghtening Families Program has demonstrated statistically significant reductions in family and child dysfunctions across several ethnocultural groups when consistently utilized. Clinical and advanced graduate programs should stress training in these evidence-based practices as well as how to ada...
Current Opinion in Psychiatry, 2018
Purpose of review To provide an update of recent studies of the incidence and impact of parental substance use disorders (SUDs) on children, and to identify effective treatment programs to assist parents with SUDs and their children. Recent findings Children of parents with alcohol and drug use disorders (COPADs) suffer from physical, mental and behavioral problems at higher rates than other children and are more likely to develop their own SUDs in adolescence. Parenting styles and familial dysfunction contribute to the intergenerational transmission of SUDs. Studies of the negative effects of parental SUDs on children identified the effects of inconsistent, disengaged or harsh parenting practices on mother-child bonding. Exposure to violence and father's hostility contribute to children's externalizing and internalizing behaviors. Family-based intervention programs, as well as programs for mothers with SUDs and their young children, have shown positive results. For high-risk families with multiple needs, the ongoing support of multidisciplinary services is required. Summary Parental SUDs have a profound impact on their children, including intergenerational transmission of SUDs. A variety of interventive programs are being studied in order to devise effective programs to assist these children.
2021
Substance abuse is a pervasive issue affecting Canadian families, and a substantial number of children are impacted by alcohol or drug abusing parents. Children exposed to parental substance misuse are at increased risk for negative psychological, emotional, developmental, and behavioural outcomes, and a substantial proportion will go on to experience substance use issues later in life. Early intervention is key to providing support for these children and ultimately disrupting the family cycle of addiction. However, few family-based programs for children of substance abusing families are reported in the literature and information on program theory is lacking. A 2-study dissertation was conducted in order to address these gaps. First, a realist review study was undertaken to systematically review existing evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents. A systematic search of academic and grey literature unc...
A realist review of family-based interventions for children of substance abusing parents
Systematic Reviews, 2015
Background: Millions of children across North America and Europe live in families with alcohol or drug abusing parents. These children are at risk for a number of negative social, emotional and developmental outcomes, including an increased likelihood of developing a substance use disorder later in life. Family-based intervention programs for children with substance abusing parents can yield positive outcomes. This study is a realist review of evaluations of family-based interventions aimed at improving psychosocial outcomes for children of substance abusing parents (COSAPs). The primary objectives were to uncover patterns of contextual factors and mechanisms that generate program outcomes, and advance program theory in this field. Methods: Realist review methodology was chosen as the most appropriate method of systematic review because it is a theory-driven approach that seeks to explore mechanisms underlying program effectiveness (or lack thereof). A systematic and comprehensive search of academic and grey literature uncovered 32 documents spanning 7 different intervention programs. Data was extracted from the included documents using abstraction templates designed to code for contexts, mechanisms and outcomes of each program. Two candidate program theories of family addiction were used to guide data analysis: the family disease model and the family prevention model. Data analysis was undertaken by a research team using an iterative process of comparison and checking with original documents to determine patterns within the data. Results: Programs originating in both the family disease model and the family prevention model were uncovered, along with hybrid programs that successfully included components from each candidate program theory. Four demi-regularities were found to account for the effectiveness of programs included in this review: (1) opportunities for positive parent-child interactions, (2) supportive peer-to-peer relationships, (3) the power of knowledge, and (4) engaging hard to reach families using strategies that are responsive to socioeconomic needs and matching services to client lived experience. Conclusions: This review yielded new findings that had not otherwise been explored in COSAP program research and are discussed in order to help expand program theory. Implications for practice and evaluation are further discussed.
2008
Adolescent substance abuse is a prevalent problem and both individual and group family interventions are increasingly being used to assist families to cope. A literature review was conducted to identify whether individual and group family interventions for adolescent substance abuse enhance the mental health of parents and other family members. The review also sought to identify direct and indirect effects of family intervention processes on depressive symptoms and general distress. Based on quality criteria a total of nine studies were included. Of these, six quantitatively examined family intervention outcomes on family member mental health, with all six reporting positive effects. Four of the nine studies measured levels of depressive symptoms and three of these four studies reported significant direct effects of family intervention on parental depression. The positive effects were also found in the three qualitative studies included in the review. Indirect therapeutic mechanisms that contributed to mental health improvements included: reduction of stress symptoms, improved coping, improved family functioning, more effective parenting behaviours, attitude changes, perceived changes in relative's substance use, and improved social support. The available literature suggests that a number of determinants of family mental health may potentially be impacted through family intervention for adolescent substance abuse. However, definitive conclusions cannot be made at this point as the literature is mostly descriptive and there have been few longitudinal studies or randomised controlled trials.
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.