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 substances 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 6 to 18 (as rated by mothers, fathers, teachers, and the children themselves) whose mothers or fathers are randomly assigned to participate in LST with their nondrug using partners as compared to parents who are assigned to IBT. We will also focus on potential mechanisms of action that are positively influenced by LST.