Substance-Using Mothers and Parenting: Adapting an Evidence-Based Model

Background and Purpose: Past studies of mothers with Substance Use Disorders (SUDs) often demonstrate decreased capacities to understand and reflect upon their children's development and emotional experience (RF, reflective functioning) (Levy, Truman, & Mayes, 2001). These mothers frequently have histories of multiple trauma exposures, which in turn can be linked to elevated levels of psychological distress (Suchman, et al., 2005). Their children often experience increased trauma exposure and impaired development. All of these factors can contribute to dysfunction in mother-child interactions and attachment insecurities.

Responding to the needs of these families and community service providers , two agencies and a university developed BRIGHT, an adaptation of evidence-based Child-Parent Psychotherapy (Lieberman & Van Horn, 2005), for mothers with children birth to five in residential treatment for SUDs. While this is the first time that CPP has been adapted for use with this population, the need for evidence-based interventions in community SUD settings is well-established (Bromberg et al, 2010). The weekly dyadic intervention (M= 14 sessions) concentrates on strengthening the parent-child relationship by improving mothers' mental health and promoting increased parental RF and parent-child attachment. This study focuses on outcome data from maternal self-reports and observer-rated parent-child interactions.

Methods: Participants were 76 mothers (treatment group, n=52; comparison group, n=24), who were predominantly Caucasian, in their late 20s, with a child birth to five (M= 19 months). Most were high school educated, unemployed, single and in treatment for addiction to heroin and other opiates. All had severe histories of trauma exposure and high levels of psychological distress. The comparison group received SUD treatment, but did not receive BRIGHT. Data were collected with standardized measures at baseline and post-treatment and used to assess change in mothers' self-reported psychological distress, parental RF and attitudes, and observer ratings of parent-child interactions. Bivariate and multivariate analyses were computed to assess change over time in both treatment and comparison groups.

Results: Maternal psychological distress levels at baseline were significantly associated with greater levels of traumatic exposure in children, and a higher risk of child maltreatment. BRIGHT mothers experienced significant improvements in their overall psychological distress. Those who improved most at follow-up self-reported more empathy with and appropriate expectations of their children. Clinician observers rated those same mothers as most improved in their parent-child relationships. Additionally, mothers who had more sessions demonstrated greater improvement in RF. None of these changes were found in comparison group participants.

Conclusions and Implications: This study provides support for the multiple foci of BRIGHT and the feasibility of adapting evidence-based interventions to community settings. Specifically, improvement in psychological distress of mothers, which in turn was related to positive changes in self-reported parenting abilities and attitudes, and observer-rated parent-child interactions speaks to the complexities of shifting parenting relationships in highly traumatized substance using populations. Augmenting community SUD treatment with an evidence-based parenting intervention can improve mental health and parent-child relationships. Social work researchers and practitioners can benefit from this knowledge in order to advance effective programs and outcomes for families struggling with SUDs.