Substance Abuse Treatment Engagement Among Parents: The Role of Children As Motivators and Inhibitors and the Agency-Imposed Barriers and Facilitators

Purpose: Parents' decisions to participate in substance abuse treatment are impacted by their parental responsibilities as well as their experiences with the treatment agency and/or social worker.  Prior work indicates that being a parent can increase the likelihood of treatment engagement or, conversely, deincentivize engagement. Likewise, parents’ experiences within the agency context can also facilitate or inhibit parents’ likelihood of remaining in treatment.  Explanations for these conflicting concepts are limited, particularly in relationship to the influence of parental responsibilities.  The purpose of this qualitative study was to explore 1)the ways parents discuss their children serving as motivators and inhibitors to substance abuse treatment and 2)parent-specific barriers and facilitators to substance abuse treatment engagement imposed by agency policies. 

Methods: Nine in-person focus groups (n=45) were conducted with current and former recipients of substance abuse treatment services at eight substance abuse agencies in one southeastern state.  Participants were asked to discuss their service use (e.g., What motivated you to seek treatment?) and perception of services (e.g, What do you like about services?).  The majority of participants identified as female (82.2%), unemployed (62.2%), high school graduates/GED (73.4%), and were in their mid-thirties (mean=34.02).  Clients identified as predominantly white non-Hispanic (71.1%), black non-Hispanic (26.7%), or Hispanic (2.2%). Using inductive thematic analysis, transcripts were analyzed using first-cycle and second-cycle axial coding to identify key themes related to children and the substance abuse agency.

Results:Children were referred to frequently as a motivation for treatment and occasionally as inhibitors for treatment.  Motivations for treatment related to children included involvement with child protective services (CPS), to keep custody of children, to be a better parent, and to make a better life for the child.  Inhibitors for treatment included anxiety over separation from child and concern about losing child custody.  Participants also discussed the ways substance abuse treatment agencies facilitate or create barriers to participation for parents.  Facilitators for participation included flexible scheduling of child visits for parents in residential treatment, advocating with CPS for the client’s rights, treatment services provided to the child, offering child activities, and not making the client feel like “a bad parent.”  Barriers to treatment participation included decreased time with the child and a lack of child care services.

Conclusions/Implications:  Although being a parent imposes logistical barriers to treatment engagement, the emotional connection with the child can provide a strong source of motivation to obtain treatment.  Consistent with Self-Determination Theory, participants in this study discussed how their relationship with their child was a factor in seeking treatment. To enhance treatment engagement among parents, social workers should address agency-level barriers and draw upon children as intrinsic motivation for change.  However, for some parents, a strong parent-child bond may actually inhibit the initiation of treatment due to the conflicting goals of self-care versus caring for one’s child. Future research should continue exploring the complexity of how parental responsibilities and agency factors intersect to promote or inhibit parent engagement in treatment. Policies are needed that promote flexibility, choice, and support for parents to engage in treatment services.