Examining the Feasibility of Enhancing Substance Use Treatment with a Therapeutic Parenting Intervention

Background:  Young children of mothers with substance use disorders (SUDs) are at risk for cognitive, social and emotional difficulties (Salo & Flykt, 2013). Although it is known that in utero exposure to substances can increase these risks, the quality of relationships with caregivers and caregiving practices are themselves significantly associated with developmental outcomes (Nair, et al, 2003). Furthermore, 61% of infants in foster care are from substance involved families (Wulczyn, et al., 2011). Because of these concerns, attachment-focused therapeutic parenting interventions have been developed to enhance treatment for substance dependence (Suchman, et al., 2013; Paris, et al., 2015). Given the importance of examining the process and feasibility of enhancing SUD treatment, this study explores client and staff perspectives regarding a parenting program at 3 methadone clinics.

Methods:  Qualitative interview data were used from a process and outcome evaluation of Project BRIGHT II, a dyadic evidence-informed attachment-based parenting intervention designed to enhance methadone treatment. Interviews were conducted with opioid dependent mothers of young children (N=24; predominantly Caucasian; M age=30) at discharge from BRIGHT II and methadone clinic staff (N=14; social workers, counselors, nurses and supervisors). Mothers’ interviews focused on parenting, experience of BRIGHT II and participating in a parenting intervention within methadone treatment. Clinic staff were questioned about their perspective on parenting and recovery, knowledge gained from BRIGHT II staff, and the fit of BRIGHT II in their methadone clinic. Interviews were coded by two research assistants and supervised by the study PI. Analyses used grounded theory techniques (Charmaz, 2006) including line-by-line coding and subsequent creation of concise themes and categories.

Results:  Findings show that mothers were motivated to participate in BRIGHT II due to wanting to become good parents, impress child welfare staff and obtain extra support. Many perceived benefits such as improved parenting skills, increased ability to understand their child’s needs and behaviors and greater patience and confidence in parenting. Some mothers described that BRIGHT II clinicians were calm and reflective, different from clinic staff, and that they answered questions about child development—crucial given worries about children’s in utero exposure to substances.

Methadone clinic staff described improved understanding of children and trauma and a broader family perspective on recovery, subsequent to interactions with BRIGHT II. They viewed BRIGHT II clinicians as knowledgeable, available, and an easy fit in the clinic; the focus on parenting was appreciated and seen as the catalyst to improvement in clients’ parenting abilities. Many reported previously believing that parenting was only a stressor- something to provoke relapse. Now they understood that feeling good and competent as a parent could lead to longer sobriety.

Conclusion:  Given the extreme concern about children in substance involved families and their overwhelming presence in the child welfare system, effective attachment-focused parenting interventions are essential additions to any SUD treatment program. Findings from this study, although small, provide evidence of the feasibility of offering a therapeutic parenting intervention as an enhancement in methadone treatment to both improve parenting capacities among caregivers and offer a necessary family-based perspective to clinic staff.