effects of gender and level of parental involvement among parents in drug treatment

Effects of Gender and Level of Parental InvolvementAmong Parents in Drug Treatment

Cyleste C. Collins, Christine E. Grella,* and Yih-Ing Hser

UCLA Integrated Substance Abuse Programs, Los Angeles,

California, USA

ABSTRACT

Most studies of parents in drug treatment have focused exclusively on

mothers, and few studies have examined the effects of parents’ level of

involvement with their children on the parents’ drug use and

psychological functioning, either before or after treatment. This study

examined mothers and fathers ðn ¼ 331Þ who were parents of children

under the age of 18; participants were sampled from 19 drug treatment

programs across four types of treatment modalities in Los Angeles

County. A majority of each group (57% of 214 mothers and 51% of 117

fathers) were classified as being highly involved with their children. At

the baseline assessment, higher parental involvement was related to lower

levels of addiction severity, psychological severity, and symptoms of

psychological distress, and to higher levels of self-esteem and perception

of parenting skills. In general, fathers had higher levels of alcohol and

drug-use severity than did mothers, but fathers who were more involved

237

DOI: 10.1081/ADA-120020510 0095-2990 (Print); 1097-9891 (Online)

Copyright q 2003 by Marcel Dekker, Inc. www.dekker.com

*Correspondence: Christine E. Grella, UCLA Integrated Substance Abuse Programs,

1640 S. Sepulveda Avenue, Suite 200, Los Angeles, CA 90025, USA; Fax: (310)

473-7885; E-mail: [email protected].

THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE

Vol. 29, No. 2, pp. 237–261, 2003

MARCEL DEKKER, INC. • 270 MADISON AVENUE • NEW YORK, NY 10016

©2003 Marcel Dekker, Inc. All rights reserved. This material may not be used or reproduced in any form without the express written permission of Marcel Dekker, Inc.

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with their children showed lower levels of addiction severity than fathers

who were less involved. Parental involvement at baseline was unrelated to

drug use at the 12-month follow-up, although parents who were less

involved with their children reported experiencing more stressors. Given

the association of parental involvement with lower levels of addiction

severity and psychological distress at baseline, treatment protocols should

build upon the positive relationships of parents with their children, and

seek to improve those of less-involved parents.

Key Words: Gender; Parental involvement; Drug treatment,

Psychological distress.

INTRODUCTION

Research on parental drug abuse has focused largely upon its effects on

children, whereas little research has focused on the parents themselves.

Specifically, little is known about how being a parent affects drug-abusing

parents’ participation in and response to drug treatment. Most studies have

been concerned with the effects of parental drug use on children’s

development, the intergenerational transmission of drug abuse, and the

increased risk of physical abuse and neglect of children by drug-abusing

parents (1). Children of women who used drugs during pregnancy have been

found to be at greater risk for poor developmental outcomes, in part because

they are more likely to be born prematurely and to have low birthweight as

compared with children of nonabusers (2,3).

In addition to developmental risks, children of drug abusers are more

likely to have psychological and behavioral problems as compared with

children of nonabusers (4–8). Such problems are likely factors in the findings

from several studies that have shown that children of substance abusers are at

greater risk for becoming drug users themselves, perpetuating the cycle of

drug abuse across generations (9–11). Finally, drug-abusing parents have

been found to be at greater risk of abusing or neglecting their children

(12–15). These studies have established the negative consequences of

parental substance abuse upon children, but have not examined how the

parental role affects substance-abusing parents themselves.

Some studies have examined the levels of stress among substance-abusing

parents and their parenting behaviors with regard to their effects upon their

children. In one study, substance-abusing mothers were found to be more likely

than nonsubstance-abusing mothers to have higher levels of overall stress and

parenting-related stress (16). These mothers were also more likely to use

Collins, Grella, and Hser238



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ineffective and maladaptive coping strategies, such as child abuse, in response

to parenting stressors. The psychological state of parents in drug treatment has

been associated not only with their own parenting, but also the behavior of their

children. For example, in one study, parents’ expectations of treatment,

satisfaction with treatment, and investment in treatment were associated with

improved child behavior and more authoritative parenting (17). Substance-

abusing mothers have been found to interact differently with their children than

nonsubstance-abusing mothers, and this has been demonstrated to have an

impact on the children. One study compared mothers who abused cocaine with

mothers who did not and found that the cocaine-abusing mothers were less

attentive and more distracted during interactions with their children at a 3-

month follow-up (18). These mothers’ inattentiveness and distraction were

strongly associated with recent cocaine use and with depression. Such parenting

behavior has lasting effects; parents who parent poorly tend to have been

parented poorly themselves (19), and without intervention, the cycle of

substance use and poor parenting perpetuates itself (20).

Research has suggested that parent-child bonding may be a critical factor in

determining whether this cycle of intergenerational drug abuse continues (21).

The theory of psychological wholeness asserts that psychosocial adjustment of

children is more closely related to the quality of parental support rather than to

family structure (22). This theory was tested and supported by the work of Knight

and colleagues (20), who found that parental support, or the perception of such,

was related to better psychosocial adjustment later in life. Clients in this study

were asked to recall their relationships with their parents when they were children

in regards to parental support, conflict, and parental absence. The findings

indicated that perceptions of parental support were better predictors of good

psychosocial functioning than parental absence, which was unrelated to

psychosocial functioning. Under the assumption that drug abuse is in part due to

psychosocial problems, these findings suggest that intergenerational drug use at

least has the possibility of being curbed with improved familial relationships.

Although parental support appears to be important to a child’s functioning,

until recently, the impact of parental support on parents themselves has been

unclear. Substance-abusing parents are often quite aware of their deficits as

parents. One study found that mothers in drug treatment experienced feelings of

guilt and shame in relation to their children and perceived themselves as failing

as parents (23). Additionally, these feelings were considered to be barriers to

successful participation in treatment. Although less research concerning

parenting among substance abusers has focused on fathers, one study found that

fathers in methadone maintenance treatment also had more guilt and shame

associated with their parenting than fathers who did not abuse drugs or alcohol

(24). Other studies have shown the importance of parents’ feelings of adequacy

Effects of Gender and Parental Involvement 239



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and the influence of a poor parental self-concept on appropriate coping

strategies (19,25,26). These studies suggest that their roles as parents may

influence the psychological well-being of both drug-abusing mothers and

fathers. Substance-abusing parents’ self-perceptions may be influenced by the

extent to which they are involved in their children’s lives, and may have

implications for how they respond to drug treatment.

This study assesses the impact of parental involvement on the

pretreatment characteristics and drug treatment outcomes of both mothers

and fathers. We focused on two key research questions: (1) Do parents who are

more involved with their children differ in their sociodemographic

characteristics, pretreatment drug-use patterns and level of psychological

distress, and treatment outcomes, as compared with less involved parents, and

(2) do mothers and fathers differ from one another in these areas? Past

research indicating that interpersonal relationships between parents and

children are a critical factor in determining the well-being of a family led us to

believe that more highly involved parents would show lower levels of drug use

and psychological distress as compared with less-involved parents.

Additionally, because of the generally greater centrality of parenting for

mothers than for fathers, we expected that mothers would derive more benefits

from parental involvement than fathers, specifically regarding levels of

psychological distress and drug-use severity.

METHOD

Study Design

Data were obtained from adult clients participating in a prospective study

of processes and outcomes of drug treatment. Clients were sampled from 19

treatment facilities selected by stratified random sampling to represent all

substances abuse treatment modalities available in Los Angeles County in

1995. These included: outpatient drug-free (nonmethadone)/day treatment

(11 sites), residential (4 sites), inpatient/detoxification (2 sites), and

methadone maintenance (2 sites). Within each treatment modality, programs

were randomly selected. Additionally, programs that served women were

oversampled to ensure adequate representation of clients treated in these

programs. Approximately 30 clients were randomly selected from each

participating program. For programs with 30 or fewer clients, all currently

enrolled clients were selected for participation; consecutively enrolled clients

were subsequently sampled until 30 cases were obtained from each site.




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Follow-up interviews were scheduled for approximately 1 year after the

baseline interview.

In accord with ethical guidelines, all data were collected only after clients

were assured of confidentiality and consent had been obtained. A federal

Certificate of Confidentiality was obtained to assure that data provided would

not be used against the clients in legal proceedings.

Participants

At baseline, 565 clients were recruited, yielding a participation rate of

85%. Face-to-face follow-up interviews were completed with 514 clients

approximately 12 months after the intake assessment (91% follow-up rate).

Subjects were lost to follow-up ðn ¼ 51; 10%Þ for the following reasons: 3

had not completed the intake assessment, 7 were deceased, 11 refused, and the

remaining 30 had either moved out of the area or were not located. The sample

used within this article was further limited to individuals who were parents of

children under the age of 18, resulting in a final sample of n ¼ 331: The mean

age for these clients was 36.0 years ðSD ¼ 7:5Þ and 64.7% were mothers.

Whites and African Americans were each about 37% of the sample, Hispanics

were 19.2%, and individuals of other ethnicities were 6.7%. Most of the clients

were single (69.8%). Approximately 66% of the sample had a high school

education and fewer than a quarter (23.9%) were employed at treatment

admission.

About 58% of the clients were attending outpatient drug-free or day

treatment modalities at the time of the intake interview, 28.7% were in

residential treatment, 7.9% were participating in methadone maintenance, and

5.1% were in inpatient detox. Almost three quarters of the sample (71.6%)

reported having received prior treatment for drug or alcohol problems.

Procedures

At baseline, all clients in the residential, methadone maintenance, or

outpatient programs who had been in treatment for at least 2 weeks

participated in a structured face-to-face interview. Among clients in short-

term detoxification programs, the baseline interviews were completed within 3

days. Participants were paid $15 for the interviews, which took approximately

45 minutes to complete and were conducted in private rooms at the treatment

facility. A voluntary urine specimen was collected at the end of the interview.

The follow-up interviews were conducted at UCLA or at a location convenient




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for the clients. The follow-up interview took approximately 2 to 3 hours and

clients were paid $50 for the interview. At the end of the follow-up interview,

a voluntary urine specimen was collected from respondents, except when it

was logistically infeasible (e.g., with respondents who were incarcerated).

Measures

Unless indicated, all measures were assessed for the 12 months preceding

either the date of the baseline or follow-up interview.

Background Characteristics

The key demographics assessed were age (measured on a continuous

scale), gender, ethnicity, educational status, marital status, and employment.

Treatment history was assessed by the number of prior treatments clients had

undergone and the age of first treatment. Drug use history included age of first

use of any illicit drug, age when regular drug use was initiated, having ever

injected drugs, and the primary problem drug for which the client was

receiving treatment.

Characteristics Related to the Parenting Role

These variables included number and ages of children; whether the client

had legal custody of any of their children, and if not, who had custody of these

children; whether they lived with any of their children; and whether the

parent’s participation in drug treatment would affect the custody of their

children. Clients were also asked to rate their skills as a parent, with 1 ¼ poor;2 ¼ fair; and 3 ¼ good:

The level of parental involvement at baseline was assessed using a

composite of four items, with an alpha reliability of .89. These items addressed

the amount of time that parents spent with their children engaging in various

activities in the year before treatment entry and were rated on a 4-point Likert-

type scale, with 1 ¼ not at all and 4 ¼ almost daily: Questions asked about

the frequency with which parents spent time engaging in the following

activities with at least one of their children: (1) leisure activities away from

home, (2) at home working on a project or playing together, (3) helping with

reading or homework, and (4) eating meals together. An index of parental

involvement was created by summing the four items and dichotomizing




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the total scores using a median split to reflect high (1) and low (0) levels of

involvement in parenting. Overall, approximately half or more of the sample

participated in the following activities with at least one child on a weekly or

more frequent basis (Table 1): engaging in leisure activities (50%), working

on a project or playing with their children (60.8%), helping their children with

reading or homework (47%), and eating meals with their children (66%).

By definition, parents who scored higher on parental involvement had higher

rates of engaging in these activities with their children. There was no

statistically significant gender difference in degree of parental involvement,

with 56.5% of the mothers and 51.3% of the fathers categorized as having

“high involvement.”

Drug/Alcohol Use

The Addiction Severity Index (ASI) (27) was used at baseline and follow-

up to assess the severity of drug and alcohol use. Severity scores are measured

on a continuous scale, with 1 indicating greater severity and 0 indicating less

severity. Drug use at follow-up was assessed using a dichotomous scale for

questions asking whether the client had used any illicit drugs or alcohol in the

preceding 12 months.

Psychological Distress and Self-Esteem

The Hopkins Symptom Checklist (28) was used to assess psychological

state at both baseline and follow-up. This measure comprises 58 items with

five subscales assessing the following: somatization, obsessive-compulsive-

ness, interpersonal sensitivity, general anxiety, and depression. Respondents

are asked to rate how distressed they have been by these symptoms in the past

week, ranging from 0 indicating the absence of distress to 3 indicating great

distress. The ASI psychological severity score was also assessed at both intake

and follow-up. Self-esteem was assessed at intake with the Rosenberg Self-

Esteem Scale (29), which ranged from 1 (low) to 4 (high).

Stressful Life Events

Exposure to stressful life events was measured at both baseline and

follow-up by summing positive responses regarding 27 different stressful

events that could have occurred in the preceding 12 months. These items




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Table 1. Background characteristics and parenting behaviors by gender and parental involvement.

Parental involvement

Fathers Mothers

Variables

Low

(n ¼ 57)

High

ðn ¼ 60Þ

Low

(n ¼ 93)

High

ðn ¼ 121Þ

Total

ðn ¼ 331Þ

Log-linear/ANOVA

Results

Background characteristics

Mean age (SD) 38.4 (9.4) 37.5 (8.2) 32.2 (5.8) 33.4 (6.1) 36.0 (7.5) G

Ethnicity (%) G

White 40.4 33.3 44.1 32.2 37.2

African American 29.8 25.0 37.6 45.5 36.9

Hispanic 28.1 31.7 9.7 16.5 19.3

Other 1.8 10.0 8.6 5.8 6.7

Married or living together (%) 22.8 56.7 28.0 22.3 30.2 G, I, I*G

Employed (%) 36.8 38.3 14.0 18.2 23.9 G

Completed high school (%) 80.7 81.7 55.9 57.9 65.6 G

Current treatment modality (%) ns

Outpatient drug-free/day treat

ment

49.1 61.7 53.8 64.5 58.3

Inpatient detox 14.0 3.3 3.2 3.3 5.1

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without the express w

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Residential 26.3 25.0 37.6 24.8 28.7

Methadone maintenance 10.5 10.0 5.4 7.4 7.9

Parenting characteristics and

behaviors

Number of children (SD) 2.5 (1.6) 2.6 (1.3) 3.2 (1.7) 3.3 (1.6) 3.0 (1.6) G

Age of children (SD) 11.3 (6.7) 9.4 (5.0) 6.6 (4.7) 7.7 (4.2) 8.3 (5.3) G, I*G

Live with any of your

children (%)

14.0 50.0 44.1 60.3 45.9 G, I, I*G

Have legal custody of any

child (%)

21.1 61.7 41.1 55.4 46.7 I, I*G

If do not have custody:

Spouse or sexual partner has

custody (%)

22.8 5.0 3.3 4.1 7.3 G

Former spouse or sexual

partner has custody (%)

38.6 30.0 9.9 5.0 16.7 G

Other relative has custody (%) 17.5 11.7 47.3 41.3 33.4 G

Drug treatment would affect

custody (%)

15.8 22.0 56.2 48.7 40.1 G

(continued)

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Table 1. Continued.


Fathers Mothers

Variables

Low

(n ¼ 57)

High

ðn ¼ 60Þ

Low

(n ¼ 93)

High

ðn ¼ 121Þ

Total

ðn ¼ 331Þ

Log-linear/ANOVA

Results

Concerned about losing

custody (%)

10.5 13.3 19.8 22.7 18.0 G

Activities engaged in weekly or almost daily with child: (%)

Leisure activities away from

home

5.3 81.7 14.3 82.5 50.0 I

Working on a project or playing 10.5 96.7 18.7 98.4 60.8 I

Helping child read or do

homework

1.8 75.0 4.4 86.7 47.0 I

Eating meals with children 24.6 95.0 30.8 97.5 66.0 I

Perception of parenting skills (%) I

Poor 51.9 22.0 54.7 9.9 30.3

Fair 32.7 47.5 28.0 52.9 42.4

Good 15.4 30.5 17.3 37.2 27.4

Note: Continuous variables were analyzed using two-way ANOVA, categorical variables with log-linear modeling, significant at

p , .05.

Anova ¼ analysis of variance; SD ¼ standard deviation; I ¼ main effect of parental involvement, G ¼ main effect of gender,

I*G ¼ interaction of parental involvement and gender, ns ¼ not significant.

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included moving, divorcing, experiencing the death of a close friend or family

member, having a serious illness or injury, having serious conflicts with

friends or family members, being laid off or fired from work, experiencing

significant debt, having civil or criminal legal problems, being unemployed

for a month or more, having a child leave home, having difficulty with

superiors or coworkers, losing something of sentimental value, being

assaulted, being robbed, being physically abused, being sexually abused,

being emotionally abused, having housing or landlord problems, and being

homeless. The number of stressors reported at baseline ranged from 0 to 20,

with a mean of 6.8 ðSD ¼ 4:2Þ; and at follow-up from 0 to 17, with a mean of

5.3 ðSD ¼ 3:5Þ:

Analyses

To examine our research questions, analyses were conducted on

continuous variables using two-way analysis of variance and on categorical

variables using log-linear modeling techniques, testing for the main effects

and interactions of parental involvement and gender. SAS Version 8.0 was

used to conduct the analyses.

RESULTS

Background Characteristics and Parenting Behaviors

With regard to background characteristics of the sample, there were

differences by degree of parental involvement and by gender (see Table 1). On

average, fathers were older than mothers, and were more likely to be Hispanic,

whereas mothers were more likely to be African American. A higher

proportion of fathers as compared with mothers had completed high school

and were currently employed. A significant interaction was found for marital

status; fathers who were highly involved with their children had the highest

rate of being married compared with the other groups. There were no

significant differences by gender or degree of parental involvement for type of

treatment modality.

Overall, these parents had an average of three children, although mothers

averaged more children than fathers. The average age of children was 8.3

years. There was a significant interaction between gender and parental

involvement, with low-involvement fathers having older children as compared

with the other groups ð p , :01Þ: Nearly half of the sample (46%) currently




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lived with at least one of their children, but there were significant variations by

gender and parental involvement, with high-involvement mothers the most

likely to live with a child. A significant interaction was also obtained for

whether the parent had legal custody of his or her children. Low-involvement

fathers were least likely to report having legal custody of their children.

A higher proportion of fathers without custody reported that their children

were in the custody of a current or former spouse/sexual partner, whereas

more mothers without custody reported that their children were in the care of

other relatives. Mothers were significantly more likely than fathers to report

concerns about losing custody of their children and were also more likely to

report that their participation in drug treatment would affect their custody

status.

When participants were asked to rate themselves as parents, 30.3%

regarded their parenting skills as poor, 42.4% rated themselves as fair, and

27.4% rated their parenting skills as good. A main effect of level of

involvement was found regarding perception of parenting skills ðp , :0001Þ;indicating that a greater proportion of high-involvement parents rated their

parenting skills as fair or good compared with low-involvement parents.

Baseline Characteristics

Drug Use and Treatment History

In terms of age of first use of any illicit drug, significant main effects were

found for both gender ðFð1; 330Þ ¼ 8:41; p , :01Þ and parental involvement

ðFð1; 330Þ ¼ 4:27; p , :05Þ: Mothers and high-involvement parents were

significantly older at age of first use of any drug (Table 2). Mothers were also

significantly older than fathers at age of first regular use of an illicit drug

ðFð1; 330Þ ¼ 3:90; p , :05Þ and had lower rates of injection drug use

ðx2ð1; n ¼ 331Þ ¼ 9:01; p , :01Þ: There were no significant differences by

gender or parental involvement regarding whether participants had had

previous drug treatment; however, there were significant gender differences in

number of prior treatments ðFð1; 330Þ ¼ 8:26; p , :01Þ and age at first

treatment ðFð1; 330Þ ¼ 11:56Þ: Fathers had participated in more treatment

episodes than mothers, and mothers were younger than fathers when they first

entered treatment. A higher proportion of fathers were currently in treatment

for alcohol or heroin/opiates, whereas a higher proportion of mothers were in

treatment for the use of amphetamines or cocaine/crack ðx2 ð5; N ¼ 331Þ ¼

27:88; p , :001Þ:




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Table 2. Baseline characteristics of clients by gender and parental involvement.


Fathers Mothers Log-linear/

ANOVA

Variables Low ðn ¼ 57Þ High ðn ¼ 60Þ Low ðn ¼ 93Þ High ðn ¼ 121Þ Total ðN ¼ 331Þ Results

Drug use history

Age first use any drug

(SD)

12.9 (3.7) 13.2 (3.5) 13.6 (4.5) 15.3 (4.2) 14.0 (4.2) G, I

Age first regular use

any drug (SD)

16.4 (7.9) 15.7 (4.6) 16.8 (6.4) 18.3 (6.6) 17.1 (6.5) G

Ever injected drugs

(%)

45.6 35.0 29.0 19.8 29.6 G

Treatment History

Any prior treatment

(%)

80.7 63.3 73.1 70.3 71.6 ns

Number prior

treatments (SD)

10.8 (21.3) 7.6 (21.3) 4.5 (5.9) 4.5 (8.4) 6.1 (14.1) G

Age of first treatment

(SD)

31.8 (9.8) 32.9 (9.1) 28.2 (6.3) 30.2 (6.4) 30.4 (7.7) G

Drug currently in

treatment for (%)

G

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Table 2. Continued.


Fathers Mothers Log-linear/

ANOVA

Variables Low ðn ¼ 57Þ High ðn ¼ 60Þ Low ðn ¼ 93Þ High ðn ¼ 121Þ Total ðN ¼ 331Þ Results

Marijuana/other 3.6 6.6 9.7 2.5 5.4

Amphetamines 17.5 21.7 26.9 23.1 23.0

Alcohol 17.5 21.7 3.2 9.9 11.5

Heroin/opiates 26.3 25.0 11.8 10.7 16.3

Cocaine/crack 35.1 25.0 48.4 53.7 43.8

Addiction severity index (SD)

Alcohol 0.19 (0.26) 0.11 (0.18) 0.05 (0.11) 0.08 (0.19) 0.10 (0.19) G, I*G

Drug 0.08 (0.11) 0.04 (0.08) 0.03 (0.07) 0.03 (0.07) 0.04 (0.08) I, G, I*G

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Psychological 0.13 (0.18) 0.06 (0.11) 0.11 (0.18) 0.07 (0.13) 0.09 (0.16) I

Psychological distress (SD)

Somatization 1.7 (0.6) 1.5 (0.4) 1.6 (0.5) 1.5 (0.5) 1.6 (0.5) I

Obsessive-compulsive 2.0 (0.8) 1.8 (0.5) 2.0 (0.7) 1.6 (0.6) 1.8 (0.6) I

Interpersonal sensitivity 1.9 (0.6) 1.7 (0.5) 2.0 (0.6) 1.6 (0.5) 1.8 (0.6) I

Depression 1.8 (0.6) 1.9 (0.6) 1.9 (0.6) 1.7 (0.5) 1.7 (0.5) I

Anxiety 1.7 (0.6) 1.5 (0.5) 1.6 (0.6) 1.4 (0.5) 1.5 (0.5) I

Self-esteem 3.0 (0.5) 3.2 (0.5) 3.0 (0.6) 3.3 (0.5) 3.1 (0.5) I

# of life stressors last

12 months

7.1 (4.4) 6.5 (4.1) 7.4 (4.5) 6.4 (4.0) 6.8 (4.2) ns


p , .05.

I ¼ main effect of parental involvement, G ¼ main effect of gender, I*G ¼ interaction of parental involvement and gender, ns ¼ not

significant.

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Addiction/Psychological Severity

A significant interaction was found between parental involvement and

gender on both the ASI alcohol ðFð1; 330Þ ¼ 16:94; p , :0001Þ and drug

severity scores ðFð1; 330Þ ¼ 5:05; p , :05Þ; with low-involvement fathers

having significantly higher severity scores than any other group. A significant

main effect of parental involvement was found for the psychological domain

of the ASI ðFð1; 330Þ ¼ 9:55; p , :01Þ; indicating that low-involvement

parents had significantly higher psychological severity scores than high-

involvement parents.

Psychological Distress

Main effects of parental involvement were found for all categories of

psychological distress. Low-involvement parents had higher levels of

psychological distress across the domains of somatization, obsessive

compulsiveness, interpersonal sensitivity, depression, and anxiety

ð p , :05 for allÞ: Additionally, low-involvement parents had significantly

lower levels of self-esteem ðFð1; 330Þ ¼ 15:59; p , :0001Þ: One factor that

could account for higher levels of distress is having experienced more stressful

life events; however, there were no differences between the groups regarding

the number of stressful events experienced in the previous 12 months. Thus

low-involvement parents showed higher levels of psychological distress and

lower self-esteem, regardless of the stressors they had experienced.

Treatment Outcomes at Follow-Up

Treatment outcomes at follow-up were examined controlling for the

effects of age, ethnicity, and baseline levels of the outcome variable, where

applicable (Table 3). Consistent with pretreatment findings, there was a

significant gender difference in employment at follow-up, with higher rates of

employment among fathers than among mothers ðx2 ð1; N ¼ 331Þ ¼

11:12; p , :01Þ: No group differences were found for addiction severity or

psychological distress, however. In contrast to the pretreatment findings, there

was a significant gender difference in self-esteem, with mothers having

significantly higher self-esteem than fathers ðFð1; 330Þ ¼ 6:74; p , :01Þ:A main effect of parental involvement on number of stressors since last

interview was found, with low-involvement parents reporting a significantly




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Table 3. Follow-up outcomes by gender and parental involvement.


Fathers MothersLog-linear/

Variables

Low

ðn ¼ 57Þ

High

ðn ¼ 60Þ

Low

ðn ¼ 93Þ High ðn ¼ 121Þ Total ðN ¼ 331Þ

ANOVA

Results

Employed (%) 43.9 55.0 23.9 28.1 34.6 G

Addiction severity index (SD)

Alcohol 0.08 (0.13) 0.09 (0.11) 0.05 (0.14) 0.04 (0.10) 0.06 (0.12) ns

Drug 0.03 (0.07) 0.02 (0.04) 0.03 (0.08) 0.01 (0.06) 0.02 (0.06) ns

Psychological 0.08 (0.12) 0.06 (0.11) 0.08 (0.15) 0.05 (0.12) 0.07 (0.13) ns

Psychological distress (SD)

Somatization 1.6 (0.5) 1.5 (0.5) 1.6 (0.4) 1.5 (0.5) 1.5 (0.5) ns

Depression 1.8 (0.6) 1.7 (0.5) 1.8 (0.6) 1.5 (0.5) 1.7 (0.6) ns

Obsessive-compulsive 1.8 (0.6) 1.7 (0.6) 1.9 (0.7) 1.6 (0.5) 1.7 (0.6) ns

Interpersonal sensitivity 1.8 (0.6) 1.6 (0.5) 1.9 (0.6) 1.6 (0.5) 1.7 (0.6) ns

Anxiety 1.5 (0.6) 1.4 (0.5) 1.5 (0.6) 1.3 (0.4) 1.4 (0.5) ns

Self-esteem 3.0 (0.5) 3.1 (0.5) 3.1 (0.6) 3.3 (0.5) 3.1 (0.5) G

# of life stressors last

12 months

6.0 (4.2) 4.9 (3.1) 6.0 (3.4) 5.1 (3.2) 5.5 (3.5) I

Drug use since last interview (%)

Abstinent (not

including alcohol)

41.1 35.0 66.7 59.5 53.9 G

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Table 3. Continued.


Fathers MothersLog-linear/

Variables

Low

ðn ¼ 57Þ

High

ðn ¼ 60Þ

Low

ðn ¼ 93Þ High ðn ¼ 121Þ Total ðN ¼ 331Þ

ANOVA

Results

Abstinent (including

alcohol)

30.4 23.3 50.5 44.6 40.0 ns

Cocaine/crack use 31.6 30.0 16.1 18.2 22.1 G

Heroin/opiate use 19.3 18.3 10.8 9.9 13.3 G

Amphetamine use 12.3 18.3 10.8 9.2 11.8 ns

Alcohol use to intoxication 28.1 28.3 8.7 14.1 17.6 ns

Marijuana use 26.3 31.7 15.1 16.5 20.5 G

Completed treatment (%) 70.2 85.0 92.5 93.4 87.6 G


p , .05.

I ¼ main effect of parental involvement, G ¼ main effect of gender, I*G ¼ interaction of parental involvement and gender, ns ¼ not

significant.

All statistical tests were performed to test the main effects and interaction effects of gender and parental involvement, controlling for

demographics (age and ethnicity), and pre-treatment levels (if applicable).

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greater number of stressors as compared with high-involvement parents

ðFð1; 330Þ ¼ 4:99; p , :05Þ:A main effect of gender was found for abstinence from any drug (not

including alcohol) since the baseline interview ðx2 ð1; N ¼ 331Þ ¼

8:95; p , :01Þ; with mothers reporting higher levels of abstinence. There

were significant gender differences on three types of drug use: cocaine and

crack ðx2 ð1; N ¼ 331Þ ¼ 7:67; p , :01Þ; heroin and other opiates

ðx2 ð1;N ¼ 331Þ ¼ 12:90; p , :001Þ; and marijuana ðx2 ð1; N ¼ 331Þ ¼

10:10; p , :01Þ; with higher rates of use among fathers. A main effect

of gender was also found for treatment completion, with mothers having

higher rates of treatment completion than fathers ðx2 ð1; N ¼ 331Þ ¼

8:17; p , :01Þ: No other significant results were found on the follow-up

variables.

To ensure that we were measuring level of parental involvement rather

than whether the parents and children lived together (which was associated

with degree of parental involvement), we reran all analyses using three

separate control variables. These control variables included whether the parent

lived with his or her children, whether the parent had custody of any of his or

her children, and whether the parent was married. None of these variables had

an appreciable effect on the findings.

DISCUSSION

Our goals in this study were to explore the effects of parental involvement

on the drug use and treatment history, drug use severity, and psychological

distress of parents in drug treatment, and whether these relationships differed

for mothers and fathers, both before and after drug treatment. We had

expected to find that parents who were more involved with their children

would show less severe drug use and psychological distress, especially for

mothers. We found that the effects of parental involvement were evident with

regard to addiction severity and psychological status at intake, but not at

follow-up.

Contrary to our prediction, parental involvement seemed to be more

“protective” against drug/alcohol use severity for fathers than for mothers.

Significant interactions between gender and parental involvement on the ASI

drug and alcohol composite measures indicated that there were greater

differences in severity of alcohol and drug use between fathers, based on level

of parental involvement, than among mothers, although both groups of fathers

had higher severity scores than mothers. This finding suggests that greater

parental involvement among fathers inhibits more severe alcohol/drug use or,




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conversely, that fathers with lower levels of substance use are therefore able to

become more highly involved with their children. This finding is supported by

McMahon and colleagues (24), who found that among fathers in methadone

maintenance treatment, perceptions of failure as a parent were closely

associated with chronic drug abuse. In addition, although we found that

parents who lived with their children were also more involved with them, this

effect was more pronounced for fathers. The findings of main effects of

parental involvement for psychological distress suggest that highly involved

parents derive a protective benefit from their parenting activities with regard

to psychological distress, or conversely, that less distressed parents are able to

become more involved with their children.

We found no differences in posttreatment levels of drug and alcohol use

and psychological severity based on level of parental involvement; however,

mothers generally had higher rates of abstinence during the follow-up period.

Initially, there were main effects of parental involvement for drug use severity

and psychological distress in the follow-up models, echoing the results of the

pretreatment models. However, when the means were adjusted to control for

baseline levels of these variables, these differences disappeared entirely. This

finding suggests that, although raw levels of distress and severity differed by

level of involvement, patterns of improvement between baseline and follow-

up were similar for the groups.

The finding of gender differences in the initiation of drug use coincides

with the findings of previous studies showing that, on average, women report

having been older at the onset of their drug use career (30,31). The findings

that mothers had undergone fewer treatments than fathers and that they were

younger when they initiated treatment supports previous research indicating

that women tend to enter treatment earlier than men, after a briefer period of

use (31,32). In addition, the finding that fathers are more likely to be employed

after drug treatment confirms prior research showing generally higher rates of

employment among men than among women after drug treatment (33). The

finding that, overall, these parents did not regard their parenting skills highly is

not surprising considering that they were undergoing drug treatment; previous

literature has indicated that parents in drug treatment often feel ashamed of

that status (23,24). That mothers were more likely to believe that their

participation in drug treatment would affect their custody of their children is

also not surprising given the greater likelihood that children reside with and

are cared for by their mothers.

Most studies involving parents who are substance abusers have focused

on the adverse effects of their substance use on their parenting behaviors,

children’s drug use, and potential for child abuse, especially among mothers.

In this study, we examined to what extent substance-abusing parents benefit




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from their interactions with their children. The findings that parents who were

more highly involved with their children had less psychological distress and

lower addiction severity suggest that being involved with their children is a

positive force for substance abusers. These findings support previous research

suggesting that the quality of the parent-child relationship is important for

psychosocial functioning for all involved (20,22). Future investigations should

seek to elucidate the specific ways in which stress, addiction severity, and

parental involvement are related. Our findings suggest that the parenting role

is a potentially important one among both substance-abusing mothers and

fathers, and treatment providers should build upon the existing positive

relationships of highly involved parents with their children and seek to address

the psychological needs of less-involved parents.

Study Limitations

The study is limited by not having measures of parenting involvement at

follow-up with which to evaluate changes in level of parental involvement and

its relationship with posttreatment outcomes. In addition, the mechanism

through which highly involved parents have better psychological function-

ing—whether parenting confers a protective effect or is a consequence of

better psychological adjustment—cannot be determined from this study.

We also lacked detailed measures of social support, which may affect

psychological distress among parents. We did examine marital status, as a

proxy measure of social support, but as mentioned, entering marital status as a

control variable into the follow-up models did not change the findings.

Directions for Further Research

Follow-up exploration of our data indicates that the parents in this study

were not receiving counseling regarding their parenting problems or issues.

When asked the number of days in the past week they had had a significant

discussion about their parenting problems in an individual counseling session,

87% of the sample reported that they had never had such a discussion. When

asked the same question regarding group counseling, 82% of the sample

reported never having had a significant discussion about their parenting

problems. Mothers, however, were more likely than fathers to report that they

had discussed parenting problems in individual or group sessions. Although

these rates were not significantly different by type of treatment modality, the

data did suggest that clients participating in outpatient drug-free and




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residential programs were more likely to have had their parenting problems

addressed, compared with those in inpatient or methadone maintenance

programs. Parents in outpatient drug-free and residential treatment also

reported higher rates of their children receiving services from the treatment

program.

Indeed, previous research has confirmed the benefits of family-oriented

services for substance-abusing parents (34–38). For example, an evaluation of

a family-focused intervention for parents in methadone treatment that

involved family skills training demonstrated positive changes in parents’

parenting skills, drug use, and family management skills (34). Moreover,

several studies have shown that substance-abusing mothers are more likely to

stay in treatment if they are treated in programs geared to their needs. In one

study, women who were mandated to drug treatment by the criminal justice or

child welfare system, and who had custody of their children, had higher rates

of treatment retention, but only when treated in an intensive day treatment

program that was designed specifically for women, and not in a traditional,

mixed-gender outpatient program (39). Similarly, women who are allowed to

have their children reside with them while in residential drug treatment have

shown better outcomes compared with those who receive treatment without

their children (40). Pregnant and parenting women had higher rates of

treatment retention in another study when they received treatment in

residential programs in which there were higher concentrations of other

pregnant and parenting women, and these programs provided more services

related to family and mental health issues (41).

The unique needs of parents in drug treatment deserve more attention

within both clinical practice and treatment outcomes research. The treatment

of parents with regard to their role as parents may be particularly important to

address, not only with regard to drug abuse issues, but also for other, related

social problems, including decreasing abuse and neglect in these families. It is

imperative, then, that drug researchers and treatment providers work to better

understand the characteristics, needs, and outcome prospects for substance-

abusing parents to provide better services not only to them, but also to their

children.

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effects of gender and level of parental involvement among parents in drug treatment

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