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.