Accelerating the Pace of Science: Improving Parenting Practices in Parents with Opioid Use Disorder

A randomized controlled trial to improve fathering among fathers with substance use disorders: Fathering in recovery intervention

In early recovery for substance use disorders (SUDs), fathers may experience a desire to become more active in their role as a parent but may need support in using effective parenting strategies. Parent management training programs may be effective for fathers in recovery from SUD as they have been shown to improve parenting knowledge, self-efficacy, parenting practices, and child behavior, as well as decrease parent substance use. Using the Parent Management Training-Oregon model, we adapted a video-based program for text delivery to fathers in their first year of recovery from SUD, the fathering in recovery (FIR) intervention. In this pilot study, we randomized 41 fathers to control or 6 weeks of video content and three brief coaching calls and assessed outcomes in the parenting, child, and substance domains at baseline, 6-week, and 4-month follow-ups. We found FIR was effective for improving parenting knowledge, fathering efficacy, and in reducing fathers' ineffective parenting. The intervention showed promise for reducing child behavior problems. While larger studies are needed to replicate and build on these FIR findings, our data suggest that FIR holds promise for improving the lives of fathers and their families affected by SUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Addressing stigma within the dissemination of research products to improve quality of care for pregnant and parenting people affected by substance use disorder

Substance use disorders are a common and treatable condition among pregnant and parenting people. Social, self, and structural stigma experienced by this group represent a barrier to harm reduction, treatment utilization, and quality of care. We examine features of research dissemination that may generate or uphold stigmatization at every level for pregnant and parenting individuals affected by substance use disorder and their children. We explore stigma reduction practices within the research community that can increase uptake of evidence-based treatment programs and prevent potential harm related to substance use in pregnant and parenting people. The strategies we propose include: (1) address researcher stereotypes, prejudice, and misconceptions about pregnant and parenting people with substance use disorder; (2) engage in interdisciplinary and transdisciplinary collaborations that engage with researchers who have lived experience in substance use; (3) use community-based approaches and engage community partners, (4) address stigmatizing language in science communication; (5) provide contextualizing information about the social and environmental factors that influence substance use among pregnant and parenting people; and (6) advocate for stigma-reducing policies in research articles and other scholarly products.

Telehealth delivery of modified attachment and biobehavioral catch-up: feasibility, acceptability, and lessons learned

The COVID-19 pandemic necessitated dramatic shifts in the delivery and evaluation of attachment-based home-visiting services. The pandemic disrupted a pilot randomized clinical trial of modified Attachment and Biobehavioral Catch-Up (mABC), an attachment-based intervention adapted for pregnant and peripartum mothers with opioid use disorders. We transitioned from in-person to telehealth delivery of mABC and modified Developmental Education for Families, an active comparison intervention targeting healthy development. Of 40 mothers then enrolled in study interventions, 30 participated in telehealth, completing an average of 4.7 remote sessions each (SD = 3.0; range = 1-11). Following the transition to telehealth, 52.5% of randomized cases and 65.6% of mothers maintaining custody completed study interventions, comparable to pre-pandemic rates. Overall, telehealth delivery was feasible and acceptable, and mABC parents coaches' ability to observe and comment on attachment-relevant parenting behaviors was preserved. Two mABC case studies are presented and lessons learned for future telehealth implementation of attachment-based interventions are discussed.    .

The Value of Mechanistic Experiments to Target the Shared Neural Circuitry of Parenting and Addiction: The Potential for Video Feedback Interventions

Certain neural processes that underlie addiction are also central to parenting, notably stress and reward. Parenting interventions that incorporate the unique context of caregivers with addiction have demonstrated some success: However, real-world implementation of evidence-based interventions can be difficult with this population. Video feedback interventions are an especially promising approach to reach parents who experience barriers to participation, particularly caregivers with addiction. A translational neuroscientific approach to elucidating the mechanisms of change in these interventions will aid the delivery and success of this method and advance theory surrounding parenting in the context of addiction. Along these lines, we provide an example of one video feedback intervention, Filming Interactions to Nurture Development, that will serve as such a mechanistic experiment.

Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up

Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.

The Family Check-Up Online: A Telehealth Model for Delivery of Parenting Skills to High-Risk Families With Opioid Use Histories

Growing opioid misuse in the United States has resulted in more children living with an adult with an opioid use history. Although an abundance of research has demonstrated a link between opioid misuse and negative parenting behaviors, few intervention efforts have been made to target this underserved population. The Family Check-Up (FCU) has been tested in more than 25 years of research, across multiple settings, and is an evidence-based program for reducing risk behavior, enhancing parenting skills, and preventing the onset of substance use. It is designed to motivate parents to engage in positive parenting practices and to change problematic parenting and has been tested across a variety of ages including early childhood and adolescence. It is highlighted in NIDA’s Principles of Substance Use Prevention for Early Childhood: A research-based guide as one of only three effective selective prevention programs for substance abuse among families with young children. Recently, we developed an online version of the FCU that has now been adapted for early childhood and families with opioid use histories. The online platform and telehealth model allow for wide-scale dissemination, ease of training with community providers, and increased public health reach for families in remote, rural areas. This is particularly important when targeting families with opioid misuse and addiction because there are high rates of addiction in remote areas, yet few services available. In this article, we describe the FCU Online and review new content in the model that targets a population of young adult parents with substance abuse histories, including opioid use. New modules include content focused on harm reduction for this high-risk population of parents, such as safety in the home, substance use while parenting, and managing conflict with partners and friends.

Improving Parenting Practices Among Fathers Who Misuse Opioids: Fathering Through Change Intervention

Fathers have been largely neglected in the parenting literature though there is a critical need to improve parenting practices among fathers who misuse opioids in the midst of the opioid epidemic. Urgency is critical to rapidly intervene in the lives of fathers and children to reduce misuse and interrupt intergenerational cycles of substance misuse. Thus, we provide an overview of solutions to adapt existing parenting interventions for fathers who misuse opioids to accelerate the pace of science for this population.

Psychosocial Needs of Parents Engaged in Treatment for Opioid Use Disorder

Background: Little research has examined the needs of parents with opioid use disorder (OUD) who are receiving medications for OUD (MOUDs), which is striking given growing rates of OUD among parents. Objective: The current study expands the literature by examining psychiatric, psychosocial, and parenting-related functioning, as well as 12-month MOUD treatment retention among parents versus non-parents participating in a buprenorphine program at an academic family medicine residency clinic. Methods: Patients (N = 144; 61 parents) completed measures of psychiatric and psychosocial functioning at the first MOUD visit; parents also completed measures of parental functioning. Results: Parents endorsed less anxiety and loneliness, as well as greater social connection, life satisfaction, and life meaning. Parents were also older, more likely to be female, of a race other than white, married, employed, and had higher incomes. Although parents endorsed high levels of parental self-agency and strong bonds with children, many also reported elevated parental shame. Among parents, higher levels of shame were also associated with higher depression, anxiety, anger, stress, and loneliness. Over 25% of parents reported that a child lived with friends/relatives over 3 months, and 11% noted a child having been removed from the home by child protective services. Finally, parents were more likely to be retained in treatment at 12 months, although this finding was non-significant after controlling for covariates. Conclusions/Importance: These findings illustrate the needs experienced by parents engaged in MOUD treatment, which may prove valuable in informing policy, program development, and treatment approaches for parents with OUD.

Participation in the Fathering through Change intervention reduces substance use among divorced and separated fathers

Recent evaluations of parent training programs have demonstrated beneficial crossover effects in reducing parental substance use. Because divorce is associated with substance use risk and substance use interferes with effective parenting, parent training programs are critically important for divorced fathers but there are few evidence-based programs tailored to fathers. We tested whether an evidence-based parenting program would exhibit beneficial impact on fathers' substance use and whether these changes were mediated by changes in parenting efficacy. We tested hypotheses in a sample of 426 divorced and separated fathers randomly assigned to the online Fathering through Change (FTC) program or the wait-listed control condition. Models specified as 3-month pre-post analyses of self-reported substance use. The FTC was associated with reductions in total substance use (d = 0.14) and drinking (d = 0.26) but not with reductions in tobacco smoking and marijuana use. Data also supported a significant indirect effect for FTC through pre-post changes in parenting efficacy (d = 0.36). We discuss clinical implications for the integration of parent training within substance use treatment.

Mother and Father Prescription Opioid Misuse, Alcohol Use Disorder, and Parent Knowledge in Pathways to Adolescent Alcohol Use

Parenting during early adolescence is key in protecting adolescents against substance use initiation and patterned use. Parental alcohol use disorder is a robust risk factor for maladaptive parenting and adolescent alcohol use. However, it is unclear what effect parent prescription opioid misuse has on parenting and adolescent alcohol use. Associations were examined among parent alcohol use disorder, prescription opioid misuse, and parent knowledge of adolescent activities in early adolescence and their prediction of adolescent alcohol use approximately five years later. The current sample consisted of mothers (N = 457) and fathers (N = 368) drawn from a large longitudinal sample (The Adult and Family Development Project: AFDP). The average age was 11.68 in early adolescence and 16.22 in adolescence and 47% of adolescents were female. Parent knowledge was tested as a mediator of the effects of parent alcohol disorder and parent opioid misuse on adolescence alcohol use. This model was examined separately in mothers and fathers. For mothers, alcohol use disorder and prescription opioid misuse both predicted adolescent alcohol use indirectly via parent knowledge. Mothers' alcohol use disorder also directly predicted adolescent alcohol use. For fathers, no direct or indirect effects of alcohol use disorder or prescription opioid misuse were detected although a covariate effect of illicit drug use on parent knowledge emerged. The results are discussed with regards to the processes that may explain how alcohol disorder or prescription opioid misuse affect mothers' knowledge and increase risk for adolescent alcohol use.

Advancing preventive interventions for pregnant women who are opioid using via the integration of addiction and mental health research

Purpose of Review

This review examines how research focused on treatment for opioid use in perinatal populations and preventive interventions for postpartum psychopathology have remained separate, despite significant overlap.

Recent Findings

Guidelines for best practice in caring for pregnant women with opioid use disorder suggest the use of medication-assisted treatment with additional comprehensive care, including behavioral and mental health interventions. However, intervention research often mutually excludes these two populations, with studies of behavioral interventions for opioid use excluding women with psychopathology and research on preventive interventions for postpartum psychopathology excluding women who are substance using.

Summary

There is a limited evidence-base to inform the selection of appropriate preventive interventions for pregnant women with opioid use disorder that can address opioid use and/or treatment adherence and concurrent mental health risks. We argue it is critical to integrate research on pregnant women who are opioid using and preventive perinatal mental health interventions to catalyze pivotal change in how we address the opioid epidemic within this growing population.