Recovery coaches and the stability of reunification for substance abusing families in child welfare

Substance abuse is a long-standing challenge for child welfare systems. Parental substance abuse disrupts family stability, family cohesion, and jeopardizes the well-being of children. In the current study we test an intervention to improve child welfare outcomes for substance abusing families, specifically the probability of families achieving a stable (at least 12 months) reunification. The intervention was an integrated case management model where recovery coaches were appointed to substance abusing parents associated with an open foster care placement. A diverse group of families (n = 1623) were randomly assigned to either a control group (services as usual) or an experimental group (services as usual plus a recovery coach). Multinomial logistic regression indicated that substance abusing parents associated with a recovery coach were significantly more likely to achieve a stable reunification as compared with similar families in the control group.     

A qualitative study of exodus graduates: family-focused residential substance abuse treatment as an option for mothers to retain or regain custody and sobriety in Los Angeles, California

In this article, 21 long-term, poly-substance abusing mothers describe how they successfully completed an 18-month family-focused residential substance abuse treatment program in southern California that helped them retain or regain custody of their children. Their stories and experiences with specific program characteristics and approaches of this rare treatment option are described, in their own voices. Policy implications for child welfare and parental substance abuse treatment are examined in light of these success stories.     

SYSTEMIC TREATMENT OF SUBSTANCE ABUSE: A GRADUATE COURSE

Today, family therapists should have an understanding of the development and maintenance of substance abusing patterns in families. In this paper, the authors describe a graduate course for teaching therapists about the contributions that have been made to the understanding and treatment of substance abuse by family researchers, theorists and clinicians. Course purpose, student selection, instructional methods and course content are delineated.     

The Development of Theory and Treatment with Substance Abusing Female Juvenile Offenders

Little is known regarding the specific treatment needs of those female juvenile offenders with a history of substance abuse. While social scientists have advanced distinct theories regarding adolescent substance use and juvenile delinquency, minimal work has been conducted to integrate or link these two. In attempting to further explore their interrelationships, this article will review and incorporate the relevant theoretical and practice milestones in three areas: (1) substance abuse and women, (2) substance abuse and adolescents, and (3) substance abuse and juvenile delinquency, leading to the development of new theory and practice relevant to the female substance abusing juvenile offender population. The authors propose some practice considerations for current interventions with this population and discuss implications for future research and exploration.     

Trying to come home: Substance exposed infants, mothers, and family reunification

Substance abusing mothers comprise a significant proportion of caregivers in public child welfare, and achieve low reunification rates. Unfortunately little is known about treatment options intended to facilitate recovery and increase reunification. This study focuses particular attention on the relationship between specific treatment modalities (e.g., residential and outpatient), recovery from substance abuse and family reunification. Analyzing a sample of 160 mothers and their substance exposed infants, the findings clearly identify the benefits of residential treatment in terms of both treatment progress (directly) and family reunification (indirectly), but only when residential services are delivered in combination with transitional services.     

Co-Occurring Substance Use and Personality Disorders: Current Thinking on Etiology,Diagnosis, and Treatment

ABSTRACT

Despite the high prevalence of personality disorders among substance abusing individuals, the literature on these co-occurring disorders is limited. This paper reviews the literature and provides the most current data on the demographics, the criteria for diagnosing both personality disorders and substance use disorders, and the effects of substance abuse and co-occurring personality disorders, particularly antisocial and borderline, on prognoses and treatment approaches. Recommendations for further research on these co-occurring disorders are provided.     

Substance abuse among Asian American youth: An ecological review of the literature

The purpose of this review is to understand the risk and protective factors that are associated with substance use among Asian American youth. Using the Bronfenbrenner's (1994) ecological systems theory, we examine how individual characteristics (age, gender, psychopathology, genetics, and ethnic differences), micro- (family and peers), meso-/exo- (relations between family and peers, cultural norms, and economic stress), macro- (academic achievement and cultural influences), and chrono-systems (acculturation) level factors influence or inhibit substance use among Asian American youth. In addition, this review highlights major implications for practice and policy to prevent substance misuse and to improve outcomes for substance abusing Asian American youth.     

A community based approach to clinical services for children of substance abusers

This paper presents children of substance abusing parents as incurring risk factors that place many in need of social work intervention. The strength of this approach lies in integrating community resources as sources of corrective emotional experiences in clinical intervention.     

The residential treatment of an abusing family

Abstract

This article discusses the residential treatment of an abusing family in a local authority setting, when the use of short-stay children's homes was changed to provide a preventive service for families in trouble. The Centre has room to admit a family where the child's safety cannot be guaranteed in its own home.

The structure of the treatment programme is described, the partnership of residential and field work staff, the monitoring role provided by residential staff and the importance of supervision, particularly for those closely involved with the family. The role of the NAI Conference is discussed, and the individual functions of its members in relation to the family. The varied methods of working with the family are described, and the family's emotional response is illustrated with the theme of separation.

The article concludes that the family did respond to treatment, and that we have further to go in developing residential work with abusing families at our Centre.     

Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

Psychological treatment of adolescent substance abusers:: A review

Alcohol and drug abuse among youth has become a major national concern. Psychological treatment strategies reported in the literature that have been used with adolescent substance abusers include five approaches: (a) behavior therapy, (b) skills training, (c) reality therapy, (d) psychodynamic therapy, and (e) family therapy. A limited number of studies have evaluated these treatments. Behavior therapy, skills training, and family therapy approaches show some evidence of effectiveness. However, most studies had methodological flaws.     

Oxford house: a review of research and implications for substance abuse recovery and community research

After treatment for substance abuse, whether it is in hospital-based treatment programs, therapeutic communities, or recovery homes, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of a relapse. As a consequence, substance abuse recidivism following treatment is high for both men and women. Alternative approaches need to be explored, and there are some promising types of recovery homes. From a public health perspective, a series of studies conducted at DePaul University suggests that one type of recovery home for alcohol abuse recovery has much potential. For example, within this self-help communal living setting, recovering alcoholics were able to maintain employment, thereby reducing their need for government subsidies. Maintaining employment for recovering alcoholics may promote increased personal responsibility, which may impact self-efficacy beliefs. These pilot studies, then, raised both theoretical and practical issues needing further evaluation.     

Children of Substance Abusing Women on Federal Welfare

SUMMARY

The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children.     

Early childhood and maternal antecedents to drug use.

In a longitudinal study, the substance use/abuse histories were obtained on a community sample of 640, (mean age of 24.9 years) randomly selected from the 8,000 Philadelphia black subjects who had been studied comprehensively from birth to seven years of age in the National Collaborative Perinatal Project (NCPP). Among other conclusions, it is postulated from some of the many significant associations found between early life variables and substance use/abuse in early adulthood, that an infant is at risk who has the following combination of characteristics and family situation: outgoing, responsive, assertive or impulsive, or willful, and who is in an unfavorable family environment, with a mother who is generally negative toward the infant, has a larger number of small children and has had more fetal deaths, in a generally poor social environment.     

Getting reluctant substance abusers to engage in treatment/self-help: a review of outcomes and clinical options

This review examines the results from 19 outcome studies, involving 1,501 cases, within 10 different clinical approaches to getting alcohol or drug abusers to engage in treatment or self-help. Each approach is summarized and its "success rate(s)" presented. Comparisons are made across various subcategories, such as alcohol vs. drug abusers, adolescents vs. adults, and experimental conditions vs. controls. A distinction is drawn between "Dual-Purpose" approaches, which combine engagement with counseling of the concerned person who originally sought help for the substance abuser, and "Engagement-Primary" approaches, which generally confine their efforts (through working with family members and others) to getting the substance abuser into treatment/self-help. "Best bet" clinical options are presented in terms of which particular approach appears to have the edge with which kind of substance abuser.     

An Endangered Species: The Female as Addict or Member of an Addict Family*

When a woman is the identified addict or a member of a drug/alcohol abusing family system she often experiences considerably more psychiatric abuse than her male cohorts. This paper surveys some of the representative literature reflecting attitudes and practices imposed on these women. Explanations based on a study of healthy family systems are given with interpretations anchored in cultural rather than sexist phenomena. It is suggested that women need to be understood according to the complex interlocking transactions within family systems.     

Neighborhoods, Family, and Substance Use: Comparisons of the Relations across Racial and Ethnic Groups

This study examines how substance use among adolescents is related to several risk and protective factors derived from two ecological contexts: the neighborhood and the family. It explicitly investigates how the relationships between substance use and the factors vary across different racial and ethnic groups. Findings suggest many common correlates and processes of substance use for adolescents, regardless of race or ethnicity, including that neighborhood safety is associated with substance use. There are also some racial and ethnic group differences in relationships, including that low attachment to and lack of social opportunities in neighborhoods more strongly predict substance use among whites than among other racial and ethnic groups and that family management decreases the relationship between neighborhood safety and substance use among African Americans. A better understanding of the associations among factors that influence substance use across racial and ethnic subgroups can help effectively target preventive interventions for different groups.     

Networks,Neighborhoods, and Depression: Negative Interactions by Social Support Members as a Mediator of Neighborhood Characteristics and Depressive Symptoms in a Sample of Recovering Substance Abusing Women

Abstract

Although social networks and substance abuse have been extensively studied, less is known about the role social networks play in the context of neighborhood disorder and depression. Sixty-five women were recruited from CASAWORKS for Families, a national demonstration project for substance abusing women. Average participant age was 31; half of the sample was European American, 40% African American, and 10% was other ethnicities. The average length of time in the program was about three months. We found that negative interactions partially mediated the relationship between neighborhood disorder and depression. Specifically, higher levels of neighborhood disorder predicted increased negative social exchange that in turn predicted higher levels of depressive symptoms. However, mediation analysis indicated that the strength of the relationship between neighborhood disorder and depression was attenuated when negative interactions were considered. These results support the importance of community endeavors that seek to improve basic living conditions in disadvantaged communities.     

Psychiatric,Family, and Ethnicity-Related Factors That Can Impact Treatment Utilization Among Hispanic Substance Abusing Adolescents

SUMMARY

There is great significance to improving our understanding of predictors of treatment utilization among Hispanic substance abusing youth. One hundred and ten Hispanic substance abusing adolescents and their parents participated in a study of treatment utilization. Analyses showed that adolescents with lower numbers of externalizing disorders (χ² = 4.18, df = 1, p < .05) and parents with better parenting strategies (χ² = 8.73, df = 2, p < .05), predicted overall treatment utilization (residential + outpatient). Better parenting practices and higher parental years in the U.S. predicted more utilization of outpatient services and lower parenting stress predicted more utilization of residential services. Without specialized engagement strategies, adolescents and families most in need may be the least likely to engage in recommended treatment.