Co‐Occurring Trajectory of Mothers’ Substance Use and Psychological Control and Children's Behavior Problems: The Effects of a Family Systems Intervention

Abstract

This study examined the effects of a family systems therapy (Ecologically-Based Family Therapy [EBFT]) on the co-occurring trajectory of mothers' substance use and psychological control, and its association with children's problem behaviors. Participants included 183 mothers with a substance use disorder who had at least one biological child in their care. Mothers were randomly assigned to one of the three intervention conditions: EBFT-home, n = 62; EBFT-office, n = 61; or Women's Health Education, n = 60. Participants were assessed at baseline, 3, 6, 12, and 18 months post-baseline. A dual-trajectory class growth analysis identified three groups of mothers in regard to their change trajectories. The majority of the mothers exhibited a synchronous decrease in substance use and psychological control (n = 107). In all, 46 mothers exhibited a synchronous increase in substance use and psychological control. For the remaining 30 mothers, substance use and psychological control remained stable. Mothers in the family therapy condition were more likely to show reduced substance use and psychological control compared to mothers in the control condition. Moreover, children with mothers who showed decreased substance use and psychological control exhibited lower levels of problem behaviors compared to children with mothers showing increased substance use and psychological control. The findings provide evidence for the effectiveness of family systems therapy, EBFT, in treating mothers' substance use, improving parenting behaviors, and subsequently improving child behavioral outcomes.

Preventive interventions in offspring of parents with mental illness: a systematic review and meta-analysis of randomized controlled trials

“…Another limitation is that most studies used only one informant's report for symptoms scales, especially parental reports, while it has been reported that parents with depression or substance use disorder might be less sensitive indicators of intervention effects (Compas et al, 2015;Lam et al, 2008;Zhang et al, 2018). Future trials should assess outcomes using multiple informants, including parents, children, as well as others such as teachers, to prevent this bias.…”

“…Twelve authors were contacted, of whom only four replied (Clarke et al, 2001;Compas et al, 2015;Kelley & Fals-Stewart, 2002;Van Santvoort, Hosman, van Doesum, & Janssens, 2014). Three trials could not be included in our meta-analysis because either the design (Zhang, Slesnick, & Feng, 2018) or the available data (Murray, Cooper, Wilson, & Romaniuk, 2003;Van Santvoort et al, 2014) did not allow us to conduct our analysis.…”

“…A study evaluated a family system therapy (Zhang et al, 2018), focusing on mothers with a substance use disorder to target dysfunctional family interactions and identify factors contributing to maintain maternal symptoms. The efficacy of incentives (monetary prices) on compliance of parents with substance use disorders was also reported in another trial (Stanger, Ryan, Fu, & Budney, 2011).…”

Interruption of dysfunctional mother–child reciprocal influences associated with family therapy.

“…Our study adds to the evidence base supporting the positive effects of family systems therapy on substance using mothers, showing that by addressing the dysfunctional family dynamics, maternal depressive symptoms and child behavioral problems no longer serve as precursors of maternal substance use. Moreover, as the negative reciprocal pattern be-tween maternal substance use and child behavioral problems was interrupted by family therapy, family therapy may have significant preventive effects on these children's mental health (Zhang et al, 2018), underscoring the systemic perspective in working with substance using mothers and their children. Finally, findings further showed that the efficacy of family therapy on mother and child well-being differed with different types of maternal substance use, suggesting tailoring components of family intervention to the special needs of subpopulations of mothers with different drugs of choice.…”

The Effects of a Family Systems Intervention on Co‐Occurring Internalizing and Externalizing Behaviors of Children with Substance Abusing Mothers: A Latent Transition Analysis

“…Studies show the effectiveness of EBFT in treating mothers’ substance use (Slesnick & Zhang, ) and improving parent–child interactions (Zhang & Slesnick, ). While research indicates that EBFT results in improved parenting and parent–child interaction benefiting children's behavioral outcomes (Zhang & Slesnick, ; Zhang, Slesnick, & Feng, in press), these earlier studies did not examine different co‐occurring patterns of children's internalizing and externalizing behaviors across time, or whether children of different co‐occurring patterns would respond differently to EBFT.…”