Approximately 20% of adults in treatment for drug dependence live with and parent children ages 2 to 18 (Stanger et al., 1999). Several studies have shown that children living with parents in treatment for drug dependence have higher rates of internalizing and externalizing problems than do demographically matched children in the general population (Nunes et al., 1998b; Stanger et al., 1999; Wilens et al., 1995). In addition, children living with drug-dependent parents are more likely to experience socioeconomic disadvantages and report higher stress levels and more social isolation than comparison groups of children of nonabusing parents(Kumpfer and DeMarsh, 1986).
To determine whether children of drug abusers had higher rates of problems than comparison groups did, our initial study compared children of drug abusers with children referred for mental health services and children not referred for mental health services in the past 12 months (Stanger et al., 1999). Children living with parents who were receiving treatment for cocaine or opiate dependence showed more problems than children of similar age, gender, ethnicity and social class in the general population. The problems included internalizing, externalizing, and school and social problems. The children of drug abusers were at higher risk for these problems relative to nonreferred children, but showed significantly fewer problems than children who were referred for mental health services.
A significant percentage of children of drug abusers also showed clinical deviance, with a similar pattern of group differences for males and females from ages 2 through 18. For example, a total of 42% of children of drug abusers, compared to 27% of nonreferred children and 80% of referred children, scored in the clinical range on 1 syndrome or scale on the Child Behavior Checklist (CBCL) (Achenbach and Rescorla, 2001; Stanger et al., 1999). Of the eight syndromes scored for the CBCL, children of drug abusers showed the highest rate of deviance (18.6%) on the syndrome assessing rule-breaking behavior, compared to 6% of nonreferred youth (Stanger et al., 1999). Our results were highly similar to those of several other investigators (Moss et al., 1994; Nunes et al., 1998b; Wilens et al., 1995)
How Does Parental Substance Use Increase Risk to Children?
Although not all children living with drug-dependent parents experience behavioral/emotional problems, it is important to understand factors within families with a drug-dependent parent that increase or decrease the risk to children. Research on families with a substance-abusing parent has shown that psychopathology among the parents is an important risk factor for children's problems (Dierker et al., 1999; Luthar et al., 1998). We hypothesize that parental substance abuse and psychopathology exert much of their influence on children's behavior by disrupting parenting. This hypothesis is consistent with the stage model of the development of antisocial behavior articulated by Patterson and colleagues (1992). This model suggested that problems such as parental substance use, psychopathology and social disadvantage lead to early parent-child interaction problems, especially the use of ineffective discipline. These parenting problems lead directly to externalizing problems in early childhood. At later ages, children's externalizing problems predict other poor outcomes such as academic problems, rejection by nondeviant peers, association with deviant peers, low self-esteem, depressed mood, antisocial attitudes, delinquency and substance use.
Prior research has also shown that substance-dependent parents are at risk for parenting problems. For example, heroin-dependent mothers express more doubts about their parenting adequacy and their ability to control their children than do matched control mothers (Colten, 1982). Similarly, drug-abusing families reported having poorer family management techniques than control families did (Kumpfer and DeMarsh, 1986). In addition, parenting problems are important predictors of outcomes for children in substance-dependent families (Dobkin et al., 1997; Tarter et al., 1993).
Our research with drug-abusing families tests the hypothesis that parental substance use and psychopathology lead to problems among children living in the home by raising the risk for parenting problems. To test this hypothesis, we asked parents receiving treatment for cocaine-, opiate-, alcohol- or marijuana-dependence to participate in an assessment study. From November 1992 through January 2002, 271 patients receiving substance-abuse treatment entered the study. The parent participants were 60% female and 39% male.
In our earlier research on predictors of outcomes among children of substance abusers, we found that family conflict and parental psychopathology are important predictors for children of substance-dependent parents (Stanger et al., 2002). Our most recent analyses have tested whether parent and family problems among drug-dependent parents raise the risk to children by disrupting parenting (Kamon, 2003). These results help to explain how parental substance abuse leads to children's externalizing problems. We found that substance-abusing parents with more severe substance abuse and psychopathology tend to have more family problems. Parent and family problems are likely to co-occur, but either one alone can lead to disruptions in parenting. When parenting problems are present, children are highly likely to show conduct problems. In our study, parenting problems accounted for 49% of the variance in children's conduct problems among substance-abusing families. Other studies with general population samples have also shown that parenting problems mediate relations between parental substance-use and children's problems (Blackson et al., 1996; El-Sheikh and Flanagan, 2001).
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