Evaluation of a family-oriented parenting intervention for methamphetamine-involved mothers and fathers - The SHIFT Parent Training.

INTRODUCTION: A large number of people who use crystal methamphetamine in Germany are parents of young children. In the context of methamphetamine use, family situations and parenting are frequently impacted, and children are at risk of developing behavioral or emotional difficulties. SHIFT Parent Training was developed as a parenting intervention targeted specifically to the needs of methamphetamine-involved parents. The eight-session group training is delivered in substance use treatment settings and aims to foster abstinence and improve parenting skills and resilience within the families. METHODS: The primary goal of this pilot study was to assess the initial effectiveness and acceptance of the SHIFT intervention. The quasi-experimental study design included pre-, post- and 6-month follow-up measurements. Sixty-eight methamphetamine-involved parents participated in all stages of the study. Substance use, parenting practices, and family functioning and resilience were primary effectiveness outcome measures. Additionally, acceptance was assessed by participants' and professionals' feedback. RESULTS: Substance use problems were significantly lower in the intervention condition at the 6-month follow-up. Positive parenting of mothers and fathers also increased in the intervention group directly after participation. Both the intervention and control groups showed significant improvements in family functioning, parenting stress and children's behavioral issues. Participants and facilitators reported that they were highly satisfied with the program. CONCLUSION: Our findings suggest that SHIFT Parent Training is an effective intervention and is well-accepted among parents and health professionals. The program improves relevant aspects of substance use-related issues and parenting and therefore poses a valuable addition to support services for methamphetamine-involved families.

Evaluation of the mindfulness-augmented "Trampoline" programme - a German prevention programme for children from substance-involved families tested in a cluster-randomised trial.

BACKGROUND: Children of substance-abusing parents are at a substantial risk of developing substance-use and other mental disorders. Children involved in substance abuse - not diagnosed with substance-use problems but integrated in psychiatric treatment or youth welfare services - constitute a particular high-risk group that is in need of substance use prevention. Emerging evidence indicates that self-regulatory determinants of substance use and other mental disorders, particularly stress reactivity, are modifiable by mindfulness-based interventions, such as mindfulness-based stress reduction. METHODS: In this ongoing cluster randomised-controlled trial, a mindfulness-augmented version of the modularised evidence-based "Trampoline" programme for children affected by parental substance use problems is evaluated in a sample of 420 children who are from substance-involved families, aged from 8 to 12 and receiving non-substance-specific care in psychiatric or youth welfare services. Larger effects on adaptive stress-coping strategies (primary outcome), internalising and externalising problem behaviours and distress due to parental substance use are expected compared to the standard "Trampoline"-programme version. Mindfulness components will be added and regularly practiced for 30 min in each validated "Trampoline" module. Moreover, the feasibility of mindfulness-based interventions in psychiatric care and youth welfare services for children suffering from emotional and behavioural problems will be investigated in this study. DISCUSSION: Despite recruitment challenges, this study provides a unique opportunity to develop and test a promising addiction-specific, mindfulness-based intervention for a target group at risk, i.e. children from substance-involved families. TRIAL REGISTRATION: The trial was registered in the German Clinical Trials Register on July 16th 2018 (trial registration number (TRN): DRKS00013533 ). Any important protocol modifications are to be reported immediately. Protocol version v.2.1, 15th April 2019.

Methamphetamine Use in German Families: Parental Substance Use, Parent-Child Interaction and Risks for Children Involved.

BACKGROUND: With an immense increase in methamphetamine use in Germany in the past decade, large sections of the drug-using community have been identified as parents of young children. OBJECTIVE: With the fast-emerging issue of psychosocial and familial consequences of methamphetamine use, this study focused on gaining an insight into substance use, parenthood, and parenting by German methamphetamine users, with special emphasis on the psychological outcomes for the children involved. METHODS: We conducted 24 qualitative interviews with parents (16 mothers and eight fathers), who were in outpatient treatment for their Crystal Meth use and were currently abstinent from using drugs. Personal information on parenting, drug use, and effects on the children was supplemented by standardized parents' reports on the children's behavioral patterns. RESULTS: Parenting was described as challenging and often emotionally neglectful, impulsive, and inconsistent. The interview results further indicated an inter-relatedness of substance use and the parental role. Overall, children of methamphetamine users appeared to be at an increased risk of pre-and postnatal substance exposure and great psychosocial distress, especially evident in externalizing behavior such as hyperactivity and behavioral problems. CONCLUSION: Results demonstrate the complex problems of methamphetamine-involved parents and suggest the need for a close cooperation between addiction treatment and child welfare services in providing appropriate psychological and educational support for parents and children.

Selective prevention programs for children from substance-affected families: a comprehensive systematic review.

Children from substance-affected families show an elevated risk for developing own substance-related or other mental disorders. Therefore, they are an important target group for preventive efforts. So far, such programs for children of substance-involved parents have not been reviewed together. We conducted a comprehensive systematic review to identify and summarize evaluations of selective preventive interventions in childhood and adolescence targeted at this specific group. From the overall search result of 375 articles, 339 were excluded, 36 full texts were reviewed. From these, nine eligible programs documented in 13 studies were identified comprising four school-based interventions (study 1-6), one community-based intervention (study 7-8), and four family-based interventions (study 9-13). Studies' levels of evidence were rated in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) methodology, and their quality was ranked according to a score adapted from the area of meta-analytic family therapy research and consisting of 15 study design quality criteria. Studies varied in program format, structure, content, and participants. They also varied in outcome measures, results, and study design quality. We found seven RCT's, two well designed controlled or quasi-experimental studies, three well-designed descriptive studies, and one qualitative study. There was preliminary evidence for the effectiveness of the programs, especially when their duration was longer than ten weeks and when they involved children's, parenting, and family skills training components. Outcomes proximal to the intervention, such as program-related knowledge, coping-skills, and family relations, showed better results than more distal outcomes such as self-worth and substance use initiation, the latter due to the comparably young age of participants and sparse longitudinal data. However, because of the small overall number of studies found, all conclusions must remain tentative. More evaluations are needed and their quality must be improved. New research should focus on the differential impact of program components and delivery mechanisms. It should also explore long-term effects on children substance use, delinquency, mental health, physical health and school performance. To broaden the field, new approaches to prevention should be tested in diverse cultural and contextual settings.

Targeting children of substance-using parents with the community-based group intervention TRAMPOLINE: a randomised controlled trial--design, evaluation, recruitment issues.

BACKGROUND: Children of substance-abusing parents are at risk for developing psychosocial development problems. In Germany it is estimated that approx. 2.65 million children are affected by parental substance abuse or dependence. Only ten percent of them receive treatment when parents are treated. To date, no evaluated programme for children from substance-affected families exists in Germany. The study described in this protocol is designed to test the effectiveness of the group programme TRAMPOLINE for children aged 8-12 years with at least one substance-abusing or -dependent caregiver. The intervention is specifically geared to issues and needs of children from substance-affected families. METHODS/DESIGN: The effectiveness of the manualised nine-session group programme TRAMPOLINE is tested among N = 218 children from substance-affected families in a multicentre randomised controlled trial. Outpatient counselling facilities across the nation from different settings (rural/urban, Northern/Southern/Eastern/Western regions of the country) will deliver the interventions, as they hold the primary access to the target group in Germany. The control condition is a group programme with the same duration that is not addiction-specific. We expect that participants in the intervention condition will show a significant improvement in the use of adaptive coping strategies (in general and within the family) compared to the control condition as a direct result of the intervention. Data is collected shortly before and after as well as six months after the intervention. DISCUSSION: In Germany, the study presented here is the first to develop and evaluate a programme for children of substance-abusing parents. Limitations and strengths are discussed with a special focus on recruitment challenges as they appear to be the most potent threat to feasibility in the difficult-to-access target group at hand (Trial registration: ISRCTN81470784).

Health-related lifestyle, physical and mental health in children of alcoholic parents.

AIM: To identify potential differences between children of alcoholics (COAs) and controls in their health-related lifestyle, mental and physical health. METHODS: The recruitment of COAs took place in inpatient and outpatient treatment and rehabilitation units. Controls were recruited in elementary and high schools. 57 COAs (72% response rate) and 84 controls (88% response rate) aged between 12 and 18 years completed a postal questionnaire about their health-related lifestyle, and mental and physical health. RESULTS: Bivariate analysis showed that COAs' families have higher unemployment rates and lower economic status (P = 0.000). COAs reported poorer school performance (P = 0.000), spending more time in sedentary (television: P = 0.000, Internet: P = 0.014, music: P = 0.040) and less time in physical activities (P = 0.048), having poorer eating habits (fruits and vegetables: P = 0.001, sweets: P = 0.001, fast food: P = 0.000, soft drinks: P = 0.004), a higher substance use (cigarettes: P = 0.030; marijuana: P = 0.564, heavy drinking: P = 0.050) and more mental health difficulties (emotional symptoms: P = 0.015, conduct problems: P = 0.012, suicidal tendencies: P = 0.007, mental disorder: P = 0.040). Among COAs, girls reported more emotional and somatic symptoms compared to boys (P = 0.020 and P = 0.047, respectively). Multivariate analysis showed that after controlling for socioeconomic status, significant mental health and health-related lifestyle inequalities between COAs and controls persist. CONCLUSION: Our findings suggest that COAs have a less healthy lifestyle and more mental health difficulties above and beyond the poorer economic environment they live in.

Parental problem drinking predicts implicit alcohol expectancy in adolescents and young adults.

The present study aimed to investigate the influence of parental problem drinking on implicit and explicit alcohol expectancy of adolescents and young adults (12-24 years). The study was conducted via the Internet, employing a between-subjects design. We measured alcohol expectancy by means of an Implicit Association Test (IAT) and a self-report questionnaire. A short version of the Children of Alcoholics Screening Test (CAST) was used to measure alcohol-related parental problem behavior. Our results showed that increased CAST-scores were correlated with a stronger implicit association between the concepts alcohol and arousal. In contrast, no such relationship was observed between parental problem drinking and self-reported expectancy of alcohol arousal. These findings provide tentative evidence that an implicit cognitive processing bias is implicated in the intergenerational transmission of addictive behaviors.