Including children in mothers` treatment hastens recovery

There is no easy fix for substance use disorders, and the road to recovery is paved with setbacks. For patients who are mothers, this can compromise the stability of their relationship with their children and threaten the family unit. A study titled “Family Systems Therapy for Substance-Using Mothers and Their 8- to 16-Year-Old Children,” published in Psychology of Addictive Behaviors by researchers from The Ohio State University, sought to determine whether mothers who are in therapy for drug and alcohol use recover faster with the involvement of their children.

The study showed that women who included their children—ranging in age from 8 to 16—in their therapy were quicker to decrease their drug use than mothers in individual therapy.

Natasha Slesnick, PhD, co-author of the study and professor of human sciences at Ohio State, says that while children traditionally have not been a prominent part of substance use treatment, she hopes the results of this study will change that.

The study followed 183 mothers in outpatient treatment with at least one child age 8 to 16. They were placed in either Ecologically Based Family Therapy or individual therapy programs. Ecologically Based Family Therapy is a 12-session family systems therapy that targets dysfunctional interactions that can lead to problem behaviors. It focuses on improving social interaction, emotional connectedness and problem resolution skills.

The researchers measured daily substance use at baseline and at four intervals during the study. In addition, they rated the relationship between the mothers and their children by observing them in a 10-minute interaction task at the start of the study period and again at 6 and 18 months after the start of therapy.

While mothers in both the individual and family therapy groups experienced success on substance use measures, the mothers in the family therapy group saw more rapid reductions in substance use involving alcohol, marijuana and cocaine. Decreases in rates of usage were similar for opioid abuse in the two groups.

The researchers also found that increased relatedness by the mother was associated with decreased likelihood of alcohol use, while the child’s relatedness was associated with decreased opioid use by mothers in family therapy. In the individual therapy group, increased relatedness by the mother was associated with increased opioid use, as was increased autonomy.

The study didn’t indicate whether an improved relationship between mothers and their children over the course of therapy was the reason substance use decreased, but Slesnick believes the link is there.

Impact on family

Family therapy could be particularly attractive for mothers and their children because substance abuse has such a far reach into the health of the family unit. Twenty percent of the children in the study had been placed in foster care, 13% in juvenile detention, 8% were wards of the state, 7% were placed in group homes, and 7% had spent a night in jail. The mothers, too, had faced hardship, with 62.8% reporting a history of physical abuse and 48.6% reporting past sexual abuse. One-third of the women said their romantic partner also had a substance use problem.

Many treatment programs view substance abuse as an individual problem, Slesnick says, whereas family therapists believe that the root cause and continuation of substance abuse are best understood in terms of relationships.

“Because many providers have not been exposed to a family systems orientation, they would not naturally think to include the children of the mothers in treatment,” Slesnick says. “So, training in family systems approaches is needed. Also, engaging the children in services can be a huge prevention intervention for a high-risk group of children who would not otherwise receive any intervention.”

During a typical family therapy session, Slesnick says, a counselor helps the family accept that no one is to blame for the problems, rather than assigning blame to the addicted parent. She explains that the therapeutic techniques here “offer new interpretations of people and events. For example, re-frames and re-labels offer a less negative view of a behavior, such as, ‘Maybe your mom goes silent, not because she doesn’t care about you, but because she cares so much?’”

The sessions focus on the relationships among family members, resolution of ineffective communication strategies, and how harmful strategies or behaviors have been used to meet the family’s emotional and interpersonal needs.

“The early sessions focus on developing the mom’s and child's readiness to renew and tap the underlying bond of love and care, which can open the way for change,” Slesnick says. “When family members begin to understand problems as residing in family interaction, they are more open to learning and implementing problem-solving and communication skills to resolve conflicts.”

The study didn’t extend to fathers, since mothers typically have children in their care, Slesnick says, but she says this is an area for future research. According to Slesnick, an estimated 12% of children under 18 live with a parent with an alcohol or drug use disorder, and 70% of those children are raised by single mothers with substance use problems.

“Children are a major motivator for women’s abstinence, and can be a major stressor as well,” Slesnick says. “We see here that including children in treatment improves substance use outcomes for mothers. Our research also shows that it leads to better outcomes for their children.”

She adds, “Some research suggests that family therapy is more difficult to adopt due to training demands. Just because it is more difficult, and we have not figured out how to implement it across programs, does not mean we should give up trying.”

Rachael Zimlich, RN, is a freelance writer based in Ohio.