Predictors of the psychosocial adjustment of children living in households of parents in which fathers abuse drugs

Abstract

The purpose of this study was to examine the relationship between the psychosocial adjustment of children living in households of parents (N=112) in which fathers were entering treatment for substance abuse and the following sets of variables: (a) parents' sociodemographic characteristics, (b) parents' dyadic adjustment, (c) fathers' substance use severity, and (d) parents' psychological adjustment. Mothers did not meet current criteria for a psychoactive substance use disorder on alcohol or other drugs; moreover, based on reports by parents, none of the children was not exposed prenatally to illicit drugs. Results of hierarchical-by-blocks regression analyses revealed that each of the variable sets made a significant unique contribution to the prediction of children's psychosocial adjustment. Furthermore, the following variables within the sets were also found to be significant: (a) parents' age, (b) weekly family income, (c) frequency of male-to-female physical aggression between the parents, (d) frequency of fathers' substance use during the previous year, (e) diagnosis of antisocial personality disorder of fathers, and (f) mothers' level of psychological distress.

Introduction

Although alcohol and other drugs can have serious physical, emotional, behavioral, economic, and social consequences for adults who regularly misuse them, children who live with alcoholic or drug-abusing parents can also fall victim to the deleterious familial environments these caregivers often create. Unfortunately, data from some epidemiological surveys suggest that many children live in, and cope with, these circumstances as part of their daily home lives. For example, it is estimated that 17.5 million children live in homes with an alcoholic parent (Eigan & Rowden, 1995). Comparable epidemiological data are presently not available for children living in homes of parents who primarily abuse drugs other than alcohol; however, it has been estimated that over 12 million children live in homes in which at least one parent used an illicit psychoactive substance during the previous year (US Department of Health and Human Services, 1994).

Over the last century, an extensive literature has evolved examining the functioning of children of alcoholics, who are often collectively referred to as COAs (for a review, see Windle & Searles, 1990). In general, these investigations have concluded that COAs exhibit elevated rates of various psychosocial problems. For example, COAs are approximately four to six times more likely to develop alcohol problems during their lifetimes (Russell, 1990). Furthermore, both internalizing (e.g., anxiety, depression), and externalizing behavior problems (e.g., conduct disorder, alcohol use, drug use) are more common among COAs than children of nonalcoholics Seilhamer & Jacob, 1990, West & Prinz, 1987. Several factors appear associated with the problems observed in COAs. A subset of these children is prenatally exposed to alcohol during gestation by mothers' drinking, and thus is at risk for physical and central nervous system insult, resulting in some instances in Fetal Alcohol Syndrome (FES) and its cognitive, affective, growth, and morphologic sequalae (Larkby & Day, 1997). In addition, COAs are also exposed to inadequate parenting and negative parent–child interaction patterns (e.g., Jacob & Johnson, 1997).

Empirical research examining the functioning of children whose parents primarily abuse drugs other than alcohol, often referred to as “children of substance abusers,” or COSAs, is far less evolved at present than the COA literature. Of the preliminary studies that have been conducted, investigators have found that COSAs often display maladaptive behavioral and emotional adjustment. For example, Sowder and Burt (1980) reported that many children of heroin-dependent mothers who were receiving outpatient treatment experienced emotional and school-related difficulties. Similarly, parental drug use has been associated with reports of child symptomatology on standardized rating scales of child behavior Billick et al., 1999, Wilens et al., 1994, and increased incidence of diagnosable childhood psychological disorders (e.g., Moss, Mezzich, Yao, Gavaler, & Martin, 1995).

Although these investigations indicate that COSAs often display emotional and behavioral difficulties, it is far less clear what factors are associated with the development of these observed adjustment problems. For example, some investigators have argued that the psychosocial problems observed in COSAs are often a consequence of prenatal drug exposure, which results in growth deficits and neurodevelopmental problems that are apparent throughout early childhood (e.g., Householder, Hatcher, Burns, & Chasnoff, 1982). However, many investigations have failed to find this link, particularly when other risk factors, such as poverty and nonoptimal caregiving environments, are carefully controlled (for a review, see Eyler & Behnke, 1999). Conversely, other authors have posited that the effects of postnatal drug exposure (i.e., the concomitant sequelae of drug use by parents, such as poverty and lack of emotional attachment of parents with their children) are the primary contributory factors in the emotional and behavioral problems observed in COSAs. For example, Bays (1991) has argued that parents' substance use severity may be related to poor child outcomes, largely because of parental resources, both financial and emotional, being shifted away from the children's needs and concentrated on the procurement of drugs.

Exploring these issues in her review, Young (1997) noted that investigations examining factors related to the psychosocial adjustment of COSAs have been unable to disentangle prenatal and postnatal social exposure effects because the children who are included in the studies often live with parents who are currently or have recently abused drugs and have typically been exposed to drugs during gestation due to mothers' substance use. This problem is a consequence of the fact that nearly all investigations of COSAs, to date, have focused almost exclusively on children of drug-abusing mothers (Hogan, 1998).

To isolate the effects of postnatal social exposure to parental drug use on the psychosocial adjustment of COSAs, it would be important to recruit families in which at least one parent abuses drugs but in which there is no evidence of maternal substance abuse during pregnancy. Although largely ignored in the literature to date (Hogan, 1998), assessing children from families with substance-abusing fathers and nonsubstance-abusing mothers would provide a unique opportunity to examine the effect of postnatal drug exposure on children's psychosocial adjustment not confounded by the effects of prenatal exposure. Moreover, collecting data from such a sample would also enable researchers to begin exploring the unique effects of fathers' substance use on the children in their homes.

Based on longstanding child development theory, it would be expected that children who have extensive postnatal exposure to drugs via being raised in homes with a drug-abusing father would be likely to have psychosocial adjustment problems. Sometimes referred to as the “high-risk paradigm” (Johnson & Leff, 1999), this theory suggests that chronic environmental, social, and familial stressors contribute additively or synergistically to poor adjustment in children. We can posit that children living with substance-abusing fathers often have prolonged exposure to such stressors, and thus are likely to have emotional and behavioral problems, when we examine the converging lines of evidence in the following areas: (a) studies of the relationship between parent characteristics and psychosocial functioning of COAs; (b) research examining parent and family factors associated with poor behavioral and emotional adjustment of children in nonsubstance-abusing families; and (c) dyadic adjustment studies of drug-abusing patients and their intimate partners.

For example, substance abuse is associated with low family income and financial problems (e.g., Ondersma, Simpson, Brestan, & Ward, 2000). Children from poor families exhibit lower levels of academic achievement, self-esteem, social development, and self-control than children from more advantaged families (e.g., Hanson et al., 1997, Smith et al., 1997). Moreover, low family income is associated with parent characteristics, such as lower levels of parent education and lower age of childbearing, that are risk factors in both nonsubstance-abusing (e.g., Fox, Platz, & Bentley, 1995) and substance-abusing families (Jansen, Fitzgerald, Ham, & Zucker, 1995).

Dyadic distress and conflict figure prominently among couples in which male partners abuse drugs. For example, Fals-Stewart, Birchler, and O'Farrell (1999) found that couples with drug-abusing male partners reported very high levels of relationship distress across multiple measures of dyadic adjustment. In addition, couples in which male partners abuse drugs are nearly four times more likely to engage in acts of partner physical violence than are observed among couples in the general population (e.g., Fals-Stewart, O'Farrell, & Birchler, 1995). Thus, children in these homes are likely to witness considerable partner violence. In turn, results of multiple studies indicate that children who live in homes in which parents engage in acts of partner violence are at high risk for the development of a host of behavioral and emotional problems, including depression, anxiety, aggressive social interactions, and delinquency (e.g., Jouriles et al., 1998, Shipman et al., 1999). In nonsubstance-abusing families, fighting between parents and reports of negative child behavior are moderately correlated; marital conflict commonly accounts for 4–20% of the variability in children's psychological adjustment (Cummings & Davies, 1994).

Other types of parent distress are also detrimental for children's development. Specifically, relationships between parents' psychological distress and children's adjustment have been demonstrated in high-risk environments Holden & Ritchie, 1991, Levendosky & Graham-Berman, 1998 and low-risk environments (Abidin, Jenkins, & McGaughey, 1992). Parental antisocial personality disorder (ASPD) has been associated with conduct disorder among children in general (e.g., Lahey et al., 1995) and increased likelihood of severe externalizing behavior problems among COAs, including experimentation with alcohol and other drugs, disregard for authority figures, and trouble with the law (e.g., Chasin et al., 1991, Ellis et al., 1997). In homes where fathers abuse drugs, perhaps mothers may serve as a protective influence; however, the presence of psychological distress may reduce mothers' abilities to shield children from the postnatal social effects of fathers' substance use. Some pieces of empirical evidence support this notion. For example, mothers with personality disorders provide less stable homes for children in terms of household composition change, school change, and exposure to substance abuse (Feldman, Zelkowitz, Wesis, & Vogel, 1995); mothers' elevated scores on personality tests are related to increased risk of children's conduct disorder (Lahey, Russo, Walker, & Piacentini, 1989).

Although recent research has examined psychosocial influences on the interpersonal functioning of school-aged children of individuals who misuse alcohol (e.g., Johnson & Leff, 1999), it is not clear whether parental drug use contributes to children's psychosocial adjustment above other socioeconomic and environmental risk factors that are often present in these children's lives. Moreover, it may be the cumulative effects of multiple risk factors that account for child adjustment. Clearly, identifying these relationships is important for determining risk for maladaptive outcomes and targeting substance abuse treatment for parents.

Thus, the purpose of the present investigation was to examine the psychosocial adjustment of children living in homes in which fathers primarily abuse psychoactive substances other than alcohol and mothers do not currently abuse drugs or alcohol. More specifically, we collected data from COSAs who (a) were not, from the available information, exposed in utero to psychoactive drugs due to mothers' substance use; (b) were presently living in homes in which fathers were diagnosed with a current psychoactive substance use disorder; and (c) were living in homes in which the mother did not meet criteria for a psychoactive substance use disorder. Based on a review of the findings from the COA research, child development literature, and studies of dyadic adjustment of drug-abusing couples, we sought to determine the independent and unique contributions to the prediction of COSAs' psychosocial adjustment by (a) parents' sociodemographic characteristics, (b) parents' dyadic adjustment, (c) fathers' substance use severity, and (d) parents' psychological functioning.