Almost Everything We Need to Better Serve Children of the Opioid Crisis We Learned in the 80s and 90s

Opioid use disorder impedes dependent parents' abilities to care for their children. In turn, children may languish in unpredictability and persistent chaos. Societal responses to these children are often guided by a belief that unless the drug dependent parent receives treatment, there is little help for the child. While a preponderance of the drug dependence research is adult-centric, a significant body of research demonstrates the importance of not only addressing the immediate well being of the children of drug dependent caregivers but preventing the continuing cycle of drug dependence. The present commentary demonstrates through a brief review of the US history of drug dependence crises and research from the 1980s and 1990s, a range of “tried and true” family, school, and community interventions centered on children. We already know that these children are at high risk of maladjustment and early onset of drug dependence; early intervention is critical; multiple risk factors are likely to occur simultaneously; comprehensive strategies are optimal; and multiple risk-focused strategies are most protective. Where we need now to turn our efforts is on how to effectively implement and disseminate best practices, many of which we learned in the 1980s and 1990s. The greatest opportunity in both changing the nature of the opioid epidemic at scale and influencing rapid translation of existing research findings into policy and practice is not in asking what to do, but in asking how to do the right things well, and quickly.

Predicting functional resilience among young-adult children of opiate-dependent parents

PURPOSE

This study describes the adversities experienced by a sample of children of opiate-dependent parents, examines criteria for young adulthood functional resilience, and tests parent, child, and school predictors of resilience.

METHODS

The Focus on Families (FOF) project was a randomized trial of a family-focused intervention with opiate-dependent individuals in methadone treatment and their children. Analyses were conducted on data from the children in treatment and control families during the original study (1991-1995) and a long-term follow-up interview (2005-2006).

RESULTS

Although all participants had an opiate-dependent parent, 70% experienced two or more additional types of childhood adversity and 20% experienced four or more types. A total of 24% met the following three criteria for functional resilience at the time of their young-adult interview: (1) working or being enrolled in school, (2) no history of substance abuse or dependence, and (3) no adult criminal charges in the prior 5 years. The FOF intervention did not significantly predict functional resilience. Girls were approximately four times more likely to exhibit resilience than boys. Experiencing a wider range of adversities in addition to having an opiate-dependent parent did not reduce the likelihood of functional resilience. Of the five child, family, and school predictors tested, only externalizing or internalizing problems in childhood were significantly associated with the likelihood of functional resilience (odds ratio = .30, p = .04) as a young adult.

CONCLUSIONS

These findings suggest that early intervention with families with opiate-dependent parents to prevent and reduce internalizing and externalizing problems in their children holds the most promise of supporting resilient adaptation in early adulthood.

Treating paternal drug abuse using Learning Sobriety Together: effects on adolescents versus children

The focus of this study was whether couples-based treatment for substance abuse had comparable secondary benefits on the internalizing and externalizing behaviors of adolescent versus child siblings living in their homes. Couples took part in a couples-based treatment for substance abuse that combines Behavioral Couples Therapy and individual counseling (i.e., Learning Sobriety Together). During a 17-month assessment period, the relationship between parents' functioning (i.e., fathers' drug use as determined by percent days abstinent and parents' dyadic adjustment) as rated by mothers, fathers, and children's teachers and internalizing behavior (as rated by mothers' only) was stronger for children than their adolescent siblings, particularly in terms of children's externalizing behaviors. Interventions that reduce paternal drug use and improve couple functioning may reduce internalizing and externalizing symptoms for children in their homes; however, adolescents may need more intensive interventions to address internalizing and externalizing symptoms.