May/June 2001 Article 1 Article 2

Development of a Skill Training Program for Parents of Substance-Abusing Adolescents Neil B. McGillicuddy, Ph.D., Robert G. Rychtarik, Ph.D., Joan A. Duquette, and Elizabeth T. Morsheimer Abstracted from Journal of Substance Abuse Treatment, 20, 59-68, 2001. Are parents to blame for their adolescent’s alcohol or drug problem? Or, could they be thought of as victims? The most common view is that the parents are to blame for their adolescent’s substance abuse. Poor parental communication and high conflict with the teen, and limited effort to keep track of him/her are often thought to set the stage for the adolescent to develop a substance abuse problem. Consider the alternative: Could it be that some conditions seen in these families result from the teen’s problem? In fact, many parents of substance-abusing adolescents report depression, anxiety, and anger over failed efforts to address their child’s problem. Could alternative coping skills help these parents handle the emotional distress of living with a teen substance abuser and, indirectly, favorably impact on the adolescent’s problem? The latter view was taken in a recent pilot study at RIA by Neil B. McGillicuddy, Ph.D. and Robert G. Rychtarik, Ph.D. Though recognizing the reasons for adolescent substance abuse are complex, these investigators postulated that the substance abuse may be maintained inadvertently by how parents cope with it. Often parents and their adolescent can get into a vicious cycle of teen substance abuse, followed by parental efforts to stop it, followed by more adolescent substance abuse and acting out, and so on. Eventually, the parents can feel increasingly unable to cope with the adolescent and with their own emotions because they cannot stop the problem. Sometimes they just give up. These investigators speculated that if parents received training in more effective coping skills they might be able to relieve their own emotional distress and impact favorably on the adolescent’s behavior. To this end, they developed a research-based coping skill training program for parents of substance-abusing adolescents. Two typical concerns of research-based treatment programs are that they lack real-world applicability, and their effectiveness is not easily measured. In this research, clinician knowledge and scientific method were integrated through the Parent Situation Inventory (PSI) - a tool developed by McGillicuddy and Rychtarik to assess the effectiveness of parent coping with adolescent substance abuse. The PSI is comprised of two forms, each with 28 situations. The PSI assesses parental responses to various scenarios involving a teen’s substance abuse. Responses are scored for effectiveness using a rating system specific to each situation. These same PSI situations and rating systems were used to develop much of the content of the skill training intervention. Effectiveness of the intervention can be measured, in part, by differences in pretreatment to posttreatment coping. To this end, parents could be assessed on one PSI form at pretreatment assessment, receive training, and be assessed on the alternate PSI form at posttreatment assessment. The PSI and the skill training program were developed to have strong applicability to the real world. The situations utilized in the PSI, and the rating system used to measure coping effectiveness, were based on consensus judgements of substance abuse counselors who specialize in adolescent treatment. In this way, the researchers were able to utilize counselor expertise regarding the most important situations on which to provide training, and components of the most effective responses. Participants and the Process Participants responded to flyers and multimedia advertisements publicizing a program for parents encountering problems due to their adolescent’s substance use. Parents from 22 families participated. To be able to participate, the parent needed to live in the same household as the adolescent at least 30 of the previous 90 days. Parents also had to report that the child was actively engaged in substance use and not currently receiving alcohol or drug treatment. Parents could not have their own active alcohol or drug use problem. The purpose of the pilot was to determine the effectiveness of the skill training program on parent coping, parent distress, parent-adolescent communication, and adolescent substance use. Parents were assigned randomly to receive to receive treatment immediately (i.e., skill training) or following an eight-week delay (i.e., wait list control). Treatment groups consisted of between two-five parents. Parents were assessed prior to random assignment, and for a second time following the eight-week treatment or eight-week delay. At each time period, parents were measured on their coping skills as assessed on the PSI, their coping in recent encounters with the teen, their emotional distress, their communication with the adolescent, and the number of days the adolescent used alcohol, marijuana, and other illicit drugs over the previous 50 days. (Few parents reported illicit drug use other than marijuana; therefore this report focuses on just alcohol and marijuana.) Parents assigned to the wait-list received the intervention after their second assessment, but the results presented below compare their reports following the eight-week wait to the reports of parents who received the intervention immediately. Demographics of pilot study. Characteristic Coping skills treatment n=14 Wait-list control n= 8 Parent Age 44.9 yrs. 45.4 yrs. Gender (Female) 93% 88% Race (European American) 86% 100% Married 50% 25% Employed 93% 63% Yrs. of Education 13.7 13.8 Adolescent* Age 16.6 yrs. 15.8 yrs. Gender (Female) 29% 25% Yrs. of Education 9.7 9.1 Currently in school? 71% 88% Current alcohol problem? 86% 88% Current drug problem? 79% 88% * Based on parent’s report Results Results regarding PSI performance indicate improvements in coping skills among parents receiving the skill training intervention relative to the wait list parents. Similar coping improvements were found in recent encounters with their teen, suggesting some real-world improvement. Also, parents receiving the intervention had reduced depression, anxiety, and anger, and reported fewer communication problems with their teen. Finally, skill training participants reported reductions in adolescent marijuana use. Interestingly, parents in both conditions reported nearly 50% fewer days of adolescent alcohol consumption from pretreatment to post-treatment. Although this finding may be an anomaly, future research might consider whether the expectation of a parent treatment program accounts for modified perceptions of adolescent alcohol use. Discussion Data collected in this and other studies conducted by McGillicuddy and Rychtarik indicate that parents of substance-abusing adolescents are distressed, and that many lack effective substance-related coping skills. These results are encouraging in that a treatment program was successfully developed that led to improved substance-related coping skills and lower emotional distress. In addition, these pilot data suggest that parent skill training may lead to reductions in teen marijuana use. Some limitations inherent with pilot research surfaced in this study. First, the study sample was small. Second, the skill training intervention was not compared to an alternate intervention, so it is unknown whether the findings were due to program content, or to less relevant factors (e.g., attention from a therapist). Also, there was no assessment beyond post-treatment; it is unknown whether the changes in coping skills and associated distress may maintain or even accelerate over a lengthier time. These limitations are being addressed in a full-scale clinical trial currently being conducted by these same researchers. In the trial, the skill training program is being evaluated along with a 12-Step Facilitation Program to examine their differential impact on parent and adolescent functioning. Participants are followed for one year post-treatment to determine the long-term effect of the interventions. Clinical Implications: Parents who believe that nothing can be done if a substance abusing adolescent is unwilling to enter treatment can look toward a parents-only treatment such as that described here as a viable option to improve parental and family functioning. Parent skill training may help reduce parent distress and indirectly reduce teen substance use. This research was funded by a grant (DA09581) to Neil B. McGillicuddy from the National Institute on Drug Abuse (NIDA). Article 2

William R. Greiner, President

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