Improving Delay Discounting to Decrease Harsh Parenting Among Parents Receiving Substance Use Treatment

Behavioral Health Clinical Trial

Official title:

Improving Delay Discounting to Decrease Harsh Parenting Among Parents Receiving Substance Use Treatment in Low Income Community

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT05229120
• Other study ID #: 14781
• Status: Completed
• Phase: N/A
• Start date: April 7, 2022
• Est. completion date: March 31, 2023

Study information

• Verified date: June 2023
• Source: Henry Ford Health System
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Parents with substance use disorders are disproportionately more likely to engage in harsh physical discipline, which can lead to serious clinical outcomes, including child maltreatment and the intergenerational transmission of addictive disorders. One mechanism linking substance use and maladaptive parenting strategies is parental delay discounting, or the tendency to value smaller, immediate rewards (such as stopping children's misbehavior via physical punishment) relative to larger, but delayed rewards (like shaping adaptive child behaviors over time). This study will examine the efficacy of implementing a low-cost, brief intervention targeting the reduction of parental delay discounting to inform broader public health efforts aimed at reducing child maltreatment and interrupting intergenerational cycles of substance abuse in traditionally underserved communities.

Description:

Parents with substance use disorders (SUD) are significantly more likely to engage in harsh parenting practices, including spanking, hitting, and belittling their children, than parents without SUD. Punitive physical and emotional discipline is, in turn, associated with increased rates of child maltreatment and the subsequent intergenerational transmission of substance use disorders. Parents in residential substance use treatment facilities are among those at highest risk for perpetrating harsh and abusive parenting; yet most behaviorally based parenting interventions available within inpatient settings do not take into account the unique mechanisms linking parental substance use to harsh parenting. Specifically, parents with SUD may be at heightened risk for engaging in maladaptive parenting approaches given a tendency to prioritize immediate rewards (such as stopping a child's misbehavior using physical punishment) relative to larger, but delayed rewards (including shaping positive child behavior over a longer term). This behavioral tendency is known as delay discounting and recent findings suggest that rates of delay discounting predict parents' use of harsh physical discipline. Existing research also indicates a strong link between steeper (more problematic) rates of delay discounting and the severity of alcohol and illicit drug use across the lifespan. Thus, delay discounting may represent a specific vulnerability underlying both harsh parenting and disordered substance use. The current project proposes to pilot and feasibility test an adapted episodic future thinking (EFT) intervention to target the reduction of parenting-related delay discounting and examine its effects on parenting practices among families in a residential substance use treatment setting. The intervention will be delivered by peer recovery coaches who are already employed in the center.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: March 31, 2023
• Est. primary completion date: February 10, 2023
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Parent of child between 6-10 years of age

• Able to provide informed consent and take part in all study procedures in English

• Have current diagnosis of SUD

• Currently reside with their child at least 50% of the time

• Be willing to receive daily postcards

Exclusion Criteria:

• Active suicidality/homicidally

• Active bipolar disorder, schizophrenia, or psychosis.

• Only one parent-child dyad from each family.

Related Conditions & MeSH terms

• Behavioral Health
• Substance-Related Disorders

Intervention

Behavioral:
• Episodic Future Thinking
The adapted episodic future thinking (EFT) intervention will focus on generation of vivid, substance-free, rewarding events that could happen in the future with their children.

Locations

Country	Name	City	State
United States	Odyssey Village	Flint	Michigan

Sponsors (3)

Lead Sponsor	Collaborator
Henry Ford Health System	University of Kansas, University of Maryland, College Park

Country where clinical trial is conducted

United States, 

References & Publications (17)

Alati R, Baker P, Betts KS, Connor JP, Little K, Sanson A, Olsson CA. The role of parental alcohol use, parental discipline and antisocial behaviour on adolescent drinking trajectories. Drug Alcohol Depend. 2014 Jan 1;134:178-84. doi: 10.1016/j.drugalcdep.2013.09.030. — View Citation

Amlung M, Vedelago L, Acker J, Balodis I, MacKillop J. Steep delay discounting and addictive behavior: a meta-analysis of continuous associations. Addiction. 2017 Jan;112(1):51-62. doi: 10.1111/add.13535. Epub 2016 Sep 1. — View Citation

Bickel WK, Marsch LA. Toward a behavioral economic understanding of drug dependence: delay discounting processes. Addiction. 2001 Jan;96(1):73-86. doi: 10.1046/j.1360-0443.2001.961736.x. — View Citation

Committee on Child Maltreatment Research, Policy, and Practice for the Next Decade: Phase II; Board on Children, Youth, and Families; Committee on Law and Justice; Institute of Medicine; National Research Council; Petersen AC, Joseph J, Feit M, editors. New Directions in Child Abuse and Neglect Research. Washington (DC): National Academies Press (US); 2014 Mar 25. Available from http://www.ncbi.nlm.nih.gov/books/NBK195985/ — View Citation

Felton JW, Collado A, Ingram K, Lejuez CW, Yi R. Changes in delay discounting, substance use, and weight status across adolescence. Health Psychol. 2020 May;39(5):413-420. doi: 10.1037/hea0000833. Epub 2020 Jan 9. — View Citation

Herrenkohl RC, Herrenkohl EC, Egolf BP. Circumstances surrounding the occurrence of child maltreatment. J Consult Clin Psychol. 1983 Jun;51(3):424-31. doi: 10.1037//0022-006x.51.3.424. No abstract available. — View Citation

Kaminski JW, Valle LA, Filene JH, Boyle CL. A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol. 2008 May;36(4):567-89. doi: 10.1007/s10802-007-9201-9. Epub 2008 Jan 19. — View Citation

Lin H, Epstein LH. Living in the moment: effects of time perspective and emotional valence of episodic thinking on delay discounting. Behav Neurosci. 2014 Feb;128(1):12-9. doi: 10.1037/a0035705. — View Citation

Liu L, Feng T, Chen J, Li H. The value of emotion: how does episodic prospection modulate delay discounting? PLoS One. 2013 Nov 28;8(11):e81717. doi: 10.1371/journal.pone.0081717. eCollection 2013. — View Citation

MacKillop J, Amlung MT, Few LR, Ray LA, Sweet LH, Munafo MR. Delayed reward discounting and addictive behavior: a meta-analysis. Psychopharmacology (Berl). 2011 Aug;216(3):305-21. doi: 10.1007/s00213-011-2229-0. Epub 2011 Mar 4. — View Citation

Milligan K, Meixner T, Tremblay M, Tarasoff LA, Usher A, Smith A, Niccols A, Urbanoski KA. Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice. Child Maltreat. 2020 Aug;25(3):247-262. doi: 10.1177/1077559519873047. Epub 2019 Oct 14. — View Citation

Neger EN, Prinz RJ. Interventions to address parenting and parental substance abuse: conceptual and methodological considerations. Clin Psychol Rev. 2015 Jul;39:71-82. doi: 10.1016/j.cpr.2015.04.004. Epub 2015 Apr 24. — View Citation

Peters J, Buchel C. Episodic future thinking reduces reward delay discounting through an enhancement of prefrontal-mediotemporal interactions. Neuron. 2010 Apr 15;66(1):138-48. doi: 10.1016/j.neuron.2010.03.026. — View Citation

Reynolds B. A review of delay-discounting research with humans: relations to drug use and gambling. Behav Pharmacol. 2006 Dec;17(8):651-67. doi: 10.1097/FBP.0b013e3280115f99. — View Citation

Staton-Tindall M, Sprang G, Clark J, Walker-Barnes R, Craig CD. Caregiver Substance Use and Child Outcomes: A Systematic Review. Journal of Social Work Practice in the Addictions. 2013;13(1):6-31. doi:10.1080/1533256X.2013.752272

Whipple EE, Richey CA. Crossing the line from physical discipline to child abuse: how much is too much? Child Abuse Negl. 1997 May;21(5):431-44. doi: 10.1016/s0145-2134(97)00004-5. — View Citation

Young NK, Boles SM, Otero C. Parental substance use disorders and child maltreatment: overlap, gaps, and opportunities. Child Maltreat. 2007 May;12(2):137-49. doi: 10.1177/1077559507300322. — View Citation

* Note: There are 17 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Delay Discounting 5 Trial Adjusted Measure	The computer based adjusting amount discounting task uses an adjusting algorithm to determine the amount of immediately available money that is equivalent to a large sum that is delayed by seven discrete durations of time presented in a randomized order (i.e., 1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years).At each delay, a choice is first presented between the delayed larger sum and a smaller sum available immediately. For each trial, the position of the delayed and immediate amounts are randomly assigned the left or right portion of the screen, and the participant chooses the preferred option by pressing the corresponding left or right response button. Change in the Delay Discounting score is measured by comparing baseline scores with scores at the intervention (approximately 1 week after baseline) and the post-intervention assessment (approximately 4 weeks after baseline)	Baseline, 1 week, and 4 weeks
Primary	Change in Consideration of Future Consequences Scale	The Consideration of Future Consequences Scale1 (CFCS-14) is a 14-item self-report questionnaire that assesses active consideration of longer-term implications of an individual's actions. Lower scores on the CFCS-14 are associated with a greater focus on immediate needs and have been found to be associated with less engagement in health behaviors1819 and greater substance use. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Research suggests modest but significant correlations with the MCQ. Change in CFCS-14 score is measured by comparing baseline scores with scores at the post-intervention assessment (approximately 4 weeks after baseline)	Baseline, 4 weeks
Secondary	Change in Dyadic Parent-Child Interaction Coding System Scores	Parents and their children will complete a 20- minute interaction task, including five minutes of free play, a ten minute "homework" task in which children are given a math worksheet and parents are told to provide help "as you see fit," and a five minute clean up task. Interactions will be video recorded and coded using the Dyadic Parent-Child Interaction Coding System (DPICS) which yields to composite scores: positive parenting (including praise, positive affect, and physical positive interactions) and negative parenting (including negative commands, critical statements, and physical negative interactions). Change in positive parenting and negative parenting scores will be calculated by comparing baseline scores with scores at the post-intervention sessions (approximately 4 weeks after baseline)	Baseline, 4 weeks
Secondary	Change in Alabama Parenting Questionnaire Scores	The Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors. The questionnaire includes five subscales: (1) positive involvement with children, (2) supervision and monitoring, (3) use of positive discipline techniques, (4) consistent use of discipline, and (5) use of corporal punishment. The measure is widely used and has demonstrated excellent internal consistency and validity. Change in APQ scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores.	Baseline, 4 weeks