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

Not Applicable

Completed

Conditions: Behavioral Health

Interventions: Behavioral: Episodic Future Thinking

Registration Number: NCT05229120

Lead Sponsor: Henry Ford Health System

Brief 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.

Detailed 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 & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 38

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.

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Episodic Future Thinking	Episodic Future Thinking	Parents who are receiving residential substance use disorder (SUD) treatment will receive an adapted episodic future thinking focused condition. Parents will meet with peer recovery coaches (PRCs) who will administer the intervention, focused on generating future, pleasant events with their children. After the intervention session, parents will receive a daily postcard over the course of two weeks including a reminder cue generated as part of the episodic future thinking (EFT) intervention and a prompt to remember these episodes in vivid detail.

Primary Outcome Measures

Name	Time	Method
Change in Delay Discounting 5 Trial Adjusted Measure	Baseline and 4 weeks	The 5-Trial Adjusting Delay (Temporal Discounting) Task is a computer based system which 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). The length of delay is titrated based on participants' responses to previous items to determine an "indifference point" (the point at which the sums of money are perceived as equal). This is then converted to a k-value and logarithmically transformed to ensure the values are normally distributed, making them unbounded by min and max values. Higher k-values indicate a greater preference for immediate rewards. Change in Delay Discounting is evaluated by comparing baseline k-value scores with scores at the intervention (approximately 1 week after baseline) and the post-intervention assessment (approximately 4 weeks after baseline).
Change in Consideration of Future Consequences Scale - Parenting Adapted	Baseline, 4 weeks	The Consideration of Future Consequences Scale-Parenting Adapted (CFCS-14-PA) is a 14-item self-report questionnaire composed of two subscales reflecting either immediate or future orientation related to parents interactions with their children. Items range from "not at all like me" (1) to "very much like me" (5) and are summed to create a total score with higher values reflecting greater future orientation. Scores range from 14 to 70. Change in CFCS-14-PA score is measured by comparing scores at the post-intervention assessment (approximately 4 weeks after baseline) with baseline scores.

Secondary Outcome Measures

Name	Time	Method
Change in Dyadic Parent-Child Interaction Coding System Scores	Baseline, 4 weeks	Parents and their children will complete a 20-minute interaction task, including 5 min. of free play, a 10 min. "homework" task, and a 5 min. clean up task. Interactions are recorded and coded using the Dyadic Parent-Child Interaction Coding System (DPICS), measuring the quality of parent and child interactions. The task is coded for 7 subscales, yielding 2 composite scores: positive parenting (a sum of: unlabeled praise, labeled praise, positive touch, reflection, and behavior description) and negative parenting (a sum of: negative talk and negative touch). Each instance of a behaviors described in the subscale (e.g., a parent giving unlabeled praise) is coded as one "point," which are summed into a subscale (no max or min values). Higher values indicate greater positive or negative parenting. 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).
Change in Alabama Parenting Questionnaire Scores	Baseline, 4 weeks	The Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors which yields five subscales: (1) positive involvement with children (range 10-50, higher = more involvement), (2) use of positive parenting strategies (range 6-30, higher = more positive strategies), (3) poor parental monitoring/supervision (range 10-50, higher = worse supervision), (4) inconsistent discipline (range 6-30, higher = more inconsistent discipline), and (5) use of corporal punishment (range 3-15, higher = more corporal punishment). Items are summed to create subscale scores. Change in each of the five APQ subscale scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores.