Parenting under the influence: The effects of opioids, alcohol and cocaine
on mother–child interaction
Natasha Slesnicka,⁎, Xin Fenga, Brittany Brakenhoffa, Gregory S. Brighamb
aDepartment of Human Sciences, The Ohio State University, Columbus, OH, United States
bMaryhaven, Columbus, OH, United States
H I G H L I G H T S
• Women addicted to opioids, compared to alcohol, show less negative parenting.
• Overall, all mothers fell into the clinical range on parenting behaviors.
• African American mothers showed less negative parenting behaviors than Whites.
• Overall, mothers appear to struggle with effective discipline for older children.
• Treatment should attend to drug of choice, culture and developmental age.
a b s t r a c ta r t i c l ei n f o
Available online 15 February 2014
Alcohol and cocaine use
Nearly 20% of adults receiving treatment for a substance use disorder live with their minor children (Stanger
et al., 1999) and women in drug use treatment are twice as likely as men to have children in their household
(Wechsberg et al., 1998). Parental drug use impacts the family through reduced family resources such as
money and food, and researchers consistently note parenting deficits among substance users (Solis, Shadur,
Burns, & Hussong, 2012). Little is known about differences in parenting and mother–child interaction among
mothers with different drugs of choice or among mothers of older children, between 8 and 16 years. This
study reports the findings from a sample of treatment seeking opioid, alcohol and cocaine using mothers and
their 8–16-year-old child. Findings from a mother–child observational task and self-reported parenting measure
indicated less undermining autonomy and higher mother maternal acceptance among opioid compared to alco-
hol addicted mothers. African American mothers were observed to have fewer negative interactional behaviors
than Whites and both African American mothers and children self-reported higher firm control and maternal
acceptance. Overall, mothers appeared to struggle with effective discipline with older versus younger children.
Findings offer useful information to clinicians seeking to effectively tailor their interventions to women and
children who present with different drugs of abuse, race/culture and developmental stage of child.
© 2014 Elsevier Ltd. All rights reserved.
differ from non-addicted mothers in terms of parenting, less is known
about how mothers with an opioid use disorder differ from mothers
with other substance use disorders (Hogan, 2003). Further, while a
small number of studies have examined substance use disordered
mothers' interactions with their infant or young child (Burns, Chethik,
Burns, & Clark, 1997; Hagan & Myers, 1997; Mayes & Truman, 2002;
Neuspiel, Hamel, Hochberg, Greene, & Campbell, 1991), studies that
have examined substance use disordered mothers of older children
have primarily relied on self-report data (Solis et al., 2012). The current
study addresses this gap in the literature by including an observational
mother and child self-report of parenting. A better understanding
of parenting and the unique mother–child interaction patterns is
necessary for targeting parenting interventions for these families, as
well as indicating whether parenting interventions should be modified
for mothers with different presenting drugs of choice.
Previous research has focused on two dimensions of parenting:
parental warmth and parental control (Amato, 1990; Schaefer, 1965).
Briefly, parental control refers to the amount of discipline and super-
vision parents provide as well as the amount of independence and
autonomy they encourage (Amato, 1990; Schaefer, 1965). Parental
warmth refers to the positive interactions and emotions experienced
Addictive Behaviors 39 (2014) 897–900
⁎ Corresponding author at: Department of Human Sciences, The Ohio State University,
135 Campbell Hall, 1787 Neil Ave, Columbus, OH 43210, United States. Tel.: +1 614 247
8469; fax: +1 614 292 4365.
E-mail address: firstname.lastname@example.org (N. Slesnick).
0306-4603/© 2014 Elsevier Ltd. All rights reserved.
Contents lists available at ScienceDirect
in the parent–child relationship such as love, acceptance, support, and
closeness (Schaefer, 1965). Previous studies have generally found
that mothers with substance use disorders struggle with both di-
mensions of parenting (Gruber & Taylor, 2006; Mayes & Truman,
2002; Suchman, Rounsaville, DeCoste, & Luthar, 2007). Among chil-
dren of substance use disordered mothers, lower levels of parental
control and warmth predict higher levels of externalizing problems,
depression, and school maladjustment (Luthar & Sexton, 2007;
Suchman et al., 2007).
ent drugs of choice on African American drug users. However, race ap-
pears to influence substance use related consequences (Bernstein
et al., 2005; Patkar, Sterling, Gottheil, & Weinstein, 1999; Zapolski,
Pedersen, McCarthy, & Smith, 2013), parental discipline (Deater-
Deckard, Dodge, Bates, & Pettit, 1996), monitoring (Slesnick et al.,
2012), and communication patterns (Baldwin, Baldwin, & Cole, 1990;
Steinberg, Dornbusch, & Brown, 1992).
The mother–child relationship may also differ based on children's
age. Stanger, Dumenci, Kamon, and Burstein (2004) found that within
substance use disordered families with children between the ages of 2
and 18 years, poor parental monitoring increased with child's age and
derstanding factors unique to mothers based on their drug of choice
(opioids, alcohol, or cocaine), race, and age of child, it will be possible
to develop targeted interventions for these mothers and their children.
The current study utilizes baseline data from a clinical trial designed to
ordered treatment seeking mothers recruited through a community
based treatment program in a large Midwestern city.
Participants included 183 mother–child dyads. Mothers were eligi-
ble to participate if they: 1) had a child between the ages of 8 and
16 years who lived with them at least 50% of the time for the past
2 years or 100% of the time in the past 6 months, 2) were seeking out-
patient treatment for their substance use disorder, and 3) met diagnos-
tic criteria for an alcohol or drug use disorder. Mother's ages ranged
from 22to54 years(M = 33.9 years) and the targetchild'sages ranged
from 8 to 16 years (M = 11.5 years). Mothers reported having 1 to 11
children (M = 3.2). Nearly half of the mothers reported opioids as
their drug of choice (89 mothers, 48.6%), 60 mothers (32.8%) reported
However, there wasa high overlapbetween alcohol and cocaineuse. Of
the 34 women who reported cocaine as their drug of choice, 33 also
reported alcohol use in the last 90 days. Because of the overlap in
alcohol and cocaine use, this group is referred to as the cocaine/alcohol
group. Thus, the final groups utilized in the analyses included 89 opioid
using mothers, 57 alcohol using mothers, and 37 cocaine/alcohol using
The Ohio State University Institutional Review Board approved all
study procedures. Both the mother and target child completed several
individual and family measures as well as a video recorded interaction
task. Mothers were offered a $75 gift card while children were offered
a $40 gift card for completing the assessment interview.
2.3.1. The Form-90
The Form-90 (Miller, 1996) is a structured interview and was used
primary drug of choice. It has demonstrated high test–retest reliability
(Tonigan, Miller, & Brown, 1997; Westerberg, Tonigan, & Miller, 1998).
2.3.2. Parental warmth and control
items used to measurechildren's report of acceptance/rejection, psycho-
logical autonomy/control, and firm/lax control (Margolies & Weintraub,
1977). The Parent Form of the CRPBI (Schwarz, Barton-Henry, &
Pruzinsky, 1985) was used to measure mothers' reports of parental
warmth and control. The measures have shown high levels of internal
consistency (Margolies & Weintraub, 1977; Schwarz et al., 1985).
2.3.3. Observation of parent–child interaction
A 10-minute interaction between mother and child was video re-
corded in the family's home. The interaction was coded using the Auto-
nomy and Relatedness Coding System (Allen et al., 2000). The coding
the behavior promotes or undermines autonomy or relatedness (Allen,
outlined in the coding manual, an autonomy and relatedness composite
score was created for both the mother and the child (Allen, Hauser, Bell,
& O'Connor, 1994). Twenty percent of the observations were double-
coded, and coding reliability (ICC) was .70.
Scores from the current study were compared to clinical cut-off
scores for the CRPBI. The following were used as clinical cut-off scores:
less than 51 for acceptance/rejection, less than 26 for autonomy/
psychological control, and less than 18 for firm/lax control (Suchman
et al., 2007). Mothers' mean scores fell below the clinical cut-off scores
for the CRPBI on all three subscales.
3.1. Observed mother–child interaction during the family discussion task
Mothers' and children's behaviors were coded separately, and three
autonomous-relatedness, undermining autonomy, and undermining re-
latedness. For each variable, a mixed-effect regression analysis was con-
ducted with grouping status, race, actor (child vs. mother), and group
by race and group by actor interactions as predictors and child age as a
covariate. Two dummy variables (alcohol versus opioid use and co-
caine/alcohol versus opioid use) were created to represent three groups
in the analyses. The interaction terms were not significant on any of the
analyses and were removed. With autonomous-relatedness, a difference
between thechild and mother was found, t(181) = 14.57, p b .001, with
mothers displaying higher levels of autonomous-relatedness than the
children. Child age was also associated with autonomous-relatedness,
t(181) = 5.13, p b .05, in that older children displayed higher levels
of autonomous-relatedness. On undermining autonomy, effects of
group [t(181) = 2.36, p b .05], race [t(181) = 3.15, p b .01], and actor
[t(181) = 5.42, p b .001] were found. Specifically, dyads in the alcohol
group were higher than the opioid group, White dyads were higher
than African American dyads, and mothers were higher than children
in undermining autonomy. For undermining relatedness, there was a
difference between the children and mothers, t(181) = −2.53, p b .05,
with children showing more of such behavior than their mothers.
dimensions, acceptance/rejection, psychological control/autonomy,
and firm/lax control. Each parenting dimension was analyzed using a
repeated measures ANOVA with informant (child vs. mother) as
within-subject factors, group and race as between-subject factors, and
child age as a covariate.
N. Slesnick et al. / Addictive Behaviors 39 (2014) 897–900
Group by race interaction was initially included in the analyses, but
was then removed because it did not contribute to the explanation of
any of the dependent variables. The analysis on maternal acceptance/
rejection yielded a group effect [F(2,175) = 3.21, p b .05, η2= .04]
and race effect [F(1,175) = 8.06, p b .01, η2= .05], as well as a child
age effect [F(1,175) = 30.40, p b .001, η2= .14] with older children
and mothers of older children reportinglower levels of maternal accep-
tance. Children's and mothers' ratings did not differ. Results indicated
that children and mothers in the opioid group reported higher levels
of maternal acceptance than those in the alcohol and cocaine/alcohol
groups (Table 1), and African American children and mothers reported
higher levels of maternal acceptance than their White counterparts
For maternal psychological control/autonomy, older children and
mothers of older children reported mothers as exerting higher levels
of psychological control, F(1,175) = 8.30, p b .01, η2= .05. With regard
to maternal firm/lax control, a race effect [F(1,175) = 13.07, p b .001,
η2= .07] was found. Specifically, African American children and
mothers reported higher levels of maternal firm control than White
children and mothers (Table 2). In addition, younger children and
mothers of younger children reported higher levels of maternal firm
control, F(1,175) = 16.21, p b .001, η2= .09.
Observational findings suggest that the relationship between opioid
addiction, parenting and parent–child interaction may be less negative
than for alcohol addiction. During the observational task, opioid-
addicted women showed less undermining autonomy behaviors than
the alcohol use disordered mothers. Furthermore, opioid addicted
mothers and their children self-reported more maternal acceptance
than did the comparison mothers and children. As these mothers had
not yet begun their treatment for substance use disorder, the observed
differences may be associated with the clinical effects of opioid use
which include anxiety reduction, euphoria and a profound sense of
oid, alcohol and cocaine/alcohol abusing mothers fell into the range ob-
served for clinical samples, supporting prior studies' conclusions that in
general, substance use disordered mothers struggle with parenting and
Similar to national reports, opioid addiction was primarily observed
tion was primarily observed among African American mothers (70.2%)
(Bernstein et al., 2005; SAMHSA, 2012). African American mothers
were observed to show less negative parenting than Whites, in terms
of lower undermining autonomy behaviors. African American mothers
and their children also self-reported higher firm control and higher
maternal acceptance than Whites. Higher firm control among African
American mothers has beenwidely reported, and is generallyperceived
positively, as caring, by youth in these families and to have a positive
impact on African American youth outcomes (Brody & Flor, 1998;
García Coll & Pachter, 2002). These findings support a group difference
hypothesis, supporting the use of culturally relevant models of sociali-
zation when working with substance use disordered African American
mothers and their children.
Differences by child age were observed. Compared to younger
children, older children were observed to express higher autonomy-
relatedness, indicating more promoting than undermining behaviors.
may experience and express more sensitivity towards them (Roberts &
Strayer, 1996). In regard to mothers, it appears that they struggle more
with effective discipline with older compared to younger children. That
is, mothers were more likely to use psychological control strategies
ing strategies among older children. This finding might indicate that
mothers struggle to adapt to the changing developmental needs of
4.1. Implications for practice and conclusions
Consideringthelimitationsofa cross-sectionaldesignand sample of
ferent behavioral and social consequences associated with different
drugs of choice. Although few treatment programs for substance use
disorders offer relational therapy to mothers with children in their
care, family therapy interventionsthat engage substanceusingmothers
and their children in treatment provide an opportunity to address
strains in the mother–child relationship and support mothers' parent-
ing efforts as they move towards sobriety. This study also indicates
that sensitivity to cultural and developmental differences in parenting
and mother–child interaction associated with age of the child appear
to be important factors to consider when effectively intervening with
Role of funding sources
This research was supported by NIDA grant R01 DA023062 to the first author. NIDA
had no involvement in the study design, collection, analysis or interpretation of the data,
writing the manuscript, or the decision to submit the paper for publication.
The first and fourth authors designed and executed the study. The first author
completed the majority of the writing. The second author had primary responsibility for
Means and standard deviations by drug of choice.
Child MotherChild MotherChildMother
M SDM SDM SDM SDM SDM SD
Means and standard deviations by race.
African AmericanEuropean American
M SDM SDM SDM SD
N. Slesnick et al. / Addictive Behaviors 39 (2014) 897–900
analyzing and reporting the data for this study. The third author drafted the introduction Download full-text
to the paper. All authors approved of the final manuscript.
Conflict of interest
There are no conflicts of interest by any author.
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