Novel Assessment of Maternal Distress Tolerance Underlying Substance Use Relapse

说明(由申请人提供)：女性证据表明使用药物的治疗结果比男性更差(Greenfield等人，2007年)，包括更高的治疗辍学率(Arfken等人，2001年；King&Canada，2004年；Sayre等人，2002年)，更低的治疗出勤率(McCaul等人，2001年)和更高的治疗后药物使用复发率(Grella等人，2006年)。然而，药物滥用研究往往很少关注与女性参与者的特定脆弱性相关的性别因素(Brady&Ashley，2005；Greenfield等人，2007)。对许多女性吸毒者来说，与复发风险特别相关的一个因素是母亲的压力；照顾孩子的责任和相关的压力因素可能会大大增加药物使用复发的风险，特别是在药物滥用治疗后复发的高风险时期。此外，尽管关于吸毒妇女的环境风险因素，产妇因素一直是一个特别的经验性和临床重点，但这项研究的主要重点是产妇使用药物对子女结果的影响，很少注意到这些妇女的吸毒结果本身就是一个重要目标(参看，Pajulo等人，2006年)。因此，在从药物滥用治疗出院后重新引入家庭环境时，可能有助于解释母亲痛苦和药物使用联系的一个有希望的因素是母亲痛苦容忍度，即容忍由于养育问题而造成的痛苦的能力。事实上，一个人忍受痛苦的能力与 在药物滥用治疗和戒断尝试的持续时间后复发。然而，尽管它与物质使用和育儿反应有关，但人们对低痛苦耐受性对使用物质的母亲的影响知之甚少。这可能至少部分是由于缺乏直接针对独特的产妇痛苦经历的痛苦容忍度评估战略。为了解决这一领域研究的不足，以下R21试图对母亲使用药物复发的风险因素进行初步检查，重点放在痛苦耐受的缓和作用上。作为第二个目标，我们探索了一种新的和生态上有效的母亲痛苦承受能力的测量方法，以检验其在标准痛苦承受能力任务中的效用。具体地说，我们将包括105名使用以低收入为主的市中心非裔美国人的母亲，她们在接受住宅药物使用治疗的最后一周，孩子处于9个月至4岁的关键年龄，以检查母亲痛苦的几个指数与药物使用结果之间的联系，以及作为这种关系的调节因素的一般和母亲容忍痛苦能力的具体措施之间的联系。 公共卫生相关性：母亲因素(即与育儿有关的压力源)一直是吸毒妇女特别关注的经验和临床焦点，但这项研究的大部分集中在父母教养不善和母亲使用药物对儿童结局的影响，很少关注这些妇女本身的吸毒结果作为一个重要目标。目前的申请提出了一个新的框架，用于在与儿童相关的应激源的背景下，使用痛苦容忍范式来理解母亲复发的风险因素。如果母亲的应激反应被证明是导致药物使用结果的一个机制，这项研究的结果可能会改善高危母亲的治疗结果的预后，并对她们孩子未来的健康产生积极的影响。

DESCRIPTION (provided by applicant): Women evidence worse substance use treatment outcomes than men (Greenfield et al., 2007), including higher rates of treatment dropout (Arfken et al., 2001; King & Canada, 2004; Sayre et al., 2002), lower treatment attendance (McCaul et al., 2001) and higher rates of post-treatment substance use relapse (Grella et al., 2006). Yet, substance abuse research often includes little attention to gender-specific factors relevant to particular vulnerabilities of female participants (Brady & Ashley, 2005; Greenfield et al., 2007). One factor especially relevant to risk of relapse for many female drug users is maternal stress; child care responsibilities and the associated stressors may significantly increase risk of substance use relapse, particularly during high- risk periods for relapse following substance abuse treatment. Further, although maternal factors have been a particular empirical and clinical focus regarding environmental risk factors for drug using women, but the large preponderance of this research is focused on the impact of maternal substance use on child outcomes, with little attention to drug use outcome for these women as an important target in its own right (cf., Pajulo et al., 2006). Accordingly, one promising factor that may help explain the maternal distress and substance use association when reintroduced to one's home environment following discharge from substance abuse treatment is maternal distress tolerance, or the ability to tolerate distress due to parenting issues. Indeed, one's ability to tolerate distress is associated with relapse following substance abuse treatment and length of abstinence attempts. However, despite its relevance to both substance use and parenting responses, little is known about the impact of low distress tolerance on substance using mothers. This may be due, at least in part, to the lack of distress tolerance assessment strategies that target directly the unique experience of maternal distress. To address the lack of research in this area, the following R21 attempts to provide an initial examination of maternal risk factors for substance use relapse, with a focus on the moderating role of distress tolerance. As a secondary aim, we explore a novel and ecologically valid measure of maternal distress tolerance to examine its utility over a standard distress tolerance task. Specifically, we will include 105 predominantly low-income, inner-city African American substance using mothers in their last week of residential drug use treatment that have a child in the critical age of 9 months to 4 years to examine the link between several indices of maternal distress and substance use outcomes with both general and maternal- specific measures of ability to tolerate distress as moderators of this relationship. PUBLIC HEALTH RELEVANCE: Maternal factors (i.e., parenting-related stressors) have been a particular empirical and clinical focus for drug using women, but the large preponderance of this research is focused on the impact of poor parenting and maternal substance use on child outcomes, with little attention to drug use outcome for these women as an important target in its own right. The current application proposes a novel framework for understanding risk factors for maternal relapse in the context of child-related stressors using the paradigm of distress tolerance. If maternal stress response is shown to be a mechanism underlying drug use outcomes, findings from this study have the potential to improve the prognosis for treatment outcome for high-risk mothers and positively impact the future health of their children.