Improving Delay Discounting to Decrease Harsh Parenting among Parents Receiving Substance Use Treatment in a Low Resource Community

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Abstract 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. EFT may be particularly well-suited for dissemination in a residential SUD setting because it is brief, flexible, and can be delivered by peer recovery coaches (PRCs), individuals with lived substance use and recovery experiences. Utilizing PRCs, who are already widely employed in SUD treatment settings, increases the scalability, acceptability and cost- effectiveness of this approach and may reduce stigma, a critical barrier to participation in parenting programs among individuals with SUD. Following a deployment-focused model, we will conduct a small case-series trial and collect data regarding critical implementation outcomes (including acceptability, tolerability, and dosage). Results from this aim will inform manual adaptation. We will then recruit 72 parents of children between the ages of 6 and 10 receiving inpatient substance use treatment in the low resource, majority-minority, city of Flint, Michigan. Participants will be randomized to receive EFT or a comparison intervention. Findings from this study will be used to plan a large-scale (R01) intervention trial and will inform public health approaches for reducing child maltreatment and preventing intergenerational cycles of addiction.