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

摘要 患有物质使用障碍(SUD)的父母更有可能进行严厉的育儿 包括打屁股、打孩子和轻视孩子的做法，比没有SUD的父母要好。惩罚性身体 而情感管教反过来又与虐待儿童的比率增加以及随后的 物质使用障碍的代际传播。父母在住宅区物质使用治疗中的应用 设施是实施严厉和虐待父母行为的最高风险之一；然而，大多数行为- 住院环境中可用的基于父母的干预措施没有考虑到独一无二的 将父母物质使用与严厉的育儿方式联系起来的机制。具体地说，患有SUD的父母可能在 由于倾向于优先考虑眼前的情况，采用不适应的育儿方法的风险增加 相对于较大但延迟的奖励(如使用体罚阻止孩子的不当行为) 奖励(包括在更长的时期内塑造积极的儿童行为)。这种行为倾向被称为 延迟打折和最近的研究结果表明，延迟打折的比率可以预测父母使用HASH 身体上的纪律。现有的研究还表明，更陡峭(更有问题)的 推迟折扣和酒精和非法药物使用的严重程度。因此，延迟折扣 可能代表着严厉的育儿方式和无序的物质使用背后的特定脆弱性。这个 当前项目建议试行和可行性测试改编的情节式未来思维(EFT)干预，以 目标是减少与育儿相关的延迟折扣，并检查其对育儿实践的影响 在居住物质使用治疗环境中的家庭中。EFT可能特别适合于 在住宅SUD环境中进行传播，因为它简短、灵活，并且可以通过同行恢复来交付 教练(PRC)，有生活物质使用和康复经验的个人。利用PRC，他们是 已经在SUD治疗环境中广泛使用，增加了可扩展性、可接受性和成本- 这种方法的有效性，并可能减少耻辱，这是参与育儿计划的关键障碍 在患有SUD的个体中。遵循以部署为中心的模式，我们将进行一个小型案例系列审判 并收集关于关键实施结果的数据(包括可接受性、耐受性和剂量)。 这一目标的结果将为人工适应提供信息。然后我们将招募72名儿童的父母 6岁和10岁在低资源、少数民族占多数的城市接受住院药物使用治疗 密歇根州弗林特。参与者将被随机接受EFT或对照干预。由此得出的结论 这项研究将用于计划大规模(R01)干预试验，并将为公共卫生方法提供信息 减少虐待儿童和防止代际成瘾循环。

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.