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养育 与没有SUD的父母相比，他们的做法包括打屁股、殴打和贬低孩子。体罚 而情感纪律反过来又与儿童虐待率的增加以及随后的 物质使用障碍的代际传播。父母在住宅物质使用治疗 这些设施是最有可能犯下严厉和虐待父母的地方;然而，大多数行为- 在住院治疗环境中提供的基于父母的干预措施没有考虑到独特的 将父母使用药物与严厉的养育方式联系起来的机制。具体来说，SUD的父母可能在 由于倾向于优先考虑眼前的问题， 奖励（例如使用体罚来阻止孩子的不良行为）相对于较大，但延迟 奖励（包括长期塑造积极的儿童行为）。这种行为倾向被称为 延迟折扣和最近的研究结果表明，延迟折扣率预测父母使用严厉的 物理纪律。现有的研究还表明，更陡峭（更有问题）的利率之间存在着很强的联系。 延迟折扣以及整个生命周期中酒精和非法药物使用的严重程度。因此，延迟贴现 可能代表着一种特定的脆弱性，这种脆弱性既存在于严厉的父母养育之下，也存在于滥用药物之下。的 目前的项目建议试点和可行性测试适应情景未来思维（EFT）干预， 以减少与养育有关的延迟折扣为目标，并审查其对养育做法的影响 在一个住宅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，并且可以通过对等恢复来提供 教练（PRCs），有物质使用和恢复经验的个人。利用PRC， 已经广泛用于SUD治疗设置，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，参与育儿计划的关键障碍 在SUD患者中。按照以部署为中心的模式，我们将进行一个小型病例系列试验 并收集有关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手动调整提供信息。然后我们将招募72名儿童的父母， 在资源匮乏、人口占多数的少数民族城市接受住院药物使用治疗的6岁和10岁儿童， 弗林特，密歇根州。受试者将随机接受EFT或对照干预。时发现的问题 这项研究将用于计划一项大规模（R 01）干预试验，并将为公共卫生方法提供信息， 减少虐待儿童现象，防止吸毒成瘾的代际循环。

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.