Novel Assessment of Maternal Distress Tolerance Underlying Substance Use Relapse

描述（由申请人提供）：女性的药物使用治疗结果比男性差（Greenfield等人，2007），包括更高的治疗辍学率（Arfken等人，2001;King & Canada, 2004； Sayre等人，2002），更低的治疗出勤率（McCaul等人，2001）和更高的治疗后药物使用复发率（Grella等人，2006）。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 et al., 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；照顾儿童的责任和相关的压力源可能显著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，尽管母亲因素一直是吸毒妇女环境风险因素的一个特别的实证和临床重点，但这项研究的大部分都集中在母亲物质使用对儿童结局的影响上，很少关注这些妇女的药物使用结果本身是一个重要的目标（参见，Pajulo等人，2006）。因此，一个有希望的因素可能有助于解释在药物滥用治疗出院后重新进入家庭环境时母亲的痛苦和药物使用的关联，即母亲的痛苦耐受性，或因养育问题而忍受痛苦的能力。事实上，一个人忍受痛苦的能力与此有关

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.