Adolescent drug use is a major problem of the modern world and will likely continue to be so for the foreseeable future. Significant effort has been placed into providing adolescent treatment and intervention options with the aim of supporting young people to make better choices around their substance use. The impact of adolescent drug use on parents and their parenting has been insufficiently researched and often overlooked in both the treatment literature and within clinical practice. The literature on familial risk or causative factors for the development of substance misuse problems is much greater. However, there has been little focus or regard for the impact on family members, and in particular, parents. Parents are people too, and too often are a forgotten population. The literature presented includes studies on how adolescent substance misuse can have a negative effect on parental wellbeing and parenting practices.
This thesis provides a rationale behind the development of a treatment approach for parents of adolescents and young people misusing substances. This is a distinct and potentially complementary approach to engaging the adolescent substance misuser, who may be uninterested or resistant to intervention. Parents accessing a tertiary treatment facility for adolescent substance misusers were requesting support and guidance to assist in managing their high levels of distress, lack of drug-specific knowledge and their struggle to find effective parenting strategies. Based on the premise that living with a substance misusing child would bring about a great deal of caregiver strain, and they would benefit from support and assistance in managing their situation, a five-week group-based parent-only group treatment intervention was developed to meet the psychological wellbeing and parenting practice needs of these parents. Over 300 parents engaged in the Parent Education and Support Program (PESP). As a result of their engagement in PESP, parents reported significant positive changes in their mood states, improved coping, increased drug knowledge and reported utilization of more functional and effective parenting strategies. This initial efficacy study provided the basis to the broader dissemination of the parenting program outside a single tertiary facility.
The PESP was written into a manualised treatment intervention and renamed Parents, Kids and Drugs (PKD). This portable and systematized version enabled delivery by external service providers into broader, diverse clinical and non-clinical environments across metropolitan, regional and remote Queensland, Australia. The ensuing studies outline the development, implementation, dissemination and evaluation of PKD over a four-year period, effectively becoming a real-world effectiveness study. Associated with the dissemination of PKD using third party providers were difficulties in obtaining complete data sets and a waitlist control. A post hoc control group was sourced using an online survey. Outcome measures were examined using paired t-tests and analyses of covariance and results showed significant differences on drug knowledge, caregiver strain, parental competence and parenting practices, however, no difference on the mood states of depression, anxiety or stress were found. The contribution of demographic variables to these relationships were examined through the use of regression trees. According to facilitator treatment protocol adherence measures, all facilitators reported implementing the program as it was intended.
An additional study of consumer feedback following treatment highlighted the vast majority of parents felt they had made progress in managing their situation as a direct result of engaging in the group treatment. Thematic analysis also highlighted the value parents found in accessing treatment in their own right, and the importance of peer support, access to information and professional facilitation of group processes. This study discusses these outcomes as significant components to providing parent-only treatment within the adolescent substance misuse field.
Parents who participated in the statewide dissemination study were actively recruited rather than referred by a treatment agency, and as a result, were more typical of a general parent presentation. The development of PKD was based on the assumption parents dealing with an adolescent child misusing substances would be psychologically distressed and in need of effective parenting practices, however, this was not fully supported in the current study. In the main, the parents from the efficacy and dissemination studies differed, in that the effectiveness trial parents were generally less distressed and not as concerned about illicit substances. The PKD parents had elevated levels of caregiver stress and stress, but non-clinical levels of depression, anxiety and stress, and were mostly concerned about their child’s use of tobacco and alcohol. Using standardized psychometrics, parents within the effectiveness study showed improvements in overall caregiver strain, parenting self-esteem, increased use of functional disciplining strategies and also demonstrated increased drug-specific knowledge. Thematic evaluation demonstrated the positive impact of PKD, with the vast majority of parents reporting making progress as a result of their engagement in PKD. It is concluded that in the transfer from clinical setting to mainstream practice, PKD became a universal parenting program whereby its target population changed. It is suggested that these were everyday parents motivated to protect their children from the deleterious effects of substance misuse by educating themselves and learning to parent better. PKD demonstrated validity as a viable frontline intervention for parents. Whether parents are distressed and engaged with a treatment agency, or motivated to parent better and seek community referral, group- based parenting programs can demonstrate bone fide changes.
The benefits, challenges and implications of using third-party providers for treatment dissemination and delivery are highlighted. The present study highlights the significant challenges of conducting a large scale, multisite research project within frontline clinical practice across a large and diverse geographical region.
As the thesis highlights, moving treatment from a single, specialist treatment setting into mainstream community health services with third generation clinicians provided many real challenges and insights. The current study contributed to the literature regarding intervention options for parents with adolescent substance misusing children, their parenting needs and their experiences of parenting.