Family Discord is Associated with Increased Substance Use for Pregnant Substance Users

Abstract

Childhood abuse and partner violence are associated with prenatal substance abuse, but the potential impact of current family discord, which reflects broader family relationships and encompasses problems less severe than violence, has had little evaluation in pregnant substance users. Using data from 196 pregnant substance users participating in a NIDA Clinical Trials Network randomized clinical trial, we examined the relationship of baseline family discord to substance use and treatment session attendance. Family discord was assessed using items from the family composite of the Addiction Severity Index. Substance use was assessed by the Substance Use Calendar and urine drug screens (UDS). Assessments were weekly for four weeks and at two- and four-month post-randomization. Women with family discord were more likely to report living with a problematic substance user, reported a higher percentage of substance use days throughout each study phase, had a greater proportion of positive UDS over the four-month study period, and attended more weeks of treatment during the first month. Specific treatment interventions targeting pregnant women with family discord may be warranted.

Keywords:

• pregnancy
• family discord
• substance use
• treatment engagement

THE AUTHORS

Wayne H. Denton, MD, PhD, is Professor of Marriage and Family Therapy and Director of the Marriage and Family Therapy Program in the Department of Family and Child Sciences at Florida State University. He studies the role of couple and family relationships in mental disorders and substance abuse, the interaction of couple communication and physiology, and has also conducted randomized clinical trials evaluating couple psychotherapy.

Bryon Adinoff, MD, is Professor and Distinguished Professorship of Alcohol and Drug Abuse Research in the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas. He is also the Chief of the Division on Addictions at the UT Southwestern Medical Center and a staff psychiatrist at the VA North Texas Health Care System. He has published over 100 articles and chapters on the biology and treatment of addiction. His research is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) the National Institute of Drug Abuse (NIDA), and the Department of Veterans Affairs.

Daniel Lewis, BA is a statistical analyst for the Cincinnati Addiction Research Center in the Department of Psychiatry at the University of Cincinnati. He studied statistics at the graduate level at University of West Florida and at the University of Cincinnati. He has three decades of experience performing statistical analyses and developing automated statistical procedures.

Robrina Walker, PhD is an Assistant Professor of Psychiatry at the University of Texas Southwestern Medical Center in Dallas, TX and the Scientific Director of the Texas Node of the National Institute on Drug Abuse's Clinical Trials Network. She obtained her PhD in Clinical Psychology from Virginia Tech and completed post-doctoral training in addiction treatment at the Dallas Veterans Affairs Hospital. She has worked on over a dozen NIDA-, NIAAA-, and Veterans Affairs-funded studies, with the majority being randomized clinical trials evaluating behavioral or medication treatments for adolescent and adult substance use disorders. Her primary research interests are in behavioral treatments for addictive behaviors.

Theresa M. Winhusen, PhD, is an Associate Professor of psychiatry and behavioral neuroscience at the University of Cincinnati College of Medicine, the Director of the Cincinnati Addiction Research Center, and Principal Investigator of the Ohio Valley Node of the National Institute on Drug Abuse's Clinical Trials Network. Dr. Winhusen is an expert in the design and conduct of multi-site clinical trials whose work focuses primarily on testing pharmacological treatments for cocaine and nicotine dependence.