Michelle L. Kelley - US grants

DESCRIPTION (provided by applicant): Approximately 9% of children in the United States live with an alcoholic or drug dependent parent (U.S. Department of Health and Human Services, 2001). Children whose parents primarily abuse drugs other than alcohol often display emotional and behavioral problems (e.g., Fals-Stewart, Kelley, Fincham, Golden, & Logsdon, in press; Kelley & Fals-Stewart, 2002; Sowder & Burt, 1980; Wilens et al., 2002). Men are more likely to abuse substances (including marijuana, hallucinogens, and heroin) than are women (Department of Health and Human Services, 2002), and data suggest that the number of men with children seeking substance abuse treatment may outnumber the number of women two to one (U.S. Department of Health and Human Services, 2003); however, studies have focused on prenatal effects or postnatal exposure to maternal drug abuse. Because of our long-standing programmatic line of research (couples-based treatments for drug-abusing adults), we have systematically collected extensive longitudinal data (i.e., pretreatment, posttreatment, 6- month, and 12-month follow-up) as part of five NIDA or private foundation grants on parenting, biological-genetic, family, and dyadic variables, and the emotional and behavioral functioning of custodial school-aged children living with drug-abusing fathers. We propose to conduct a large-scale secondary analysis of data collected from parents, children, and children's teachers who took part in the five projects. This study will provide a rare opportunity to delineate parenting, genetic, family, and dyadic factors that may be risk or protective factors for children, and to establish how different treatments for parents change parent and family functioning and impact children (i.e., the mechanisms of action that result in secondary child benefits). This will provide much-needed information that will be used to inform future multifaceted treatments for drug-abusing parents and their children.

DESCRIPTION (provided by applicant): Children who live with a substance-abusing father often manifest significant emotional, behavioral, and social problems. Although directly treating these children may be ideal, many parents are very reluctant to allow the child to take part in individual or family therapy. Preliminary research suggests that Learning Sobriety Together (LST;the "brand" name of Behavioral Couples Therapy for alcohol and drug abuse), a comprehensive psychosocial intervention for substance abuse that focuses both on reducing substance abuse and improving couple functioning, may provide an entry point into the family system from which to benefit children in these homes. To address this we will conduct a randomized clinical trial (RCT) to compare the emotional and behavioral adjustment, beliefs about aggression, and serious negative behaviors of youth ages 8 to 16 (as rated from mothers, fathers, teachers, and children themselves) whose drug- abusing fathers and non-substance-abusing mothers take part in LST as compared to youth whose fathers take part in an equally intensive individual-based treatment (IBT). We will examine whether LST is associated with significantly higher levels of adjustment (e.g., fewer internalizing and externalizing symptoms, less acceptability of aggression, less delinquency, aggression/violence, and substance use) at post treatment and during the 12-month follow-up as compared to IBT;whether participation in LST will result in lower addiction severity, increase couple functioning, lower interparental conflict, improve parenting, reduce risk for child maltreatment, and improve parental psychological functioning as compared to IBT, whether changes in addition severity, dyadic adjustment, interparental conflict, parenting, and parental psychological adjustment during and after treatment will be associated with changes in children's adjustment;and whether changes in addiction severity, dyadic adjustment, interparental conflict, parenting, and parental psychological functioning will partially or fully mediate the direct effect of treatment condition (LST versus IBT) on youth outcomes. Finally, we will test a moderated-mediation hypothesis to determine whether adolescents experience a significantly weaker effect than preadolescents. We intend to use the information collected from the proposed study to refine and modify LST to enhance its positive effects on children and provide an option for agencies to support youth in these homes. PUBLIC HEALTH RELEVANCE: Children of drug-abusing parents are at extremely high risk for a host of problems throughout childhood and into adulthood, yet their parents are reluctant to involve them in any treatment services. Empirically-based interventions are needed that can benefit not only the drug-abusing parent, but also extend further to the family system to improve their children's current psychosocial adjustment as they prepare for transitions to adulthood. Learning Sobriety Together holds great potential for having such broad and prolonged effects that will benefit families affected by drug abuse as well as the treatment community that serves them.

Abstract Combat theatres place service members in situations where they make difficult decisions that may transgress deeply held moral beliefs or witness others? acts of betrayal. Although many veterans are resilient to these types of experiences, for others, failure to accommodate these events may result in internal conflict that is theorized to lead to the development of moral injury. Moral injury is distinct from posttraumatic stress disorder (PTSD) and has been associated with poor mental health outcomes (e.g., depression, anxiety, suicidality) and alcohol/drug use among veterans. Few evidence-based interventions have been developed to target symptoms of moral injury. In studies with combat wounded veterans, community veterans, and a predominantly VA treatment- seeking sample, our team has demonstrated that mindfulness moderates associations between moral injury symptoms and negative mental health outcomes. In addition, we have demonstrated that combat wounded veterans are willing to take part in a mindfulness-based moral injury intervention, especially if administered in an online interactive web-based program. Using an iterative developmental process, the goal of this project is to adapt an integrative and theory-driven mindfulness-based intervention delivered online to target moral injury in combat wounded veterans. Aim 1 is to modify an evidence-based, online, interactive, instructor-delivered, six- session mindfulness program, originally designed to help active duty members manage physical pain (i.e., Mindfulness to Manage Chronic Pain [MMCP]), such that it addresses the psychologically painful symptoms (e.g., guilt, shame) characteristic of those with moral injury. The newly adapted program, Mindfulness to Manage Moral Injury (MMMI), will then be piloted with one group of eligible combat wounded veterans (N = 6) to generate qualitative feedback on program content and format; revisions based on this feedback will result in preliminary manualization. Subsequently, in Aim 2 we propose to develop a facilitator-led online interactive Education Support (ES) program designed to serve as a control comparison intervention, and then carry out a non- randomized pilot study comparing the feasibility (i.e., credibility, acceptability, study completion, and adherence (e.g., to homework assignments) of ES to the revised MMMI program with N = 20 (10 MMMI; 10 ES) combat wounded veterans. Following this phase of feasibility testing, we will also collect qualitative information and further refine both the MMMI and ES materials. In Aim 3, we propose a small-scale randomized controlled trial (N = 60 combat wounded veterans; 30 MMMI; 30 ES) to collect data on recruitment, credibility and acceptability, completion rates, and adherence in the two newly refined intervention arms at pre-post-test. Aim 3 will assess for potential primary and secondary outcome measures and lay the groundwork for a large-scale randomized R01 controlled efficacy trial. If supported, this work would have the potential to provide a novel and flexible theoretically grounded form of treatment delivered in-home for combat wounded veterans experiencing moral injury symptoms and associated mental health problems.