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Links Between Prevention and

Treatment for Drug-Abusing

Women and Their Children

Karol L. Kumpfer, Ph.D.

INTRODUCTION

Children of alcohol and other drug abusers are one of the groups

at highest risk for later drug abuse and many other mental health

and behavioral problems (Deren 1986; Kumpfer and DeMarsh 1985;

Kumpfer 1987, pp. 1-71; Johnson and Bennett 1988; Johnson and Leff

1997; Tarter and Mezzich 1992, pp. 149-177). Those problems result

in significant personal, social, and economic costs.

The primary purpose of this chapter is to encourage drug abuse

treatment and service providers to consider providing preventive

therapeutic services for children of drug abusers, including parent

training and family skills training. This chapter focuses on both drugabusing parents and their children because family-focused interventions

have been found to improve therapeutic outcomes for both parents and

children (Kumpfer and Alvarado 1995, pp. 255-294; Kumpfer et al.

1996, pp. 241-267).

This chapter reviews biological and environmental reasons why

children of drug-abusing mothers or parents have a higher risk of becoming drug abusers. Next, the chapter reviews prevention and treatment

programs that could be conducted during treatment of drug-abusing

women, including both prenatal and postnatal programs. Finally, the

chapter recommends areas of research for preventing children’s future

problems and treating women.

Prevention services for children of drug abusers in schools are

limited in their effectiveness by difficulties in locating and targeting

services for those children who are at risk (Emshoff and Price 1997;

Kumpfer 1997a). Therefore, identifying and providing prevention

services to such children through drug treatment facilities are appealing.

Although there are significant barriers to implementing preventive

interventions for children of drug abusers in inpatient or outpatient
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drug treatment settings, there are also significant benefits. As discussed

by Glider and associates (1996, pp. 32-51), locating and supporting the

additional space, staff, and programming to add children’s preventive

services (i.e., therapeutic child care, children’s skills training, and parent

or family skills training) within a drug treatment facility not experienced

with children’s services can be daunting. However, preliminary research

evidence suggests that these preventive services for children of drug

abusers enhance treatment outcomes for parents in drug treatment by

reducing parenting stress and depression and thereby facilitating recovery and reducing the frequency of relapse (Catalano 1996; Catalano

et al., in press; Catalano and Hawkins 1985, pp. 157-181; Hughes et al.

1995; DeMarsh and Kumpfer 1985; Kumpfer and DeMarsh 1987;

Kumpfer 1991a; Kumpfer et al. 1996, pp. 241-267).

One of the earliest research studies on the effects of admitting

children to a therapeutic community (Cuskey et al. 1979) found that

postdischarge outcomes for women in drug treatment were better than

anticipated. Parents tend to stay in drug treatment longer if their

children are also receiving services (Stevens et al. 1989). Lewis and

colleagues (1996, pp. 110-122) reported greatly improved retention of

mothers in treatment once free babysitting services and transportation

were provided. For parents, longer stays with their children result in

decreased substance abuse and criminal behavior; increased employment; and improved parenting skills, parent-child relationships, and

parental self-efficacy and self-concept (Cuskey et al. 1979; Kumpfer

1991a).

This chapter discusses the significant overlap of drug abuse treatment and prevention interventions, using as a case example drugabusing women and their children. Interestingly, the types of cognitivebehavioral skills training or therapy found to be most effective in schoolbased prevention programs (Botvin et al. 1995) and family-based

prevention programs (Kumpfer et al. 1996, pp. 241-267) are similar to

the skills training approaches used to treat drug abusers. Research

suggests that these interventions are the most effective with the most

difficult-to-treat drug-abusing clients—those higher in psychopathology

(Kaminer 1994). Thus, staff members trained in cognitive-behavioral

methodologies of structured interventions, interactive role-play, guided

practice, homework, and rewards for behavioral changes will be prepared

to work in either the parent’s drug treatment program or the children’s
419

therapeutic child-care program. The similarity of the interventions

employed in effective drug treatment programs to those used in

children’s prevention programs, even applied to general populations in

schools, suggests that it is more effective to teach core social skills (i.e.,

communication, problemsolving, decisionmaking, anger management,

stress management, coping with feelings, peer resistance skills, and

assertiveness training) early in life to prevent poor life outcomes rather

than waiting for risk factors to increase.

PREVENTION OF DRUG ABUSE IN

CHILDREN OF DRUG ABUSERS

Prevention is still a relatively new field and does not have as visible

a role in the public health continuum of services as does treatment.

Also, there is a misconception that prevention entails an educational

approach—and not therapeutic interventions—for clients who are

already manifesting precursors of drug abuse such as depression, antisocial personality, aggression, and conduct disorders. However, training

and therapeutic interventions for addressing indicated problems (e.g.,

conduct disorders, aggression, lack of attachment to school or family) in

children of drug abusers are preventive interventions for later initiation

of drug use and other adjustment problems.

Although many similarities between prevention and treatment

could be discussed, this chapter primarily addresses the need to provide

selective or indicated prevention services to children of drug-abusing

women in treatment. If children are already showing emotional or

behavioral difficulties that are identified risk factors for drug abuse, such

as aggression, conduct disorders, shyness, and depression (Kellam et al.

1983, pp. 17-42; Kellam et al. 1991; Kumpfer 1987, pp. 1-71), treatment

for these psychological disorders is indicated for prevention of later drug

abuse. For a more complete description of the new categories of prevention—universal, selective, and indicated—see Mrazek and Haggerty

(1994) or Kumpfer et al. 1997a.

According to the prevention/treatment/aftercare continuum of

services, which was adopted by NIDA and the Institute of Medicine

(IOM) (Mrazek and Haggerty 1994) and is based on Gordon’s (1987,

pp. 20-26) taxonomy:
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• Universal prevention approaches are designed for the general

population.

• Selective prevention approaches are those designed for groups at

high risk of later drug use, such as children of substance abusers.

• Indicated prevention approaches are designed for children who

are definitely manifesting precursor behavioral or emotional

problems etiologically linked to later drug use.

Thus, for children of drug abusers, prevention approaches that are

provided in drug abuse treatment programs can be designed to include

the following:

• Selective prevention services to all children of drug-abusing

women because the children represent a group at high risk for

later drug use. Appropriate interventions include therapeutic

child care, life skills and social skills training, resiliency-building,

and parenting and family relationship enhancement programs

that involve children, such as family skills training (Kumpfer et

al. 1997b; Kumpfer 1994).

• Indicated prevention services could be offered only to children

who manifest diagnosed or assessed drug precursors, such as

conduct disorders, aggression, attention deficit hyperactivity

disorder (ADHD), anxiety disorders, depression, and thrillseeking. Stronger and more enduring therapeutic interventions

would be needed to address these childhood psychopathologies.

Types of interventions that could be used include individual

counseling, play therapy, family therapy, behavior modification,

or academic tutoring programs.

Many selective or indicated prevention programs (Mrazek and

Haggerty 1994) appear to be treatment for a specific problem, that is,

emotional damage from sexual abuse, harm, neglect, discrimination, or

other forms of victimization. However, according to the IOM definition

of indicated prevention (Mrazek and Haggerty 1994), therapeutic interventions for empirically defined risk factors constitute indicated prevention programs if drug abuse has not been initiated. Therefore, there can

be a substantial linkage between prevention and treatment, and the

distinction can sometimes be difficult to make.

The relationship between prevention and treatment of drug abuse

should be apparent. Lack of a preventive environment increases the
421

likelihood of drug abuse in vulnerable individuals. Children of alcoholics and other drug abusers are the most vulnerable groups for drug abuse

(see literature reviews of the research by Kumpfer 1987, pp. 1-71;

Kumpfer 1989, pp. 310-371; Kumpfer et al. 1997a). Therefore, if

children of drug abusers are not included in the treatment process and

their therapeutic needs are not addressed during the course of drug

treatment for their parents, they remain at increased risk of becoming

drug abusers. At some point, intervention must occur in the multigenerational cycle of drug addiction and dysfunctional families. Thus,

selective or indicated prevention programs for children of drug abusers

are essential during the treatment process. These children need to

experience a safe haven during the therapeutic stay where their emotional, physical, mental, and spiritual needs are addressed. If old

enough, they should be taught life skills and resiliency skills to help

them cope with living with their drug-addicted parent(s). Supportive

services, such as therapeutic child care, play therapy, social skills training, parent training and family skills training, and educational tutoring,

should be provided onsite or elsewhere for these children.

The most important process is to involve women in parenting skills

training and family relationship enhancement programs to promote a

continually improving parent-child relationship after treatment. Research suggests that improving maternal parenting skills reduces subsequent behavioral and emotional problems of the children, which leads

to reduced drug use by the mothers, even if they are not in drug abuse

treatment (Kumpfer 1991a). This unexpected finding of the Strengthening Families Program (SFP) (Kumpfer et al. 1989), when conducted

with drug-abusing women who were not in any type of treatment,

suggests that prevention activities aimed at children can have a beneficial therapeutic impact on maternal depression, self-esteem, and drug

abuse. Thus, prevention and treatment interventions can be identical

in such cases and can improve outcomes for both mothers and children.

FOCUS ON CHILDREN OF DRUG-ABUSING

WOMEN IN TREATMENT

Research suggests that both children of other drug abusers (Kumpfer

1987, pp. 1-71; Tarter and Mezzich 1992, pp. 149-177) and children

of alcoholics (Schuckit 1992, pp. 93-108; Zucker and Fitzgerald 1996)

are at increased risk for drug abuse. Despite these observations, drug
422

treatment programs rarely deal with the preventive needs of these highly

vulnerable children (Kumpfer 1991b, pp. 1033-1060), who tend to have

a higher likelihood of manifesting difficult temperament syndrome

(Cloninger et al. 1988), conduct disorders, depression, aggression, and

anxiety disorders. Of interest is that this “difficult” temperament, as

defined by the Chess and Thomas (1984) temperament classification,

has also been found to be predictive of more severe tobacco, alcohol,

and marijuana use in adulthood (Lerner and Vicary 1984). Treatment

programs for women generally do not treat the total family unit or

system, preferring to deal only with the drug-abusing mother. Treating

the total family unit is critical to any lasting improvements in the family

system, whether interventions are considered therapeutic or preventive.

IMPACT OF IN UTERO EXPOSURE

ON CHILDREN

In the past 10 years, the general public has become concerned

about drug-exposed infants, but little relationship has been found

between prenatal exposure and poor outcomes (Sowder and Burt 1980;

Zuckerman 1996, pp. 277-287). Nevertheless, some researchers speculate that adverse effects may not emerge until children are older (Fried

1996, pp. 242-260; Spear 1996, pp. 125-145). Research suggests that

postnatal support of the mother, quality of the home environment, and

the mother’s responsiveness to the child’s needs may be more critical

than the prenatal exposure (Johnson et al. 1990; Hans 1994; Hans 1996,

pp. 261-276).

Some in utero effects of drug exposure are similar to the characteristics of difficult temperament syndrome that appear to be genetically

caused (Kumpfer and Bayes 1995, p. 1861). Zuckerman (1996, pp. 277-

287), for example, speculates that deficits in control of autonomic

regulation and arousal may underlie observed hyperresponsivity or

hyposensitivity to stimuli and result in learning and behavior problems

that would make a child more difficult to parent successfully and increase the child’s vulnerability to drug abuse. For these reasons, early

therapeutic parenting supported by parent training and family skills

training and therapeutic child care are important prevention interventions for drug-exposed children.
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FAMILY ENVIRONMENTAL

ETIOLOGICAL FACTORS

Most research (see Wetherington et al. 1996 for a review) suggests

that the home environment and maternal characteristics are more

powerful in shaping child development than is exposure to drugs.

Family characteristics and functioning are important predictors of

outcomes in children of substance abusers (Kaltenbach 1996, pp. 230-

241). Family environmental risk factors associated with lack of

nurturance, discipline, and supervision of children by drug-abusing

mothers have been summarized by Bayes (1990), Kumpfer (1987,

pp. 1-71), Kumpfer and Alvarado (1995, pp. 255-294), and Johnson

and Leff (1997) and include:

• Poor parenting and family relationships (Kumpfer et al. 1997a)

• Maternal mental illness (Brady et al. 1993)

• Reduced positive play time for maternal-child attachment

(Kumpfer and DeMarsh 1985)

• Increased child and maternal physical illness (Amaro et al. 1989;

Chasnoff 1988)

• Increased criminal involvement (Bayes 1990) resulting in loss

of child custody (Howard and Beckwith 1996, pp. 68-86)

• Diversion of family resources

• Increased child abuse and neglect (Kumpfer and Bayes 1995,

p. 1861)

LINKING PREVENTION AND TREATMENT

PROGRAMS: WHAT CAN BE DONE?

Failure to invest early in children at high risk for drug abuse could

result in paying for special services throughout their lives. Children of

drug abusers are overrepresented in almost every type of special needs

population (e.g., abused and neglected children, sexually abused children, hyperactive children, conduct-disordered and delinquent children,

mentally disordered children, special education children, and drugabusing youth) (Kumpfer 1987, pp. 1-71).

Preventive activities that focus on women of childbearing age are

also effective strategies for ensuring positive outcomes for their children.

Preventive approaches should also include public education, prevention,
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treatment, rehabilitation, and compensatory social support strategies

(e.g., parenting, support groups, job training, medical services, housing,

and legal services) for mothers.

Recommended preventive strategies for drug-abusing mothers that

reduce negative outcomes in children include the following:

• Maternal drug education concerning potential harm to infants by

the use of licit or illicit drugs during pregnancy. See Arkin and

Funkhouser (1990) or Donohew and colleagues (1991) for ways

to create effective public media campaigns.

• Pregnancy prevention for drug-abusing and women at high risk

would help solve the problem of drug-exposed children through

increased sex education in schools and in the media, public

health clinic funding of birth control, pregnancy prevention

classes for men and women, and drug treatment clinics.

• Incentives to increase recruitment of drug-abusing women and

children. “If you build it, they will come” does not always apply

to treatment programs for drug-abusing mothers (Rahdert 1996,

pp. 1-4). Successful approaches include aggressive and culturally

sensitive outreach coupled with intensive, comprehensive

medical and psychological services and practical basic support

services to address the multiple needs of these hard-to-reach

women and their children (Kumpfer 1991a; LaFazia et al. 1996,

pp. 52-67).

• Recruitment of pregnant drug-abusing women. Few drug treatment agencies want to treat pregnant women because of concerns about legal liabilities, particularly for those women who

inject drugs and are infected with the human immunodeficiency

virus (HIV) (Lewis et al. 1996, pp. 110-122). Successful strategies in the NIDA Perinatal-20 research study (Rahdert 1996,

pp. 1-4) included (1) free or low-cost treatment services, (2) free

or low-cost child care, (3) transportation, (4) food, (5) a caring

and competent staff, and (6) support for basic needs or crises,

including housing issues.
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TREATMENT OF DRUG-ABUSING WOMEN

AND THEIR CHILDREN

Pregnancy is a good time to encourage women to seek drug treatment because many drug-using women will consider stopping or reducing use for the sake of the baby. Lewis and colleagues (1996, pp. 110-

122) recommend that programs recruit pregnant addicts into treatment

as early as possible, when motivation to remain drug-free through the

rest of the pregnancy is greater. In a longitudinal study of 100 female

heroin addicts, ethnographers Rosenbaum and Murphy (1990, pp. 120-

127) found that most women want to stop their addiction when they

become pregnant accidentally. They generally want to “clean up” to

avoid having an addicted baby (Rosenbaum and Murphy 1990, pp. 120-

127). The threat of losing custody of children to protective services or

having them permanently placed in foster care is another major motivating factor for women to enter treatment and “dry out” (Rosenbaum

1981). Unfortunately, Howard and Beckwith (1996, pp. 68-86) noted

that once the court makes a ruling regarding child custody, the woman

may drop out of treatment because of lack of motivation.

The availability of publicly funded alcohol and other drug treatment

facilities for drug-using women and their children does not match the

need for such facilities. Until several years ago, there were only a few

residential treatment facilities that would allow a woman to bring her

children to the facility. With increased funding earmarked for women’s

substance abuse treatment programs involving children from the Center

for Substance Abuse Prevention and the Center for Substance Abuse

Treatment, the number of such facilities has grown. Unfortunately,

all but a few of these programs are built on the Minnesota male

model rather than on a family systems or women-in-relations model

(Finkelstein 1990; Miller 1986), and they often separate the child

from the mother. The philosophy is that the mother needs to focus on

her own recovery. Unfortunately, in the process, the author has found

that some children feel neglected and become bitter about the special

attention the mother is receiving. The children are in as much need

of therapy as the mother and should not be overlooked by the treatment

staff.
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PARENTING AND FAMILY INTERVENTIONS

Some outpatient drug treatment facilities, including methadone

maintenance programs, have included parent training, family therapy,

and children’s therapy or skills training in their programming. Both the

14-session (3 hours held once per week) SFP (Kumpfer and DeMarsh

1985; Kumpfer et al. 1996, pp. 241-267; Kumpfer et al. 1997a) and the

Focus on Families Program (Bry et al., in press; Catalano et al., in press;

Haggerty et al. 1991) have been funded by NIDA for implementation

with drug-abusing parents in treatment. The Focus on Families Program

begins with an intensive family retreat and continues for 33 sessions.

Although the program is intense and promising, it does not include

much parent-child time together in skills training but rather focuses

on relapse prevention with the parents. Although the evaluation for

the Focus on Families Program has not been completed, SFP has been

tested in several replications by independent researchers and found

to be effective as a selective prevention program for children while

enhancing supporting treatment (Kumpfer, in press).

SFP includes 14 sessions of parent training combined with family

skills training and a children’s social skills training class generally held

once a week for 14 weeks. When all three components are included in

this standardized program, significant reductions are found in risk factors

for drug use in 6- to 12-year-old children. Even the most dysfunctional

drug-abusing women were capable of improving their parenting skills

and improving children’s behaviors and emotional status (DeMarsh and

Kumpfer 1985). This program has been modified and found successful

in reducing intentions to use drugs and actual use among those children

already using drugs. It also has been found to be effective in decreasing

conduct disorders and aggression, depression, compulsive behaviors, and

social withdrawal; improving parenting and nurturing skills; improving

the family climate and environment (i.e., decreasing family conflict,

increasing family communication and organization); and reducing drug

use among drug-abusing mothers not in treatment (Kumpfer, in press).

These results have been replicated in several independently evaluated clinical trials and demonstration evaluation projects for different

ethnic populations, including African-American drug-abusing parents

in inner-city Detroit treatment programs (Aktan et al. 1996); AfricanAmerican drug-abusing single-parent mothers in Alabama (Kumpfer
427

1991a); multiethnic families in three counties and eight substance abuse

treatment agencies in Utah, a trial that included a 5-year followup

(Harrison 1994; Harrison and Proschauer 1996); Hispanic drug-abusing

parents from housing projects in Denver, CO (Wamberg and Nyholm

1995); and Asian and Pacific Islander families in Hawaii (Kameoka

and Lecar 1993, 1996). Improvements in the children were statistically

and clinically significant and were measured using standardized clinical

diagnostic measures, such as the Child Behavior Checklist (Achenbach

and Edelbrock 1988).

All the programs mentioned above address the therapeutic needs

of the child as well as the mother. Given the high dropout rate and

poor long-term prognosis of traditional drug abuse treatment for women

(Lewis et al. 1996, pp. 110-122), the area of greatest treatment improvement is probably with the children.

Through two national searches for the best family-strengthening

approaches in the country for the Federal Office of Juvenile Justice and

Delinquency Prevention, a number of effective programs were identified.

These family-strengthening programs include (1) neighborhood parentsupport groups (Kumpfer 1994); (2) case management programs that

coordinate comprehensive family services, such as United Way’s Success

by Six Program (Kumpfer et al. 1997c) and Healthy Families Hawaii

(Gomby et al. 1993); (3) in-home professional services—such as the

Nurse Home Visitation Program (Olds and Kitzman 1993; Olds and

Pettitt 1996), Home Instruction Program for Preschool Youngsters,

and Parents As Teachers; (4) volunteer family support services, such as

foster grandparents or family mentors for the mother (Yoshikawa 1994);

(5) parenting and family skills training courses, such as SFP (Kumpfer

et al. 1989), which can be conducted in hospitals, community centers,

mental health clinics, drug treatment agencies, schools, and homes; and

(6) children’s supportive and treatment services (e.g., play therapy

[Egeland and Erickson 1987, pp. 110-120; Egeland and Erickson 1990],

behavioral family therapy [Forehand and McMahon 1981], and tutoring

in school).

The best programs are the most comprehensive ones (Kumpfer 1994,

1997b). This suggests that a comprehensive family support program or

center that includes all the needed basic services for drug-abusing

mothers would be the most successful model program. Convenient
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location in high-risk areas is important, whether in or near inner-city

hospitals, housing projects, or community centers. A friendly, accessible, and cheerful atmosphere will attract more women to the program.

Colocating public health clinics and community recreational and childcare centers may create the best environment.

Safety issues must be addressed in home visiting programs. Obtaining an attractive and safe facility is a major priority. Research participants, particularly mothers with infants and toddlers, are not likely

to participate in a treatment program where the setting is dangerous

(Chasnoff et al. 1996, pp. 6-21). Special training is recommended

for the home visitors if they are working in homes of drug-abusing

mothers who may have drug-abusing spouses or partners.

RECOMMENDATIONS FOR FUTURE RESEARCH

More information is needed from large prospective and crosssectional studies on the impact of maternal drug use on children’s later

drug use. The quality of the maternal-child relationship, family climate,

and home environment should be examined in detail to determine

transactional processes that could lead to vulnerability or resiliency to

drug use and other developmental or behavioral problems. The most

cost-effective ways should be studied to improve maternal drug abusers’

parenting skills and care of the child to promote successful outcomes.

Until a better body of research exists on the family, school, and community environmental factors that lead a woman to associate with other

drug- and alcohol-using friends or to continue use during pregnancy and

parenting, neither can the effects of maternal addictions on children be

prevented nor will providers understand how to effectively treat addictions in the mothers. Once promising prevention models are evaluated,

cost-benefit analyses are needed to demonstrate that they are costeffective (Kim et al. 1995). Alcohol and other drug patients often

recycle many times through expensive inpatient treatment facilities

until a primary “cause” for their drug addiction is finally discovered

(e.g., childhood sexual or physical abuse, primary depression, lack of

social coping skills, marital conflict, parenting anxiety, or poor stressor anger-coping ability).

The U.S. population is confronted with the consequences of the

“feminization of poverty” and the dramatic cutbacks in social services to
429

low-income mothers and their children. Society must respond to these

changes or pay dearly for many years. Finding solutions for a problem

of this magnitude will not be easy. There will be no quick solution to

the problem of drug-exposed infants and children raised by drug-abusing

parents. Solutions are likely to challenge the traditional services systems

to find nontraditional solutions because the current services systems are

not working well for this population. A full continuum of care is needed

that begins with prenatal care and extends through childhood. Without

colocation and redefinition of services, a therapeutic case management

approach currently appears to be the best solution to help mothers

negotiate the maze of diverse services required to meet their multiple

needs. However, the temporary solution of having personal guides

through a complex services system is expensive and time consuming.

The best solution may be to redefine the categorical services system and

colocate or integrate most basic services into small personal agencies or

walk-in centers. These systemwide changes in how services are delivered to low-income women show promise and deserve to be thoroughly

evaluated for outcomes and implementation issues. Most importantly,

effective indicated prevention services must be provided to children of

drug abusers, and treatment services must be provided to their mothers

by strengthening the research and training of professionals in this area.

REFERENCES

Achenbach, T.M., and Edelbrock, C. Child Behavior Checklist (CBCL).

Burlington, VT: Center for Children, Youth, and Families, University of

Vermont, 1988.

Aktan, G.B.; Kumpfer, K.L.; and Turner, C.W. Effectiveness of a family skills

training program for substance use prevention with inner city AfricanAmerican families. Subst Use Misuse 31(2):157-175, 1996.

Amaro, H.; Zuckerman, B.; and Cabral, H. Drug use among adolescent mothers:

Profile of risk. Pediatrics 84(1):144-151, 1989.

Arkin, E.B., and Funkhouser, J.E., eds. Communicating About Alcohol and Other

Drugs: Strategies for Reaching Populations at Risk. OSAP Prevention

Monograph-5. Office for Substance Abuse Prevention. DHHS Pub. No.

(ADM)90-1665. Rockville, MD: U.S. Department of Health and Human

Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health

Administration, 1990. 402 pp.

Bayes, J. Substance abuse and child abuse: Impact of addiction on the child.

Pediatr Clin North Am 37(4):881-904, 1990.
430

Botvin, G.J.; Baker, E.; Dusenbury, L.; Botvin, E.M.; and Diaz, T. Long-term

follow-up results of a randomized drug abuse prevention trial in a white

middle-class population. JAMA 273(14):1106-1112, 1995.

Brady, K.T.; Grice, D.E.; Dustan, L.; and Randall, C. Gender differences in

substance use disorders. Am J Psychiatry 150(11):1707-1711, 1993.

Bry, B.; Catalano, R.; Kumpfer, K.; Lochman, J.E.; and Szapocznik, J. Scientific

findings from family prevention intervention research. In: Ashery, R.S.,

and Kumpfer, K.L., eds. Family Intervention Research for the Prevention of

Drug Use in Youth. National Institute on Drug Abuse Research Monograph.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., in press.

Catalano, R.F. “Treatment and Prevention Issues With Substance Abusing

Families.” Paper presented at the National Institute on Drug Abuse Family

Intervention Research Symposium, Gaithersburg, MD, January 25-26,

1996.

Catalano, R.F.; Haggerty, K.P.; and Gainey, R.R. Prevention approaches in

methadone treatment settings: Children of drug abuse treatment clients.

In: Bukoski, W.J., and Amsel, Z., eds. Drug Abuse Prevention: Sourcebook

on Strategies and Research. Westport, CT: Greenwood, in press.

Catalano, R.F., and Hawkins, J.D. Project skills: Preliminary results from a

theoretically based aftercare experiment. In: Ashery, R.S., ed. Progress in the

Development of Cost-Effective Treatment for Drug Abusers. National Institute

on Drug Abuse Research Monograph 58. DHHS Pub. No. (ADM)88-1401.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1985.

Chasnoff, I.J. Drug use in pregnancy: Parameters of risk. Pediatr Clin North Am

35(6):1403-1412, 1988.

Chasnoff, I.J.; Marques, P.R.; Strantz, I.H.; Farrow, J.; and Davis, S. Building

bridges: Treatment research partnerships in the community. In: Rahdert,

E.R., ed. Treatment for Drug-Exposed Women and Their Children: Advances in

Research Methodology. National Institute on Drug Abuse Research

Monograph 166. NIH Pub. No. 96-3632. Washington, DC: Supt. of Docs.,

U.S. Govt. Print. Off., 1996.

Chess, S., and Thomas, A. Origins and Evolution of Behavioral Disorders: From

Infancy to Early Life. Cambridge, MA: Harvard University Press, 1984.

Cloninger, C.R.; Sigvardsson, S.; and Bohman, M. Childhood personality

predicts alcohol abuse in young adults. Alcohol Clin Exp Res 12:494-505,

1988.

Cuskey, W.R.; Richardson, A.H.; and Berger, L.H. Specialized Therapeutic

Community Program for Female Addicts. National Institute on Drug Abuse

Research Report Series. DHEW Pub. No. (ADM)79-880. Washington,

DC: Supt. of Docs., U.S. Govt. Print. Off., 1979. 31 pp.
431

DeMarsh, J., and Kumpfer, K.L. Family-oriented interventions for the

prevention of chemical dependency in children and adolescents. Special

Issue: Childhood and Chemical Abuse: Prevention and Intervention.

J Child Contemp Soc: Adv Theory Appl Res 18(1/2):117-152, 1985.

Deren, S. Children of substance abusers: A review of the literature. J Subst

Abuse Treat 3:77-94, 1986.

Donohew, L.; Sypher, H.E.; and Bukoski, W.J., eds. Persuasive Communication

and Drug Abuse Prevention. Hillsdale, NJ: Lawrence Earlbaum, 1991. 349

pp.

Egeland, B., and Erickson, M.F. Psychologically unavailable care giving: The

effects on development of young children and the implications for

intervention. In: Brassard, M.; Hart, S.; and Germain, B., eds. Psychological

Maltreatment of Children and Youth. New York: Pergamon Press, 1987.

Egeland, B., and Erickson, M.F. Rising above the past: Strategies for helping

new mothers break the cycle of abuse and neglect. Zero to Three 11(2):

29-35, 1990.

Emshoff, J., and Price, A.W. “Prevention and Treatment Options for Children

of Alcoholics.” Paper commissioned for the National Association for

Children of Alcoholics Pediatric Initiative, Alexandria, VA, March 20-21,

1997.

Finkelstein, N. “Treatment Issues: Women and Substance Abuse.” Research

paper prepared for the National Coalition on Alcohol and Drug Dependent

Women and Their Children, Boston, MA, September 1990.

Forehand, R.L., and McMahon, R.J. Helping the Noncompliant Child: A

Clinician’s Guide to Parent Training. New York: Guilford Press, 1981. 253 pp.

Fried, P.A. Behavioral outcomes in preschool and school-age children exposed

prenatally to marijuana: A review and speculative interpretation. In:

Wetherington, C.L.; Smeriglio, V.L.; and Finnegan, L.P., eds. Behavioral

Studies of Drug-Exposed Offspring: Methodological Issues in Human and

Animal Research. National Institute on Drug Abuse Research Monograph

164. NIH Pub. No. 96-4105. Washington, DC: Supt. of Docs., U.S. Govt.

Print. Off., 1996. 297 pp.

Glider, P.; Hughes, P.; Mullen, R.; Coletti, S.; Sechrest, L.; Neri, R.; Renner, B.;

and Sicilian, D. Two therapeutic communities for substance-abusing

women and their children. In: Rahdert, E.R., ed. Treatment for DrugExposed Women and Their Children: Advances in Research Methodology.

National Institute on Drug Abuse Research Monograph 166. NIH Pub. No.

96-3632. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996.

Gomby, D.S.; Larson, C.S.; Lewit, E.M.; and Behrman, R.E. Home visiting:

Analysis and recommendation. Future Child 3(3):6-22, 1993.
432

Gordon, R. An operation classification of disease prevention. In: Steinberg,

J.A., and Silverman, M.M., eds. Preventing Mental Disorders: A Research

Perspective. DHHS Pub. No. (ADM)87-1492. Rockville, MD: U.S.

Department of Health and Human Services, Public Health Service,

Alcohol, Drug Abuse, and Mental Health Administration, National

Institute of Mental Health, 1987.

Haggerty, K.P.; Mills, E.; and Catalano, R.F. Focus on Families: Parent Training

Curriculum. Seattle, WA: Social Development Research Group, 1991.

Hans, S.L. “Impact of Children on Drug-Abusing Parents.” Paper presented at

the National Institute on Drug Abuse Technical Review on Methodological Issues: Etiology and Consequences of Drug Abuse Among Women,

Gaithersburg, MD, June 16-17, 1994.

Hans, S.L. Prenatal drug exposure: Behavioral functioning in late childhood

and adolescence. In: Wetherington, C.L.; Smeriglio, V.L.; and Finnegan,

L.P., eds. Behavioral Studies of Drug-Exposed Offspring: Methodological Issues

in Human and Animal Research. National Institute on Drug Abuse Research

Monograph 164. NIH Pub. No. 96-4105. Washington, DC: Supt. of Docs.,

U.S. Govt. Print. Off., 1996. 297 pp.

Harrison, R.S. “Final Evaluation of the Utah Community Youth Activities

Project.” Report submitted to Utah State Division of Substance Abuse,

Social Research Institute, Graduate School of Social Work, University of

Utah, Salt Lake City, UT, 1994.

Harrison, R.S., and Proschauer, S. “The Impact of Family Skills Training on

Children at Risk for Substance Abuse and Their Families: A Five-Year

Evaluation.” Report submitted to Utah State Division of Substance Abuse,

Social Research Institute, Graduate School of Social Work, University of

Utah, Salt Lake City, UT, 1996.

Howard, J., and Beckwith, L. Issues in subject recruitment and retention with

pregnant and parenting substance-abusing women. In: Rahdert, E.R., ed.

Treatment for Drug-Exposed Women and Their Children: Advances in Research

Methodology. National Institute on Drug Abuse Research Monograph 166.

NIH Pub. No. 96-3632. Washington, DC: Supt. of Docs., U.S. Govt. Print.

Off., 1996.

Hughes, P.; Coletti, S.D.; Neri, R.L.; Urmann, C.F.; Stahl, S.; Sicilian, D.M.;

and Anthony, J.C. Retaining cocaine-abusing women in a therapeutic

community: The effect of a child live-in program. Am J Public Health

85:1149-1152, 1995.

Johnson, H.L.; Glassman, M.B.; Fiks, K.B.; and Rosen, T.S. Resilient children:

Individual differences in developmental outcome of children born to drug

abusers. J Genet Psychol 151(4):523-539, 1990.
433

Johnson, J., and Leff, M. “Overview of Research on Children of Substance

Abusers.” Paper commissioned for the National Association for Children

of Alcoholics Pediatric Initiative, Alexandria, VA, March 20-21, 1997.

Johnson, J.L., and Bennett, L.A. School-Aged Children of Alcoholics: Theory and

Research. New Brunswick, NJ: Center of Alcohol Studies, Rutgers

University, 1988.

Kaltenbach, K.A. Exposure to opiates: Behavioral outcomes in preschool and

school-age children. In: Wetherington, C.L.; Smeriglio, V.L.; and

Finnegan, L.P., eds. Behavioral Studies of Drug-Exposed Offspring:

Methodological Issues in Human and Animal Research. National Institute on

Drug Abuse Research Monograph 164. NIH Pub. No. 96-4105.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996. 297 pp.

Kameoka, V., and Lecar, S. Evaluation of Strengthening Hawaiian Families.

Honolulu, HI: Coalition for Drug-Free Hawaii, 1993.

Kameoka, V., and Lecar, S. “Final Report on Strengthening Hawaiian Families.”

Report submitted to the Center for Substance Abuse Prevention by the

Coalition for Drug-Free Hawaii. Rockville, MD: Center for Substance

Abuse Prevention, 1996.

Kaminer, Y. Adolescent substance abuse: A comprehensive guide to theory and

practice. In: Kaminer, Y., ed. Critical Issues in Psychiatry: An Educational

Series for Residents and Clinicians. New York: Plenum Medical Book Co.,

1994. 265 pp.

Kellam, S.G.; Simon, M.B.; and Ensminger, M.E. Antecedents of teenage drug

use and psychological well being: A ten-year communitywide prospective

study. In: Ricks, D., and Dohrenwend, B.S., eds. Origins of Psychopathology:

Research and Public Policy. Cambridge, MA: Cambridge University Press,

1983.

Kellam, S.G.; Werthamer-Larsson, L.; Dolan, L.J.; Brown, C.H.; Mayer, L.S.;

Rebok, G.W.; Anthony, J.C.; Landolff, J.; and Edelsohn, G. Developmental

epidemiologically based preventive trials: Baseline modeling of early target

behaviors and depressive symptoms. Special Issue: Preventive Intervention

Research Centers. Am J Community Psychol 19(4):563-584, 1991.

Kim, S.; Coletti, S.D.; Crutchfield, C.C.; Williams, C.; and Helper, N. Benefitcost analysis of drug abuse prevention programs: A macroscopic approach.

J Drug Educ 25(2):111-127, 1995.

Kumpfer, K.L. Special populations: Etiology and prevention of vulnerability to

chemical dependency in children of substance abusers. In: Brown, B.S., and

Mills, A.R., eds. Youth at High Risk for Substance Abuse. National Institute

on Drug Abuse. DHHS Pub. No. (ADM)87-1537. Washington, DC: Supt.

of Docs., U.S. Govt. Print. Off., 1987.
434

Kumpfer, K.L. Prevention of mental disorders, alcohol and other drug use in

children and adolescents. In: Shaffer, D.; Philips, I.; and Enzer, N.B., eds.

Prevention of Mental Disorders, Alcohol, and Other Drug Abuse in Children

and Adolescents. OSAP Prevention Monograph-2. Office for Substance

Abuse Prevention. DHHS Pub. No. (ADM)92-1646. Rockville, MD:

U.S. Department of Health and Human Services, Public Health Service,

Alcohol, Drug Abuse, and Mental Health Administration, 1989. 478 pp.

Kumpfer, K.L. Children and adolescents and drug and alcohol abuse and

addiction: Review of prevention strategies. In: Miller, N.S., ed.

Comprehensive Handbook of Drug and Alcohol Addiction. New York: Marcel

Dekker, 1991b.

Kumpfer, K.L. “YCOSA Black Parenting Project: Final Evaluation Report.”

Report submitted to the Alabama Department of Mental Health and

Mental Retardation, Department of Health Education, University of Utah,

Salt Lake City, UT, November 1991a.

Kumpfer, K.L. Strengthening America’s Families: Promising Parenting and Family

Strategies for Delinquency Prevention: User’s Guide. Office of Juvenile Justice

and Delinquency Prevention. U.S. Department of Justice Grant 87-JS-CXK495. Silver Spring, MD: Aspen Systems, 1994.

Kumpfer, K.L. “Outcome Measures of Intervention in the Study of Children of

Substance-Abusing Parents.” Paper commissioned for the National

Association for Children of Alcoholics Pediatric Initiative, Alexandria,

VA, March 20-21, 1997a.

Kumpfer, K.L. The Strengthening America’s Families Initiative: Promising Parenting

and Family Strategies for Delinquency Prevention. Office of Juvenile Justice

and Delinquency Prevention. U.S. Department of Justice Grant 87-JS-CXK495. Silver Spring, MD: Aspen Systems, 1997b.

Kumpfer, K.L. Effectiveness of culturally tailored, family-focused substance

abuse programs: The Strengthening Families Program. In: David, S., ed.

National Conference on Drug Abuse Prevention Research: Presentations,

Papers, and Recommendations. National Institute on Drug Abuse Research

Monograph. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., in

press.

Kumpfer, K.L., and Alvarado, R. Strengthening families to prevent drug use

in multi-ethnic youth. In: Botvin, G.; Schinke, S.; and Orlandi, M., eds.

Drug Abuse Prevention With Multi-Ethnic Youth. Newburg, CA: Sage, 1995.

359 pp.

Kumpfer, K.L.; Alvarado, R.; and Adler, S. “Final Report of Success By Six.”

Report submitted to United Way, Department of Health Promotion and

Education, University of Utah, Salt Lake City, UT, June 1997c.

Kumpfer, K.L., and Bayes, J. Child abuse and alcohol, tobacco and other

drug abuse: Causality, coincidence or controversy? In: Jaffe, J.H., ed.

The Encyclopedia of Drugs and Alcohol. New York: Macmillan, 1995.
435

Kumpfer, K.L., and DeMarsh, J. Family, environmental, and genetic influences

on children’s future chemical dependency. J Child Contemp Soc: Adv Theory

Appl Res 18(1/2):49-91, 1985.

Kumpfer, K.L., and DeMarsh, J. “Prevention Services for Children of

Substance-Abusing Parents.” Final Report on National Institute on Drug

Abuse Prevention Research Grant. Submitted to Utah State Division of

Substance Abuse, Social Research Institute, University of Utah, Salt Lake

City, UT, 1987.

Kumpfer, K.L.; DeMarsh, J.; and Child, W. The Strengthening Families Program.

(Five manuals.) Salt Lake City, UT: Department of Health Education,

University of Utah, 1989.

Kumpfer, K.L.; Molgaard, V.; and Spoth, R. Family interventions for the

prevention of delinquency and drug use in special populations. In: De

Peters, R.V., and McMahon, R., eds. Preventing Childhood Disorders,

Substance Abuse, and Delinquency. Thousand Oaks, CA: Sage, 1996.

Kumpfer, K.L.; Rigby, D.; Walsh, E.M.; and Sorensen, S.L. Drug Abuse

Prevention Package: What Works! National Institute on Drug Abuse.

NIH Pub. No. 97-4110. Washington, DC: Supt. of Docs., U.S. Govt.

Print. Off., 1997a.

Kumpfer, K.L.; Williams, M.K.; and Baxely, G., eds. Drug Abuse Prevention for

At-Risk Groups. National Institute on Drug Abuse. NIH Pub. No. 97-4115.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1997b.

LaFazia, M.A.; Kleyn, J.; Lanz, J.; Hall, T.; Nyrop, K.; Stark, K.D.; Hansen, C.;

and Watts, D.H. Case management: A method of addressing subject

selection and recruitment issues. In: Rahdert, E.R., ed. Treatment for DrugExposed Women and Their Children: Advances in Research Methodology.

National Institute on Drug Abuse Research Monograph 166. NIH Pub. No.

96-3632. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996.

Lerner, J., and Vicary, J. Difficult temperament and drug use: Analysis from the

New York Longitudinal Study. J Drug Educ 14:1-8, 1984.

Lewis, R.A.; Haller, D.L.; Branch, D.; and Ingersoll, K.S. Retention issues

involving drug-abusing women in treatment research. In: Rahdert, E.R., ed.

Treatment for Drug-Exposed Women and Their Children: Advances in Research

Methodology. National Institute on Drug Abuse Research Monograph 166.

NIH Pub. No. 96-3632. Washington, DC: Supt. of Docs., U.S. Govt. Print.

Off., 1996.

Miller, J.B. Toward a New Psychology of Women. 2d ed. Boston, MA: Beacon

Press, 1986. 1,541 pp.

Mrazek, P.J., and Haggerty, R.J., eds. Reducing Risks for Mental Disorders:

Frontiers for Preventive Intervention Research. Institute of Medicine.

Washington, DC: National Academy Press, 1994.
436

Olds, D., and Pettitt, L. “Reducing Risks for Substance Abuse With a Program

of Prenatal and Early Childhood Home Visitation.” Paper presented at the

National Institute on Drug Abuse Family Intervention Symposium,

Washington, DC, January 25-26, 1996.

Olds, D.L., and Kitzman, H. Review of research on home visiting for pregnant

women and parents of young children. Future Child 14(3):53-92, 1993.

Rahdert, E.R. Introduction to the Perinatal-20 Treatment Research

Demonstration Program. In: Rahdert, E.R., ed. Treatment for Drug-Exposed

Women and Their Children: Advances in Research Methodology. National

Institute on Drug Abuse Research Monograph 166. NIH Pub. No. 96-3632.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996.

Rosenbaum, M. Women on Heroin. New Brunswick, NJ: Rutgers University

Press, 1981. 196 pp.

Rosenbaum, M., and Murphy, S. Women and addiction: Process, treatment, and

outcome. In: Lambert, E.Y., ed. The Collection and Interpretation of Data from

Hidden Populations. National Institute on Drug Abuse Research Monograph

98. DHHS Pub. No. (ADM)90-1678. Washington, DC: Supt. of Docs.,

U.S. Govt. Print. Off., 1990.

Schuckit, M.A. Advances in understanding the vulnerability to alcoholism.

In: O’Brien, C.P., and Jaffe, J.H., eds. Advances in Understanding the

Vulnerability to Alcoholism. New York: Raven Press, 1992.

Sowder, B.J., and Burt, M.R. Children of Heroin Addicts: An Assessment of

Health, Learning, Behavioral, and Adjustment Problems. New York: Praeger,

1980. 151 pp.

Spear, L.P. Assessment of the effects of developmental toxicants: Pharmacological and stress vulnerability of offspring. In: Wetherington, C.L.;

Smeriglio, V.L.; and Finnegan, L.P., eds. Behavioral Studies of Drug-Exposed

Offspring: Methodological Issues in Human and Animal Research. National

Institute on Drug Abuse Research Monograph 164. NIH Pub. No. 96-4105.

Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996. 297 pp.

Stevens, S.; Arbiter, N.; and Glider, P. Women residents: Expanding their role

to increase treatment effectiveness in substance abuse programs. Int J Addict

24(5):425-434, 1989.

Tarter, R., and Mezzich, A. Ontogeny of substance abuse: Perspectives and

findings. In: Glantz, M., and Pickens, R., eds. Vulnerability to Drug Abuse.

Washington, DC: American Psychological Association, 1992.

Wamberg, K., and Nyholm, S. “Evaluation Results of the Strengthening

Hispanic Families Program.” Paper presented at the Center for Substance

Abuse Prevention Annual High-Risk Youth National Conference, Denver,

CO, March 1995.
437

Wetherington, C.L.; Smeriglio, V.L.; and Finnegan, L.P., eds. Behavioral Studies

of Drug-Exposed Offspring: Methodological Issues in Human and Animal

Research. National Institute on Drug Abuse Research Monograph 164. NIH

Pub. No. 96-4105. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off.,

1996. 297 pp.

Yoshikawa, H. Prevention as cumulative protection: Effects of early family

support and education on chronic delinquency and its risks. Psychol Bull

115:28-54, 1994.

Zucker, R.A., and Fitzgerald, H.E. “Drug Abuse Prevention Through FamilyBased Intervention: Lessons for Programming and Evaluation From

Developmental and Etiological Studies.” Paper presented at the National

Institute on Drug Abuse Family Intervention Symposium, Washington,

DC, January 1996.

Zuckerman, B. Drug effects: A search for outcomes. In: Wetherington, C.L.;

Smeriglio, V.L.; and Finnegan, L.P., eds. Behavioral Studies of Drug-Exposed

Offspring: Methodological Issues in Human and Animal Research. National

Institute on Drug Abuse Research Monograph 164. NIH Pub. No. 96-

4105. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1996.

297 pp.

AUTHOR

Karol L. Kumpfer, Ph.D.

Associate Professor

Department of Health Education

Health Sciences Center, HPER N-215

University of Utah

Salt Lake City, UT 84112

(801) 581-7718 (Tel)

(801) 581-5872 (Fax)

kkumpfer@health.utah.edu (E-mail)