Improving Delay Discounting to Decrease Harsh Parenting Among Parents Receiving Substance Use Treatment

Study Overview
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Brief Summary
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Parents with substance use disorders are disproportionately more likely to engage in harsh physical discipline, which can lead to serious clinical outcomes, including child maltreatment and the intergenerational transmission of addictive disorders. One mechanism linking substance use and maladaptive parenting strategies is parental delay discounting, or the tendency to value smaller, immediate rewards (such as stopping children's misbehavior via physical punishment) relative to larger, but delayed rewards (like shaping adaptive child behaviors over time). This study will examine the efficacy of implementing a low-cost, brief intervention targeting the reduction of parental delay discounting to inform broader public health efforts aimed at reducing child maltreatment and interrupting intergenerational cycles of substance abuse in traditionally underserved communities.

Detailed Description
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Parents with substance use disorders (SUD) are significantly more likely to engage in harsh parenting practices, including spanking, hitting, and belittling their children, than parents without SUD. Punitive physical and emotional discipline is, in turn, associated with increased rates of child maltreatment and the subsequent intergenerational transmission of substance use disorders. Parents in residential substance use treatment facilities are among those at highest risk for perpetrating harsh and abusive parenting; yet most behaviorally based parenting interventions available within inpatient settings do not take into account the unique mechanisms linking parental substance use to harsh parenting. Specifically, parents with SUD may be at heightened risk for engaging in maladaptive parenting approaches given a tendency to prioritize immediate rewards (such as stopping a child's misbehavior using physical punishment) relative to larger, but delayed rewards (including shaping positive child behavior over a longer term). This behavioral tendency is known as delay discounting and recent findings suggest that rates of delay discounting predict parents' use of harsh physical discipline. Existing research also indicates a strong link between steeper (more problematic) rates of delay discounting and the severity of alcohol and illicit drug use across the lifespan. Thus, delay discounting may represent a specific vulnerability underlying both harsh parenting and disordered substance use. The current project proposes to pilot and feasibility test an adapted episodic future thinking (EFT) intervention to target the reduction of parenting-related delay discounting and examine its effects on parenting practices among families in a residential substance use treatment setting. The intervention will be delivered by peer recovery coaches who are already employed in the center.

Official Title
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Improving Delay Discounting to Decrease Harsh Parenting Among Parents Receiving Substance Use Treatment in Low Income Community

Conditions
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Behavioral Health

Intervention / Treatment
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* Behavioral: Episodic Future Thinking


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Parent of child between 6-10 years of age Able to provide informed consent and take part in all study procedures in English Have current diagnosis of SUD Currently reside with their child at least 50% of the time Be willing to receive daily postcards Exclusion Criteria: Active suicidality/homicidally Active bipolar disorder, schizophrenia, or psychosis. Only one parent-child dyad from each family.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Episodic Future Thinking<br>Parents who are receiving residential substance use disorder (SUD) treatment will receive an adapted episodic future thinking focused condition. Parents will meet with peer recovery coaches (PRCs) who will administer the intervention, focused on generating future, pleasant events with their children. After the intervention session, parents will receive a daily postcard over the course of two weeks including a reminder cue generated as part of the episodic future thinking (EFT) intervention and a prompt to remember these episodes in vivid detail. | Behavioral: Episodic Future Thinking<br>* The adapted episodic future thinking (EFT) intervention will focus on generation of vivid, substance-free, rewarding events that could happen in the future with their children.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Delay Discounting 5 Trial Adjusted Measure | The computer based adjusting amount discounting task uses an adjusting algorithm to determine the amount of immediately available money that is equivalent to a large sum that is delayed by seven discrete durations of time presented in a randomized order (i.e., 1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years).At each delay, a choice is first presented between the delayed larger sum and a smaller sum available immediately. For each trial, the position of the delayed and immediate amounts are randomly assigned the left or right portion of the screen, and the participant chooses the preferred option by pressing the corresponding left or right response button. Change in the Delay Discounting score is measured by comparing baseline scores with scores at the intervention (approximately 1 week after baseline) and the post-intervention assessment (approximately 4 weeks after baseline) | Baseline, 1 week, and 4 weeks | 
| Change in Consideration of Future Consequences Scale | The Consideration of Future Consequences Scale1 (CFCS-14) is a 14-item self-report questionnaire that assesses active consideration of longer-term implications of an individual's actions. Lower scores on the CFCS-14 are associated with a greater focus on immediate needs and have been found to be associated with less engagement in health behaviors1819 and greater substance use. The measure has been used extensively among adult samples and demonstrates strong reliability and validity. Research suggests modest but significant correlations with the MCQ. Change in CFCS-14 score is measured by comparing baseline scores with scores at the post-intervention assessment (approximately 4 weeks after baseline) | Baseline, 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Dyadic Parent-Child Interaction Coding System Scores | Parents and their children will complete a 20- minute interaction task, including five minutes of free play, a ten minute homework task in which children are given a math worksheet and parents are told to provide help as you see fit, and a five minute clean up task. Interactions will be video recorded and coded using the Dyadic Parent-Child Interaction Coding System (DPICS) which yields to composite scores: positive parenting (including praise, positive affect, and physical positive interactions) and negative parenting (including negative commands, critical statements, and physical negative interactions). Change in positive parenting and negative parenting scores will be calculated by comparing baseline scores with scores at the post-intervention sessions (approximately 4 weeks after baseline) | Baseline, 4 weeks | 
| Change in Alabama Parenting Questionnaire Scores | The Alabama Parenting Questionnaire (APQ) is a 42-item self-report measure of parenting behaviors. The questionnaire includes five subscales: (1) positive involvement with children, (2) supervision and monitoring, (3) use of positive discipline techniques, (4) consistent use of discipline, and (5) use of corporal punishment. The measure is widely used and has demonstrated excellent internal consistency and validity. Change in APQ scores will be measured by comparing post-intervention scores (approximately 4 weeks after baseline) with baseline scores. | Baseline, 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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episodic future thinking, delay discounting, parent-child relations, low income, substance use treatment