Novel Assessment of Maternal Distress Tolerance Underlying Substance Use Relapse

对药物滥用复发的孕产妇痛苦耐受性的新评估

• 批准号: 8358284
• 负责人: Carl W Lejuez
• 金额: $ 22.8万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8358284
• 关键词: Abstinence; Address; African American; Aftercare; Age; Alcohol or Other Drugs use; Area; Attention; Canada; Child; Child Care; Clinical; Daughter; Distress; Dropout; Drug usage; Drug user; Environmental Risk Factor; Family; Female; Future; Gender; Health; Home environment; Infant; Length; Link; Low income; Measures; Modeling; Mothers; Outcome; Parenting behavior; Parents; Participant; Patient Self-Report; Psychopathology; Relapse; Research; Residential Treatment; Risk; Risk Factors; Role; Specificity; Substance abuse problem; Testing; Treatment outcome; Vulnerable Populations; Woman; analog; behavior measurement; biological adaptation to stress; demographics; distress tolerance; early childhood; experience; high risk; improved; indexing; inner city; interest; maternal stress; men; novel; outcome forecast; response; stressor; substance abuse treatment; treatment program

DESCRIPTION (provided by applicant): Women evidence worse substance use treatment outcomes than men (Greenfield et al., 2007), including higher rates of treatment dropout (Arfken et al., 2001; King & Canada, 2004; Sayre et al., 2002), lower treatment attendance (McCaul et al., 2001) and higher rates of post-treatment substance use relapse (Grella et al., 2006). Yet, substance abuse research often includes little attention to gender-specific factors relevant to particular vulnerabilities of female participants (Brady & Ashley, 2005; Greenfield et al., 2007). One factor especially relevant to risk of relapse for many female drug users is maternal stress; child care responsibilities and the associated stressors may significantly increase risk of substance use relapse, particularly during high- risk periods for relapse following substance abuse treatment. Further, although maternal factors have been a particular empirical and clinical focus regarding environmental risk factors for drug using women, but the large preponderance of this research is focused on the impact of maternal substance use on child outcomes, with little attention to drug use outcome for these women as an important target in its own right (cf., Pajulo et al., 2006). Accordingly, one promising factor that may help explain the maternal distress and substance use association when reintroduced to one's home environment following discharge from substance abuse treatment is maternal distress tolerance, or the ability to tolerate distress due to parenting issues. Indeed, one's ability to tolerate distress is associated with relapse following substance abuse treatment and length of abstinence attempts. However, despite its relevance to both substance use and parenting responses, little is known about the impact of low distress tolerance on substance using mothers. This may be due, at least in part, to the lack of distress tolerance assessment strategies that target directly the unique experience of maternal distress. To address the lack of research in this area, the following R21 attempts to provide an initial examination of maternal risk factors for substance use relapse, with a focus on the moderating role of distress tolerance. As a secondary aim, we explore a novel and ecologically valid measure of maternal distress tolerance to examine its utility over a standard distress tolerance task. Specifically, we will include 105 predominantly low-income, inner-city African American substance using mothers in their last week of residential drug use treatment that have a child in the critical age of 9 months to 4 years to examine the link between several indices of maternal distress and substance use outcomes with both general and maternal- specific measures of ability to tolerate distress as moderators of this relationship. PUBLIC HEALTH RELEVANCE: Maternal factors (i.e., parenting-related stressors) have been a particular empirical and clinical focus for drug using women, but the large preponderance of this research is focused on the impact of poor parenting and maternal substance use on child outcomes, with little attention to drug use outcome for these women as an important target in its own right. The current application proposes a novel framework for understanding risk factors for maternal relapse in the context of child-related stressors using the paradigm of distress tolerance. If maternal stress response is shown to be a mechanism underlying drug use outcomes, findings from this study have the potential to improve the prognosis for treatment outcome for high-risk mothers and positively impact the future health of their children.

描述（由申请人提供）：女性证据比男性更糟糕的药物治疗结果（Greenfield等，2007），包括更高的治疗辍学率（Arfken等，2001; King＆Canada，2004; Sayre等，2002），较低的治疗率（McCaul等人，2001年）（McCaul等人，2001）和较高的后疗养率（较高的治疗率）。然而，药物滥用研究通常很少关注与女性参与者特定脆弱性有关的特定性别因素（Brady＆Ashley，2005； Greenfield等，2007）。与许多女性药物使用者有关复发风险特别相关的一个因素是孕产妇压力。儿童保育责任和相关的压力源可能会大大增加物质使用复发的风险，尤其是在药物滥用治疗后的复发期间的高风险期间。此外，尽管母体因素一直是使用女性药物的环境风险因素的特殊经验和临床重点，但是这项研究的大量优势集中在母体药物使用对儿童结果的影响，很少关注这些女性作为其自身权利的重要目标（请参见Pajulo等，Pajulo等，2006）。因此，在滥用药物治疗后被重新引入家居环境时，可能有助于解释孕产妇的痛苦和物质使用关联的一个有希望的因素是孕产妇的忍受容忍度，或者由于育儿问题而容忍痛苦的能力。确实，一个人容忍困扰的能力是相关的 在药物滥用治疗和禁欲尝试时复发。但是，尽管它与物质使用和育儿反应相关，但对低遇险耐受性对使用母亲的物质的影响知之甚少。这至少部分是由于缺乏直接针对孕产妇苦难的独特经验的遇险宽容评估策略。为了解决该领域缺乏研究，以下R21试图对物质使用复发的孕产妇风险因素进行初步检查，重点是调节遇险耐受的作用。作为次要目的，我们探索了一种新颖且在生态上有效的孕产妇耐受性衡量标准，以检查其对标准遇险宽容任务的效用。具体而言，我们将使用母亲在住宅毒品使用治疗的最后一周中包括105个主要是低收入的非洲非裔美国人物质，在9个月至4年的关键年龄较大的孩子中，有一个孩子在孕产妇遇险和物质使用结果的几个指数与一般性和母体的特定能力衡量这种关系的能力衡量的能力。 公共卫生相关性：产妇因素（即与育儿相关的压力源）是使用女性药物的特殊经验和临床重点，但是这项研究的巨大优势集中在育儿和产妇使用对儿童的不良育儿的影响，很少关注这些妇女作为这些妇女作为本身的重要目标的关注。当前的应用提出了一个新的框架，用于了解使用遇险宽容范式在与儿童相关的压力源中产妇复发的风险因素。如果显示出孕产妇的压力反应是药物使用结果的一种机制，那么这项研究的发现有可能改善高危母亲的治疗结果预后，并对孩子的未来健康产生积极影响。