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This article describes and illustrates the ongoing development of a treatment for working with families and friends of drug users using harm reduction principles. The author was instrumental in applying harm reduction principles to substance abuse and has used these same principles to help families deal with the pessimism, pain, and grief that accompany their relationship to a person with an active substance abuse problem. The treatment involves learning decision-making processes based on both self-care and love for the substance abuser and is based on the values of harm reduction, caring, and incrementalism, rather than those of codependency, tough love, and abrupt behavior change. A long-term family therapy group and two family consultations illustrate the treatment and its applications. [c] 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66: 164-174, 2010. Keywords: harm reduction; harm reduction therapy; harm reduction family support DOI: 10.1002/jclp.20671

This study was designed to examine patterns of family functioning among college students who are offspring of addicted parents. 218 undergraduate psychology students were administered a series of measures assessing family functioning, dissociation, parental addiction, and a history of child abuse. As predicted, offspring of addicted parents reported significantly lower Cohesion in their families of origin ([F.sub.1,161] = 10.16, p = .002), and described significantly greater dissatisfaction with the cohesion they experienced in their families of origin, when compared to their college peers ([F.sub.1,135] = 10.24, p = .002). However, these groups reported comparable Adaptability in their families of origin ([F.sub.1,161] = 1.74, ns). These data show that, although offspring of addicted parents college students appear to share commonalities with their student peers in terms of the adaptability in their families of origin, they still share some key characteristics with clinical populations of offspring of addicted parents, which distinguish them as a group.

The study describes the findings associated with the initial measurement development phase of an assessment tool available to systematically assess the economic, behavioral, and psychological problems encountered by the family members of the drug users. The results indicate that the Significant Other Checklist includes reasonable initial subscale reliability estimates.

Men (N = 124) entering treatment for opioid dependence who were living with a family member were randomly assigned to one of two 24-week treatments: (a) behavioral family counseling (BFC) plus individual treatment (patients had both individual and family sessions and took naltrexone daily in presence of family member) or (b) individual-based treatment only (IBT; patients were given naltrexone and were asked in counseling sessions about their compliance, but there was no family involvement). BFC patients, compared with their IBT counterparts, ingested more doses of naltrexone, attended more scheduled treatment sessions, had more days abstinent from opioids and other drugs during treatment and during the year after treatment, and had fewer drug-related, legal, and family problems at 1-year follow-up.

Most studies of parents in drug treatment have focused exclusively on mothers, and few studies have examined the effects of parents' level of involvement with their children on the parents' drug use and psychological functioning, either before or after treatment. This study examined mothers and fathers (n = 331) who were parents of children under the age of 18; participants were sampled from 19 drug treatment programs across four types of treatment modalities in Los Angeles County. A majority of each group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their children. At the baseline assessment, higher parental involvement was related to lower levels of addiction severity, psychological severity, and symptoms of psychological distress, and to higher levels of self-esteem and perception of parenting skills. In general, fathers had higher levels of alcohol and drug-use severity than did mothers, but fathers who were more involved with their children showed lower levels of addiction severity than fathers who were less involved. Parental involvement at baseline was unrelated to drug use at the 12-month follow-up, although parents who were less involved with their children reported experiencing more stressors. Given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline, treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents. Key Words: Gender; Parental involvement; Drug treatment, Psychological distress., INTRODUCTION Research on parental drug abuse has focused largely upon its effects on children, whereas little research has focused on the parents themselves. Specifically, little is known about how being [...]

Although providing child care and family residency options has become central to substance abuse treatment for women with dependent children, research documenting status of child coresidence prior to, during, and following treatment is currently unavailable. The purpose of this study is to examine the degree to which mothers are successful in maintaining or reestablishing their role as parents during the course of treatment. The sample included 152 female clients admitted to a residential drug treatment program for women with dependent children. Findings document an increase in child coresidency from admission to follow-up. Women who entered treatment with all children or who were reunited with children previously in others' care at admission were over five times more likely to coreside with all children at follow-up. At follow-up, mothers who reported complete coresidence were more likely to be 30 years old or younger, live independently, and have fewer than two parenting challenges.

Children of an addictive parent generally suffer from negative repercussions and constitute 'a population at risk,' in need of special therapeutic intervention. This article explores the difficulties confronting these children and the group intervention for children aged 8-11, lasting 18 months as a therapeutic intervention to help them. The description includes the group intervention framework, the expressive and non-verbal techniques used, and the rationale as well as the theoretical basis for using these techniques. The unique contribution of this article lies in the demonstration of using expressive group therapy and particularly of non-verbal techniques with children of addicted parents, with abundant examples stemming from the topics dealt with by the group. KEY WORDS: children of drug-addicted parents; group psychotherapy; expressive techniques; non-verbal techniques.

This study investigated the social adjustment of female family members and significant others (FSOs) of illicit drug users in order to gain insight into the impact of drug use upon those close to the user. Using the Social Adjustment Scale-Self Report (SAS-SR), we examined the social adjustment self-ratings (overall and in seven specific role areas) of 41 female partners and 24 mothers of drug users. We compared these ratings to the ratings they reported for their drug-using partners or children, to each other, and to self-ratings drawn from community comparison samples. As expected, results showed that the female FSOs reported significantly better social adjustment than the drug users in most role areas. However, their social adjustment was compromised relative to the community samples. Partners of drug users reported poorer adjustment than parents of drug users overall and in the specific areas of marital and economic functioning. Further inquiry is needed to improve our understanding of the impact of drug use on the users' family members. Keywords: Social adjustment; Social functioning; Family members; Drug abuse; Women

In a randomized clinical trial, 90 concerned significant others (CSOs) of treatment-refusing illicit drug users were assigned to either (a) community reinforcement and family training (CRAFT), which teaches behavior change skills; (b) CRAFT with additional group aftercare sessions after the completion of the individual sessions; or (c) Al-Anon and Nar-Anon facilitation therapy (Al-Nar FT). All protocols received 12 hr of manual-guided individual treatment. Follow-up rates for the CSOs were consistently at least 96%. The CRAFT conditions were significantly more effective than Al-Nar FT in engaging initially unmotivated drug users into treatment. CRAFT alone engaged 58.6%, CRAFT + aftercare engaged 76.7%, and Al-Nar FT engaged 29.0%. No CSO engaged a treatment-refusing loved one once individual sessions had been completed.

Children of substance abusing parents have an elevated risk for experiencing disruptions in household composition and for engaging in problem behaviors. This study investigated whether multiple parent figure transitions predicted the likelihood of delinquency and drug use among a sample of early adolescents with parents receiving methadone treatment for opiate addiction. Controlling for baseline delinquency, child characteristics, family conflict, parental depression, and parent criminal history, a greater number of parenting disruptions during the longitudinal study period was associated with a higher probability of delinquent behavior. Gender moderated the effect of parent figure transitions in a parallel analysis for drug use. After accounting for baseline drug use and potentially confounding factors, only adolescent females had a higher likelihood of drug use as the number of family disruptions increased. In contrast, age was strongly associated with drug use for males. A subgroup of youths who experienced tremendous family instability and had no single consistent parent figure during the study period were at extreme risk for delinquent behavior. The findings are interpreted in terms of cumulative stress resulting from multiple parenting disruptions over time and differential influences on the expression of problem behaviors depending on gender. Key Words: Parenting disruptions; Family instability; Divorce; Remarriage; Children of substance abusers; Delinquency; Substance use; Problem behaviors; Gender differences, INTRODUCTION Children of drug dependent parents are at an elevated risk for drug use, delinquency, and the development of other problem behaviors. [1-3] In studies comparing them to demographically matched [...]

This paper explores the consequences of drug policies, especially punitive criminal sanctions, for the families of offenders. Mandatory minimum sentences and certain legal developments have created substantial growth in the prison industry with a likely increase in the number and intensity of harms to drug offenders and their families. Negative outcomes include at-risk developmental pathways for children, uncertain quality of care and parenting, family dissolution, and weakened communities. The evidence suggests that punitive drug policies come at great social and economic cost with minimal benefits. Harm-reduction is offered as a framework for change in relation to drug offenders and their families. Recommendations for family preservation and sentencing reform are discussed.

This study compared the influence of family problems with influence of deviant and delinquent social behavior and peer relationships up to the time of the 16th birthday as risk factors for substance use, for lifetime up to age 26. Control variables for the analysis were available from the National Collaborative project's longitudinal data file, collected from time of birth, on the African American community study sample (N = 380). A key finding was that the social behavior and peer relationship problems accounted for 18.8% of the additional variance in later degree of substance use, whereas the family problems accounted for only 5.1% of the additional variance in later degree of substance use.

Behavioral couples therapy (BCT) sees the substance-abusing patient with the spouse to arrange a daily 'sobriety contract' in which the patient states his or her intent not to drink or use drugs and the spouse expresses support for the patient's efforts to stay abstinent. BCT also teaches communication and increases positive activities. Research supports three conclusions. First, BCT for both alcoholism and drug abuse produces more abstinence and fewer substance-related problems, happier relationships, fewer couple separations and lower risk of divorce than does individual-based treatment. Second, domestic violence is substantially reduced after BCT for both alcoholism and drug abuse. Third, cost outcomes after BCT are very favorable for both alcoholism and drug abuse, and are superior to individual-based treatment for drug abuse. The Institute of Medicine (1998) documented a large gap between research and practice in substance abuse treatment. BCT is one example of this gap. BCT has relatively strong research support, but it has not yet become widely used.

The present study evaluated 105 clients who were assessed for substance-related problems and a history of domestic violence. A brief survey on family violence examined whether clients were adult victims, childhood victims, and/or perpetrators of physical violence. Results indicated that 37% of the sample reported that they experienced a family history of physical violence. A total of 22% reported being an adult victim of physical violence, 14% reported being a victim of childhood abuse, and 18% reported being a perpetrator of physical violence. There was a significant positive correlation between subtypes of family violence. Substance-using clients who were older reported more incidences of family violence. Results showed that substance-using clients with a history of family violence (SAFV+) tended to have more individual therapy sessions attended than substance-using clients without a history of family violence (SAFV-). The SAFV+ group was different from the SAFV- group in that they had significantly higher scores on the Michigan Alcoholism Screening Test and the Beck Depression Inventory (BDI) scores. The SAFV+ group also had significantly more self-reported and positive urine screens for cocaine use within the 2-month monitoring period. Additionally, substance-using clients with a history of childhood trauma had significantly more individual therapy sessions attended than clients without a history of childhood trauma. The group with a history of childhood trauma had significantly higher scores on the BDI. Findings indicate the importance of assessing family history of violence in substance abusers entering treatment, as this may have significant implications for treatment outcome.

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children., INTRODUCTION The relationship between family functioning and deviant behavior in adolescent and adult years is well documented by Loeber and Stouthamer-Loeber (1) and by Wright and Wright (2). Significant factors [...]

The perceived magnitude of perinatal chemical dependency in California was the impetus for an interagency partnership within the California Health and Welfare Agency called Options for Recovery (OFR). It offered alcohol and drug treatment and recovery, case management, and recruitment and training of foster parents and relative caregivers to chemically dependent pregnant and parenting women. A 3-year, multi-method evaluation was conducted that included quantitative analyses of secondary data sources, semi-structured interviews with staff and clients, self-administered surveys of staff and clients, client focus groups, and child developmental assessments. Findings indicate that to achieve success, programs structured on the OFR model must recruit chemically dependent women early in their pregnancies, provide mechanisms for retention, offer a continuum of treatment modalities within the service system, make available a comprehensive array of ancillary services, and be responsive to the social, cultural, and familial context within which these women live.

This article approaches the treatment of addicted African American women in ways drawn from traditional African culture. While the modern African American woman is clearly not the same as her continental African foremother, the reality of her life is still predicated on the basis of her culture and her material wealth or lack of it. The approach recommended here, a rite of passage, derives from the belief that the value orientations drawn from the African wisdom of the ages offers the best way to work with families to recover both sobriety and a powerful understanding and repossession of culture that will help to ensure not only sobriety but also ways of holding together and rebuilding the families of today and the future.

This retrospective case-control study of male narcotic addicts was aimed at determining whether family structure and functioning factors, self-reported retrospectively as occurring during early teen age, were associated with subsequent addiction. It contrasted a reference group of addicts with two matched control groups: their teenage associates at age 11 (peer controls), and age-peers residing in their community but not close associates (community controls). The study population was equally divided between white and black subjects. Study results showed that during early teenage intact family structure (defined here as residence in a household consisting of both natural parents) was negatively associated at statistically significant levels with addiction. Family functioning factors negatively associated with later addiction, independently of family structure, included: strong attachment to father or father figure, positive home atmosphere, strong parental adherence to traditional norms, and expected weak parental disapproval of (hypothetical) misbehaviors by subjects if these had in fact occurred. Attachment to mother or mother figure was almost equally very high among reference and control subjects and, hence, was not associated with later addiction.

Many drag treatment programs use graduation ceremonies to mark the changes made in treatment. Such a ceremony helps stabilize at a time of transition. However, ceremonies have the power to bring up overwhelming feelings about family functioning. Workers who are aware of this can use an upcoming graduation purposefully over the course of a group to address issues of family functioning that contribute to substance abuse. Purposeful use of the ceremony can also enhance the power of the termination process.

Research on familial factors in illicit drug abuse has been approached from the perspectives of psychiatric epidemiology, which aims to assess familial clustering of disorders, and clinical psychiatry, which focuses on intrafamilial dynamics. To date, however, these two research traditions have existed in relative isolation from each other, and there has been little consideration given to enhancing the understanding of familial factors in drug abuse by combining these approaches. The intention of this article is to critically review the literature in these two areas and to offer suggestions as to how the strengths from each could be applied in a comprehensive research approach., INTRODUCTION Familial influence in the etiology of drug abuse can occur in at least two salient ways: through genetics and family environment. The exploration of relative contributions of these two [...]

A clinical trial examined whether retention of cocaine-abusing women in a therapeutic community can be improved by permitting their children to live with them during treatment. Fifty-three women were randomly assigned to either the standard community condition (n = 22), in which children were placed with the best available caretaker, or the demonstration condition (n = 31), in which one or two of the children lived with their mother in the community. Survival analysis distributions indicated that demonstration women remained in treatment significantly longer than standard treatment women. (Mean length of stay was 300.4 days vs 101.9 days, respectively.) (Am J Public Health. 1995; 85:1149-1152), Women with children may stay longer in substance-abuse residential treatment programs if the program accommodates their children. Studies have shown that cocaine-using mothers have a high drop-out rate from residential treatment programs, and they often cite childcare problems as the reason. Fifty-three women at least 18 years old and with one or two children aged 10 or younger participated in a residential treatment program. All received the same treatment except that 31 were assigned to live in group cottages with their children. Daycare and schooling was provided for the children. After three months, 77% of the mothers living with their children remained in the program versus 45% of mothers receiving standard treatment. After six months the percentages were 65% versus 18%, and by 12 months they were 29% versus 5%. The average length of stay was 300 days for mothers living with their children versus 102 days for mothers in the standard program.

The purpose of this investigation was to determine if parental substance abuse places children at a higher risk regarding their own substance abuse, illegal activities, and psychological function An intake assessment was conducted with 299 crack smokers currently undergoing treatment. It revealed that clients with a parental history of substance abuse were at over twice the risk for antisocial personality disorders, had been arrested significantly more times as an adult, were more likely to report illicit drug use in the past year, and had received prior treatmen more often than clients without a parental history of substance abuse. Surprisingly, no relationship was observed between parental history of substance abuse and preadult behaviors including age-of-onset of drug use, childhood conduct disorders, age at first antisocial behavior, or number of arrests before age 18. Future prevention and treatment efforts with similar populations should recognize the strong influence of the family in the development of substance abuse., INTRODUCTION Clinical lore and anecdotal observations have long intimated that children of alcoholic parents (COAs) are at a heightened risk for developing substance abuse problems; and more recently, a series [...]

Objectives. Maternal cocaine use is a leading grounds for newborn foster placement. This study was initiated to investigate the factors that predict custody status of infants born to substance-abusing women. Methods. A retrospective cohort design was used to study the correlates of discharge custody decisions for 99 consecutive infants testing positive for cocaine in a public hospital. Results. The population was 49% Black, 40% Hispanic, and 11% other or unknown. Custody at discharge was to mothers (38%), other family members (25%), or agency foster care (36%). Placement outside the family was greater when mothers had prior child welfare records, in Blacks vs others, with no prenatal care, and when mothers were younger at their first delivery or older at the index birth. Denial of custody to the mother was higher with prior child welfare involvement, in Blacks, and when the mother did not live in her own home. Both models also controlled for parity, child sex, and birthweight. Conclusions. Earlier involvement with child welfare authorities, race, and other factors predict continued separation of mothers and children at newborn discharge, suggesting the need to reexamine current policies and practices. (Am J Public Health. 1993;83:1726-1729), The lack of social resources and adequate health care for cocaine-addicted mothers may increase the likelihood of drug-exposed infants being placed in foster care. Ninety-nine drug-exposed infants born in a public hospital in New York City between Jul 1990 and May 1991 were studied.. A total of 38% were discharged into their mother's custody, 25% to other family members and 36% to foster care. Mothers who retained custody were most likely about 27 years old, had prenatal care, lived in their own home and had no previous involvement with child protection agencies. Mothers with a previous history had the highest chance of losing custody at discharge from the hospital. Lack of prenatal care also was a strong predictor of discharge custody to social services. Decision-making in the discharge custody of drug-exposed infants should be evaluated to understand the long-term outcome of children placed in foster care.

The morbidity risks for alcoholism in the first-degree relatives of a cohort of male cocaine addicts with or without alcoholism comorbidity were studied. Of the 71 patients who participated in our study, 40 (56.3%) had a history of alcoholism and 37 (59.1%) a history of opioid abuse. Twenty-two patients (30.1%) also met criteria for a lifetime diagnosis of a major psychiatric disorder. Significant increases in morbidity risks for alcoholism were found among male relatives of cocaine addicts with comorbid alcohol dependence when compared with relatives of cocaine addicts with no alcohol comorbidity. Among fathers, risks were .69 vs .32 (z = 2.98, p < .003). Among brothers, risks were .38 vs .15 (z = 2.35, p < .03). Significantly increased risks were also observed in male relatives when probands with a psychiatric diagnosis were excluded from the analyses. Among female relatives, increases in morbidity risks were found but they failed to reach statistical significance. Two interpretations are consistent with these findings. One of these interpretations is that alcoholism is a disorder distinct from other addictions and has its own mode of transmission. The second interpretation is that the transmission of substance use disorders lacks specificity and that the substances selected are influenced by sociocultural or biological factors., INTRODUCTION Alcohol dependence is a common disorder among patients in treatment for drug addiction and among their relatives[1-3]. The heritability of alcoholism is supported by studies of the biological children [...]

This study compared families of Indonesian (N=61) and American (N=152) adolescent drug abusers in terms of: a) the perceived levels of family cohesion and adaptability, b) the manner and extent to which the Indonesian and American samples differed on cohesion and adaptability, and c) the extent to which cohesion and adaptability were related to the severity of the adolescent's drug use. Findings indicate that the families of American drug users tended to see their families as more dysfunctional, and differed among themselves more than their Indonesian counterparts. Also cohesion was found to be a better predicator of drug use severity than adaptability for both samples. A variety of other findings are presented and discussed.

The relation of family funtioning to progress in substance abuse treament was studied by assessing the levels of cohesion and adaptabilitty within the family and correlating this with the patient's functioning while in treatment. Family cohesion predicts the severity of a patient's disfunction due to substance abuse, family dilemmas and psychological problems. Thus, family factors are important in the treatment of patients who abuse drugs.

The social and medical problems of 75 children of intravenous heroin-addicted parents were assessed between January 1985 and December 1987. The children ranged between 4 days and 14 years of age and suffered from serious childhood diseases. The problems identified in these children were classified into three groups: infectious diseases, nutritional diseases, and parental neglect and/or disinterest. Common conditions included gastroenteritis or inflammation of the stomach and intestines in 24 percent of children; pneumonia in 21 percent; malnutrition in 17 percent; infection of the upper airways in 13 percent; bacterial infection of the blood in 12 percent; child abuse in 4 percent; AIDS in 3 percent; and other types of infections in 24 percent. In addition to heroin addiction, diseases that were reported in parents included infection with hepatitis B virus, AIDS, and alcoholism. Thirty-seven percent of fathers were not employed, and 19 percent of parents had been in prison. Children of intravenous heroin-addicted parents should be managed by a multidisciplinary approach to prevent disease and to decrease the costs of health care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug misuse is common, and users of illicit drugs tend to be young. Many have children. A serious drug misuse problem in the parents can be devastating for the lives […]

Conceptually, social support among very heavily drug-involved women is complex and multidimensional. This article examines the structure and function of the social support systems of women offenders (N = 100) who used drugs during the last 6 months before entering court-mandated drug-free treatment programs. These systems typically contain about nine supporters, almost equally divided between men and women, and about half of the women's supporters are family members. The women identify parents and partners as their major providers of practical help and advice. They look most to their partners for a sympathetic ear, and to their parents for affirmation of their self-worth. Overall, two-thirds of the women identify their mothers as among their supporters. These mothers are often anxious to do whatever they can to help their daughters stop using drugs. Paradoxically, the assistance many mothers give their daughters in providing money or basic life necessities often enables the daughter's drug use. Although many daughters appreciate their mother's help, there is an element of distrust and control in many of the mother-daughter relationships, and some daughters receive unwanted help from their mothers. Drug treatment providers can benefit from understanding their clients' social support systems, especially the dynamics of important relationships with main pretreatment supporters, such as parents. By gaining this understanding and helping their clients to effectively accept and use social support, treatment providers can assist them in maintaining their recovery when they leave treatment and return to their communities., INTRODUCTION Social support has been shown to have a positive impact on women's health in ways as diverse as assisting in their successful adaptation to breast cancer, reducing the odds [...]

This report discusses the development of a coping skill training program for parents of substance-abusing adolescents and presents preliminary data on the effects of the program on parent functioning and adolescent substance use. The behavioral-analytic model of program development was used to sample representative problematic situations experienced by parents of substance-abusing adolescents, obtain an effectiveness-scaling of responses to these situations, and derive alternate forms of a situational role-play measure of parental coping. These situations and scoring guidelines were then used to create the skill training program. Parents of substance-abusing adolescents not in treatment subsequently were randomly assigned in a pilot investigation to either a skill training or delayed treatment condition. Skill training resulted in significant improvement in parental coping skills relative to delayed treatment. Moderate to large improvement in the parent's report of their own functioning, family communication, and the teen's marijuana use also favored the skill training group. [C] 2001 Elsevier Science Inc. All rights reserved. Keywords: Parent training; Coping skills training; Substance abuse; Adolescents

The present paper explores strategies that drug-using women employ to protect their children from drug-related harm. Twenty-two mothers were recruited through word-of-mouth, field recruitment, and flyers. Semi-structured interviews were used to collect mother's views on parenting and heroin use. Analysis was conducted using a standard qualitative software package. A hierarchy of seven strategies was identified: (1) stop using; (2) go into treatment; (3) maintain a stable small habit; (4) shield children from drug-related activities; (5) keep the home environment stable, safe, and secure; (6) stay out of gaol; and, if the children's needs still cannot be met, (7) place them with a trusted caregiver and maintain as active a parental role as possible. These strategies, derived innovatively from mothers' experiences, provide progressive goals for treatment and can also serve as measures of success. In addition, they may determine how well children fare in drug-affected families. [C] 2001 Elsevier Science Inc. All fights reserved. Keywords: Treatment; Substance abuse; Parent; Child; Chemical dependency; Parenting; Adolescent; Harm reduction

This study examined the amount of exposure to negative environmental risks and their association with parenting attitudes among a group of inner city substance-abusing women. Mothers (N = 198) were recruited at delivery and were part of a randomized longitudinal intervention study for substance-abusing women and their infants. When the infants were 18 months old, a cumulative environmental risk score was calculated for each mother based on nine factors: violence (both domestic and environmental), depression, homelessness, incarceration, number of children, life stress, psychiatric problems, and absence of significant other. Based on their cumulative scores, mothers were placed in a low (N = 106) or high environmental risk group (N = 92). Mothers in the high-risk group had fewer years of education and were younger when their first child was born. Multivariate analyses indicate that mothers in the high-risk group had significantly worse scores on parenting attitude scales. Given the current state of welfare reform, it is important to determine which factors besides maternal substance abuse place these mothers at risk for poor parenting., INTRODUCTION Maternal substance abuse is associated with multiple environmental risk factors. Research indicates that substance abuse by mothers is associated with maternal depression (1), child abuse (2, 3), and increased [...]