Edited by: Hui Li, Macquarie University, Australia
Reviewed by: Jana Pruett Covington, Georgia State University, United States; Madelyn Labella, University of Delaware, United States
This article was submitted to Developmental Psychology, a section of the journal Frontiers in Psychology
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Certain neural processes that underlie addiction are also central to parenting, notably stress and reward. Parenting interventions that incorporate the unique context of caregivers with addiction have demonstrated some success: However, real-world implementation of evidence-based interventions can be difficult with this population. Video feedback interventions are an especially promising approach to reach parents who experience barriers to participation, particularly caregivers with addiction. A translational neuroscientific approach to elucidating the mechanisms of change in these interventions will aid the delivery and success of this method and advance theory surrounding parenting in the context of addiction. Along these lines, we provide an example of one video feedback intervention, Filming Interactions to Nurture Development, that will serve as such a mechanistic experiment.
Caregivers of young children constitute a notable proportion of the population of individuals with substance use disorders. Increasing rates of substance use, particularly opioid use, in this subgroup reflect an already-emergent public health concern (
The significance of these consequences has fueled research examining the intersectionality of substance use and parenting (
Understanding the mechanisms underlying the interaction between parenting and addiction provides useful knowledge for identifying intervention targets that promote healthy parent and child outcomes. Although those mechanisms can be studied at multiple levels (e.g., cognitive or behavioral), investigating the neurobiological correlates of parenting processes that mediate responsive caregiving in the context of addiction draws upon the wealth of knowledge provided in these separate literatures (i.e., neurobiology of parenting and neurobiology of addiction;
In this paper, we provide rationale for applying a translational neuroscientific approach to intervention research aimed at helping parents struggling with addiction. Translational neuroscience necessitates a conceptual model of disorder that identifies specific processes supported by neurobiological systems with respect to any relevant moderators (
Certain cognitive and affective processes, such as those related to stress and reward, are central in both addiction and parenting. For example, in the context of addiction, non-medically used psychoactive substances (hereafter referred to as drugs) elicit reward responses, and stress often precedes subsequent use (
Activation of stress and reward neural circuitry across these contexts plausibly induces a mutually informed interaction wherein system responses in one context impact the response in another (
The dysregulation of these stress and reward systems associated with addiction must be considered alongside the neuroendocrine changes elicited by the onset of parenthood. Research on the maternal brain suggests that rising levels of hormones (e.g., oxytocin and cortisol) correspond with stress and reward circuit activation central to sensitive caregiving (
In addition to the impact of general addiction processes, the type of drug used can impart unique physiological changes. While there is little research on the effect of extended opioid use on parental brain circuitry, the role of endogenous opioids in maternal stress and emotion regulation and reward processing highlights the importance of investigating that effect (
As shown in
Role of brain changes in the relationship between drug use and parenting (adapted from
A reward-stress dysregulation model of addiction and parenting proposed by
Instances of household instability and child neglect along with co-occurring mental health difficulties underscore the need for effective interventions for parents with addiction (
Although dual treatment for substance use and parenting results in improvements in both domains (
Many interventions for parents with substance use disorders are based on attachment and relational theories, integrating varying aspects of caregiver responsivity, mentalization, emotion and stress regulation, and mindfulness to improve parent and child outcomes. Examples include Relational Psychotherapy Mothers’ Group (
Video feedback has been employed in parenting interventions where caregiver-child interactions are filmed. Videos are useful for capturing the reciprocal influence parents and children exert on each other. Trained therapists use recordings to replay and personalize feedback to parents. This method allows researchers to highlight parenting skills in a naturalistic environment, often in participants’ homes. Although the specificity of this intervention approach varies, many video feedback interventions aim to encourage supportive interactions between parents and their children. A review of 29 experimental studies revealed that video feedback interventions successfully resulted in a change of maternal sensitivity and more positive parent and child behaviors (
Given the disruption of maternal sensitivity in many parents with addiction, this style of intervention might be especially well suited for substance-using parents. However, the true measure of intervention effectiveness does not end within a research context but extends to the feasibility of disseminating and evaluating that intervention in community settings for those who could benefit most. Barriers to accessing treatment are a primary concern for parents with addiction and often have roots in systemic inequalities and racism prevalent in society (
Research on video feedback interventions containing proposed mechanisms of change helps discern employable components to further explore and integrate into interventions for caregivers with substance use disorders. Although there is overlap among hypothesized mechanisms, distinct interventions have not targeted mechanisms uniformly. A cursory comparison of different video feedback interventions illustrates this. PuP uses psychoeducation and mindfulness skill building to target the proposed mechanisms of change: parental emotion regulation, representation quality, and mentalization about own and child’s emotions (
These video interventions have yielded improvements in parenting and substance use behaviors (
Filming Interactions to Nurture Development is a strength-based video feedback intervention with a clearly proposed conceptual model, protocol, and potential to achieve notable impact at scale. FIND was designed to primarily target responsive caregiving and consequently improve caregiver and child outcomes. This design is informed by research on serve and return interactions that are critical to healthy development, a process where caregivers provide contingent, supportive responses to child-initiated cues (
Across 10 sessions with a family (five filming sessions and five coaching sessions), coaches share video compilations of positive micro-social interactions between parent and child to encourage parents to identify and increase the frequency of specific serve and return components (e.g., Sharing the Child’s Focus, Supporting and Encouraging, Naming, Back and Forth, and Ending and Beginnings). Further details of the program can be found in
Emerging evidence suggests that FIND is particularly effective for high-adversity families. A preliminary study with low-income fathers provides support for FIND’s conceptual model that caregiver and child improvements occur through increases in responsive parenting (
Parents with opioid addiction tend to experience difficulty understanding and reacting to child cues, exhibiting greater irritability and decreased responsiveness compared to other parents (
FIND conceptual model.
Currently, a randomized clinical trial of FIND is being conducted with 200 mothers in opioid use treatment or recovery with children aged 0–36 months. Half the parents are assigned to a control condition, which includes alternating child development information sessions and supportive observations of caregiver-child interaction. This study will both evaluate the effect of FIND on responsive caregiving and test whether observed changes in parenting and addiction circuitry, which have considerable overlap (
Investigating the neurocognitive mediators of responsive caregiving improvements and subsequent outcomes allows for more informed intervention alteration and adaptation in real-world contexts. Many evidence-based interventions fail to achieve impact when delivered at scale, and others only yield modest effects and fail to support families at highest risk (
The design process employed in developing FIND was intended to proactively tackle large-scale dissemination concerns of both scalability and real-world efficacy for high-risk populations. FIND’s descriptive, as opposed to analytical, coaching delivery permits more people (rather than only those with specialty knowledge or degrees) to implement the program, enhancing scalability. Parents of addiction may respond particularly well to the specific, strength-based nature of the program which directly addresses non-drug reward hypo-responsivity by increasing the inherent rewards of parenting without imposing feelings of shame or guilt that might accompany skill-learning present in other interventions. Previous research suggests that participation increases responsive caregiving at lower doses than many existing interventions (
The need for effective resources and interventions for caregivers with addiction necessitates carefully planned research that acknowledges their shared and unique contexts. The reciprocal influence model posits that drug-induced brain changes are implicated in a cluster of cognitive, behavioral, and affective caregiver changes that directly impact child interactions and consequently create a high-stress parenting environment that increases risk for further drug use. Such models, informed by the neurobiology of shared processes, have potential to be more efficient and scalable than those without a clearly proposed and tested mechanism.
Building, testing, and disseminating effective interventions for this population are complicated by ongoing challenges. Individuals come in with varying skills and may be experiencing concurrent and related stress or adversity. One intervention cannot be made to suit all caregivers and some caregivers may need more or less support. Continued research that connects the growing knowledge of neurobiology related to caregiving and substance use with mechanistic intervention evaluation will allow scientists to investigate what works, why, and for whom.
The original contributions presented in the study are included in the article/supplementary material, and further inquiries can be directed to the corresponding author.
PF and A-MB conceived the idea. A-MB and KM wrote the manuscript. All authors contributed to the final version of the manuscript.
The authors gratefully acknowledge grant P50 DA048756 from the National Institute on Drug Abuse to PF.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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